legislation came in there was a dramatic fall-off. I think that is a scenario we have to look at quite carefully, because mass media is a way of both identifying it as an issue that the public needed to take care of and it acts as a platform for other kinds of interventions as well.” However, the work on tobacco control is


not over. Looking ahead, Haw says the UK’s tobacco control policy is already regarded as one of the most comprehensive in Europe, so suggests it is a case of doing “more of the same”. “What I think actually affects smoking


prevalence is the population level measures. So taxation, the price of tobacco – it is very important that we maintain that. “I think, also, in relation to smoking in the home and cars, I think we need to maintain that on the agenda.”


When it comes to smoking at home, she says legislation is obviously out of the question and so suggests here we must look to develop novel approaches of communicating with and supporting parents, highlighting ASH Scotland’s REFRESH (Reducing families’ exposure to second-hand smoke in the home) study as one such example. However, she says the evidence in terms of smoking in cars is “very


mechanism. You license and you regulate the number of premises that are there.” It is very difficult for individuals to change their behaviour in the face of an obesogenic environment and without those population level drivers we will “fail”, she says, adding: “Regulation is central to addressing obesity. I feel that quite strongly.” With alcohol too, the mechanisms and levers


are at a population level if we are to achieve cultural change in our relationship with alcohol. Haw says she thinks minimum pricing will


have an effect, providing we get the price right. “Te strategy for that is difficult,” she says.


“Maybe you have to go in at 40-50p, which we know is borderline in terms of having an effect and then gradually build up. Maybe you have to do that to carry the public with you.” Or, perhaps, setting the price higher would enable the projected health benefits to be demonstrated more quickly. Haw answers honestly that she is not sure which strategy is best, but says she would prefer the price was set higher than the original modelled proposal of 40p.


“I would go higher for that. I think I would


“Regulation is central to addressing obesity. I feel that quite strongly”


clear” and she would “definitely go down the route of legislation.” Obesity is another issue that would benefit


from a population level response, Haw argues. Te consequences of the rising levels of obesity in Scotland, for instance, on Type 2 diabetes, are “horrendous”, but she accepts that this is not as black and white an issue as tobacco to address. “Te choice of food is tied up with economics.


It is tied up with industry. It has so many different stakeholders involved. It makes it a much more complicated policy field and it has many different levels. You’ve got EU, you’ve got UK, you’ve got Scotland level regulation. So it becomes much more difficult. I do think we have been frightened, though and I don’t think we’ve faced up to regulation strongly enough.” Haw argues we need to adopt a carrot and stick approach to working with the food industry.


“I think we incentivise reducing sugars, high salt and high fat. But also I think we have to have a stick so if you do sell particular products they carry an extra tax on them.” Another option she suggests is worthy of consideration would be restricting the number of fast-food outlets within a close radius of schools.


“I think there is room for that. It is a bit like licensing. What it means is you reduce the opportunity for kids to go and make the wrong choices. I would look favourably on that as a


probably go higher but I wouldn’t go to 70p. So it would be somewhere of that order.” Tere are no easy solutions to any of these challenges, she says, and neither is it straightforward to evaluate public health interventions to assess


whether they are having an effect. “Tere are some things like smoke-free where


the relationship between the intervention or the policy and the outcome is quite clear. Tere are other areas, like obesity, where really you aren’t sure what has happened, and I think we have to be a bit cleverer about how we evaluate.” At Stirling University, Haw and her colleagues


are seeking to develop research methods that can be applied to these more complicated situations. However, they are also keen to link more directly into the policy environment. Haw explains: “Although there is obviously


researcher-led work, I’ve recently been having conversations with colleagues in the Scottish Government to say, ‘Tis is our current list of projects. Tis is what our focus is within the policy context as it is developing. Are there areas or particular questions that are important for you that we can ask?’” Tis could be done either through research grant applications or, for example, through the epidemiology group who can look at information that is already available in existing data sets and do secondary analysis, she says. “In the longer term what I would hope is that


we would have a certain portion of our work that has a direct link with policy. Tat promotes an ownership which means the uptake of the findings is more likely. “So for me that is a very important aspect of


it.” 12 December 2011 www.holyrood.com 45


IN BRIEF


Care inquiry A review of the ten-year-old National Care Standards is now overdue, the Health and Sport Committee has said in its report on the inquiry into the regulation of care for older people. It also said that equality and human rights should


be embedded in the delivery of care services for older people and that the Care Inspectorate and Healthcare Improvement Scotland should work together to achieve this.


Whistle-blowing More than a third of nurses in Scotland say they have been discouraged or told directly not to report their concerns about issues such as patient safety and staffing levels at their workplace, according to a survey from the Royal College of Nursing. RCN Scotland Director Theresa Fyffe said she is


“very concerned that nurses are not being listened to”, particularly in light of cuts from the NHS workforce. “In these circumstances, it’s more important than


ever that they’re listened to when they raise their concerns about patient safety and about staffing levels,” she said.


AIDS awareness Scottish Labour MP Pamela Nash has been filmed having an HIV test to raise awareness and help allay fears of people worried about going for a test. Nash, who is Chair of the All Party Parliamentary


Group on HIV and Aids, said: “It is shocking that up to a quarter of people living with HIV in the UK are unaware that they have it. I hope that by taking the test awareness will be raised about HIV, and we can begin to tackle the stigma and discrimination that sadly surrounds the virus.” The video is available here: http://www.youtube. com/watch?v=OwzYyKzsN0A


Short breaks A short breaks initiative for disabled children and their families backed by nearly £1.9m of funding has been announced by Public Health Minister Michael Matheson. Matheson said: “Caring for a disabled child is immensely rewarding and fulfilling but can sometimes be challenging and stressful. We are determined to do all we can to help families live fulfilled and happy lives together.”


Superbugs success A lighting system that can kill hospital superbugs – including MRSA, E.coli, TB bacteria and C.diff – that was developed by researchers at the University of Strathclyde has been named Research Project of the Year at the Times Higher Education Awards. Clinical trials at Glasgow Royal Infirmary have shown


that the HINS-light Environmental Decontamination System provides significantly greater reductions of bacterial pathogens in the hospital environment than can be achieved by cleaning and disinfection alone, providing a huge step forward in hospitals’ ability to prevent the spread of infection and improve patient safety.


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