News Archive 2005

The Royal Institute of Public Health announces a new qualification to help fight hospital infections.

22nd September 2005

Today the Royal Institute of Public Health (RIPH) launches its nationally recognised QCA* Level 2 Certificate in Decontamination and Sterilisation in Healthcare Environments.

Commenting on the qualification Professor Rodney Cartwright, Microbiologist and Chair of the RIPH Qualification Standards Board said “we estimate that over 100,000 key hospital and care home workers will require training in sterilisation and decontamination over the next few years. This qualification is an essential training solution in the ongoing battle against hospital acquired infections, such as MRSA, and will have a significant impact in the fight to improve decontamination standards in hospitals and care homes”.

For more information on this new qualification, please contact Clare Waterman on 020 7291 8358 or email cwaterman@riph.org.uk.

* QCA – Qualifications Curriculum Authority

RIPH Summer Lecture: Emerging and New Pathogens – Old and New Friends.

This year the Institute’s summer lecture was presented by Professor Rodney Cartwright, a consultant medical microbiologist and RIPH Council Member. Professor Cartwright delivered an insightful and entertaining presentation on New and Emerging Pathogens, drawing on some 30 years experience. His presentation highlighted some of the new pathogens which have recently emerged into our environment and gave examples of how old bugs have managed to find ways of returning after seemingly laying dormant for several years.

The audience included food hygiene specialists, food safety trainers as well as public health specialists interested in finding out more about some of the issues facing today’s health care services.

Some New Bugs:
New bacteria and viruses that have emerged in recent decades include: Campylobacter, the most common form of food poisoning reported in the UK; Cryptosporidium, the first and only microbe to feature in a criminal law targeted at ensuring its control; Legionella pneumophila (cause of legionnaires’ disease); Human Immunodeficiency Virus (HIV) and Severe Acute Respiratory Syndrome (SARS).

HIV has affected every country around the world, with nearly 40 million people globally living with the disease. In some countries the adult population is disappearing at an alarming rate with the disease still spreading throughout the population. As a result many children, who may also be infected, are left orphaned by the spread of AIDS. HIV has forced society to look hard at the way in which the disease can be controlled and find new ways to control the spread of infection.

SARS first burst onto the scene in November 2002 and in merely a few weeks it had spread around the world resulting in global panic. This disease, which was first discovered in South East Asia and is believed to have started in Hong Kong, led to travel area restrictions in an effort to isolate the virus. SARS killed nearly 800 people worldwide in the months following its emergence in November 2002.

Some Old Friends:
Old pathogens have also reappeared in our environment after seemingly laying dormant for several years. These pathogens have in some cases adapted to previous treatment efforts, with the production of antibiotic resistant strains. Some old pathogens that have reappeared recently include Staphylococcus aureus – a bacterium that resulted in many surgical wards being closed in the 1950’s, Influenza - a virus that some people believe is overdue an epidemic , new and deadly forms of Escherichia coli (E. coli) and Salmonella typhi, the cause of typhoid fever.

One of the most recent emerging microbial infections is Methicillin- resistant Staphylococcus aureus (MRSA). This antibiotic-resistant infection is often acquired in hospitals and has highlighted the importance of infection control in ensuring effective and constant environmental cleanliness.

Escherichia coli lives happily, along with other kinds of bacteria, in our intestines and contributes to the healthy intestinal flora. However, there are many different strains of this bacterium, some of which can be harmful. A major outbreak of E. coli in Scotland in 1996 was caused by the E. coli strain E. coli O157:H7 which is highly invasive and requires few organisms to cause infection. This outbreak, thought to be associated with burgers, affected over 500 people and resulted in 21 deaths. Essential means of control include separating raw from cooked meat and hand washing.

The 1934 edition of ‘Public Health and Medical Subjects’ examined the ‘Bacteriological Examination of Water Supplies’. This report and its subsequent revisions has been the backbone in the testing of the quality of water in the UK. Bacteriology testing is essential to prevent the spread of infectious diseases, such as typhoid, via drinking water supplies. The modern water treatment system in the UK helps to keep us safe from such infection.

In 1989 a large number of holidaymakers in Spain reported a diarrhoeal illness. A joint Spanish-English investigation revealed that the probable cause was a failure of the municipality’s well water supply. Untreated water had been trucked in from a nearby river. At the same time, 14 cases of typhoid fever due to three different phage types was reported in both tourists and local people. The source of the infection was considered to be sewage contamination of the ‘trucked-in’ river water. The diarrhoea illness and the typhoid fever were not just important from a medical point of view: there were also major economic consequences for the community due to a fall in tourism. Typhoid fever remains a serious and sometimes fatal infection, despite the modern availability of effective treatment in the majority of cases.

Salmonella is a common cause of food poisoning and has been associated with undercooked poultry or eggs. In 1997 more people in the UK were affected by salmonella species than in any year since records began. Reports of Salmonella infection have since declined thanks mainly to control measures in poultry flocks. Famously in 1988, Edwina Curry, the then Health Minister of the Conservative Government, was forced to resign after sparking outrage and fear when announcing that most of the country’s egg production was infected by Salmonella. While she had exaggerated the level of infection, the scandal caused a more rigorous approach to control. The Government ordered the slaughter of more than two million chickens to control the spread of the bacteria and introduced new legislation to improve hygiene on egg production.

The increase of reports of Salmonella in England and Wales started during WWII in about 1941, possibly related to imported dried milk and other products. The subsequent increase has been attributed partly to changing eating habits and availability of cheap chicken and ‘fast food’. Research has shown that 25% of frozen chickens contain Salmonella: while poultry-flock control has reduced this in the UK, a risk remains, particularly related to under-cooking or insufficiently cool storage.

What Does History Teach Us?
The control of many micro-organisms can be achieved by the development of a good basic public health infrastructure and practices, such as sewage, water and food hygiene with, where appropriate, specific immunisation programmes. Pathogens will always be present in our environment and will continue to present themselves in different forms. Successful control strategies require an understanding of the links in the chain of infection for each pathogen. Where is the source of infection? Is there a depot or reservoir? What is the route of transmission? Who are the susceptible hosts? Stopping the pathogen requires that one or more of the four links are broken. This may depend on health care workers, engineers, politicians or society in general modifying its behaviour.

We will continue to see new and old pathogens emerging in different forms, presenting us with public health challenges that we will hopefully be able to meet.

(The lecture was based on one prepared by Prof Hugh Pennington who was unfortunately unable to be present.)

Drinking Water in England 2004 - A report by the Chief Inspector, Drinking Water Inspectorate

The Royal Institute of Public Health (RIPH) was honored to host the launching of the report on ‘Drinking Water in England 2004’ on 6 th July 2005. 

The field of Public Health has a long history of concern with drinking water. Public health pioneers have been responsible for identifying and controlling water-borne diseases such as cholera and typhoid fever. Whilst most major advances in this field date back to the Victorian age and the early 20 th century, new water-borne threats such as Legionnaires’ disease and cryptosporidiosis have continued to emerge, requiring investigation and prevention.

This important work of inspection and surveillance continues today. Safe drinking water is essential for the health of a population and hydration is particularly important for the young and the elderly.

Overall, the UK enjoys high quality drinking water. However, this is not always the experience of the consumer in some parts of the UK. This year, by measuring against the new standards and by reporting the results regionally, the Chief Inspector’s report has shown where the consumer experience occasionally does not tally with the national standard as a whole. Scientific Adviser to RIPH, Dr Rosalind Stanwell-Smith said, “The new style of the Chief Inspector's Report is particularly welcome in its emphasis on the importance of water to public health, acceptability of water to consumers, and to the role of local authorities.  Drinking adequate amounts of water is essential to the individual’s health - and high quality of drinking water is essential to public health”.  Now with the news that the 2012 Olympics will be held in London, easy public access to safe drinking water will also be an Olympic issue!

The RIPH considers that this, the 15th report from the Drinking Water Inspectorate, makes a valuable contribution to water-related public health.

For further information please contact;

Penny Moore Tel: 020 7291 8361 Email: pmoore@riph.org.uk

Websites of interest:  

Size Matters – Tackling the Challenge of Obesity

The obesity time bomb is ticking away. The UK has the highest rate of obesity in Europe and the trend is continuing upwards. Dr Alan Maryon Davis, broadcaster, health writer and vice-chair of the RIPH, gave a lecture that looked at the barriers to reversing this trend and what the government, business, professionals and the public themselves can do to overcome them. The members’ event took place at the Royal Institute of Public Health on 15th June 2005.

The adverse effects of obesity on an individual’s health are considerable, with an increased risk of Type 2 diabetes, raised cholesterol, high blood pressure, heart disease and certain types of cancer. Other health problems that are heightened with obesity include subfertility, sleep apnoea, osteoarthritis and psychological distress. Over the past 20 years, the number of overweight people in the UK has risen by 60% with the number of obese people trebling. Currently, obesity and its consequences are costing the NHS a total of 5% of its expenditure, and this figure looks set to grow unless the problem is addressed.

Obesity becomes particularly dangerous with increasing age. The Framingham Heart Study estimates that the risk of premature death increases by 1% for each extra pound a person weighs in their 30s and 2% for each extra pound they weigh in their 50s. However, it is not only a problem affecting the older generation – the true extent of the ‘obesity time-bomb’ is revealed when one studies the statistics relating to children. During the 1990s obesity doubled in 6 year-olds, trebled in 15 year-olds and ‘middle-aged’ problems such as Type 2 diabetes began to appear in children.

Dr Alan Maryon Davis put forward some possible explanations as to why the obesity epidemic has happened. These include the decline in manual labour and active travel between the 1970s and 1990s, coupled with the increased use of the car. Another contributing factor is the rapid expansion of the fast-food industry, with high calories and salt content clearly adding to the problem. A third explanation is the recent increase in the substitution of active leisure with television watching and computer games by young people.

But what are the barriers to overcoming these problems? There are certain inbuilt factors, such as age, sex and hereditary aspects, which are fixed and cannot change. However, surrounding these are wider determinants on one’s health – including:

  • individual lifestyle factors;
  • social and community influences;
  • living and working conditions; and
  • general socioeconomic, cultural and environmental conditions.

To summarise, the main barriers to overcoming the obesity time bomb lie in the fact that the UK is dealing with obesogenic people, with obesogenic habits in an obesogenic environment.

Having identified the problem and the barriers occurring to treat the problem, Dr Maryon Davis then moved on to how we can help people overcome these obstacles. The concept of the three ‘E’s for Lifestyle change was introduced – Environment, Empowerment and Encouragement. Media campaigns can increase awareness of the issue and go a long way to encourage the nation to think closely about their diet, exercise and general health. Other ways to encourage people include parental influence, health events and health advocacy. Lifestyle change through empowerment largely comes down to education, for example increasing health literacy, increasing self-esteem and confidence and providing life-skills training.

Making changes to our environment is perhaps the simplest and yet most effective way to overcome barriers to tackling obesity. By changing the way that food and drink impacts on our environment, for example by offering a wider choice of healthier food and drink at affordable prices, making easy access to affordable fruit and vegetables, ensuring user-friendly nutritional labelling and implementing health school meals, we could be sure to cut the obesity problem in the UK. Similarly, by making changes to our environment, so that we could undertake more physical activity, we would also greatly aid this crisis. This could be achieved by creating accessible and affordable places to exercise with a wide choice of activities, well-equipped school sports and games facilities, safe parks and open spaces and safe routes to walk and cycle.

There have been some successful campaigns in the UK to tackle the problem of obesity. Recently, Jamie Oliver’s School Dinners Campaign highlighted the need for radical reform in the nutritional value of school meals. Other projects include Sure Start (children’s centres), which encourage breastfeeding, healthy early nutrition and active play.

Finally, Dr Maryon Davis described the latest campaign in America, based on estimates that 90% of obesity could be abolished by walking an extra 2000 steps a day and reducing calorie intake by a mere 100 calories. Perhaps we should be following in the footsteps of the US, where the big message is simple – move a little more and eat a little less!

RIPH appoints new Interim Chief Executive

ROBERT SILBERMANN has been appointed Interim Chief Executive of the Royal Institute of Public Health. Robert, who has a wide range of senior level experience in both the commercial and not-for-profit sectors, took up his appointment on 7 February 2005.

Jack Jeffery, Chairman of the RIPH said, "I am delighted that Robert has accepted the position of Interim Chief Executive. His extensive knowledge and experience within the charity sector make him ideally placed to help us develop our strategy for the Royal Institute, at such an important time for public health."

Speaking on his appointment, Robert Silbermann said, " Now, more than ever, public health is in the media spotlight and at the forefront of the Government's agenda. With my previous experience in many other charities, such as Shelter and Save the Children, I welcome this opportunity to help the RIPH to move forward as an independent organisation ready to address tomorrow's public health agenda. This is a challenging time for public health and I'm looking forward to the opportunity to make a significant contribution to the organisation's future."

Robert Silbermann will remain in post as Interim Chief Executive at RIPH for the next 6-12 months and will manage the process of recruitment and appointment of a permanent successor.

14 February 2005



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