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** 20 July 2022
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** UK
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** Prehab: Getting patients fit for cancer treatment (#1)
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** Patient satisfaction in GP services falls sharply in latest survey (#2)
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** New women’s health strategy for England aims to end decades of inequality (#3)
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** Scotland study: Cigarette-style labels on alcohol ‘can cut drinking’ (#4)
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** International
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** US: FDA head faces scrutiny over missed regulatory deadlines for vaping product applications (#5)
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** US study: New research calls for a health equity lens in commercial tobacco product regulation (#5)
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** UK
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** Prehab: Getting patients fit for cancer treatment
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A prehabilitation (prehab) programme whereby patients ‘get ready’ for their upcoming cancer treatment is being piloted by the South Eastern Health Trust, and available to patients there who have been newly diagnosed with colorectal, lung and head and neck cancer.

The programme is designed to encourage people to take an active role in their own recovery. As well as promoting physical activity prior to surgery, a team helps address nutrition and, if required, smoking and alcohol addiction.

Mr Cairns is one of 175 patients referred to the programme which involves the Belfast City Council and Macmillan Cancer Support. Mr Cairns said taking part in the cancer prehab programme after his second diagnosis was a "win-win", not only for himself but also his surgeons, saying: "I think when you get that diagnosis you are left floundering and with prehab the support you get gives you focus and a little bit of control back in your life."

Mr Cairns, who was a heavy smoker, described the smoking cessation team as "absolutely brilliant". Having now not smoked for a year, he described the regular and accessible support he received, from daily calls to home deliveries of patches and gum.

Dr Cherith Semple, who is a leader in clinical cancer nursing, said this new approach to getting patients fit prior to their surgery was proving a success, both in the short and long-term, for physical and mental health needs. She said: "We know that it can reduce a patient's hospital stay post-surgery and it can reduce your return to hospital with complications directly afterwards."

The programme is being evaluated and it is hoped it will be expanded to other health trusts with the backing of the local council.

Source: BBC News, 20 July 2022
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** Patient satisfaction in GP services falls sharply in latest survey
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Patient satisfaction in GP services, particularly regarding the ease of getting an appointment, has fallen dramatically in the latest annual GP patient survey for England. The survey also found that people living in more deprived areas were more likely to have a bad experience of general practice compared with those living in more affluent areas.

Ipsos Mori sent out 2.47 million questionnaires to patients aged 16 and over, with 719,137 returned completed from January to April 2022—a response rate of 29%.

Only 56% of respondents reported a good overall experience of making an appointment—down from 71% in 2021. Around half of respondents said they do not find it easy to get through to their practice by phone—up from less than a third last year. The survey found that 55% of people who said they needed an appointment had avoided making one over the past year, up from 42% the previous year.

More than seven in 10 patients (72%) had a good overall experience of their GP practice, with 38% describing their experience as “very good.” But the proportion of patients reporting a good overall experience is down 11% compared with the 2021 survey. The proportion of people with a poor experience of their practice overall has doubled in a single year, from 7% to 14%. Some 6% described their experience as “very poor.”

Many measures of trust and good quality care remain strong although still down on previous years. At their last appointment, 93% of patients said they had confidence and trust in the healthcare professional, down from 96% in 2021. Some 91% said their needs were met and 84% said the healthcare professional was good at treating them with care and concern.

The BMA said the fall in patient satisfaction is a “stark reflection of the workforce crisis in general practice.” Farah Jameel, BMA England GP committee chair, said, “It’s only right that patients expect and deserve high quality, timely care whenever they interact with their GP practice, and we share their frustration when this doesn’t happen […] We too feel dissatisfied after years of underinvestment, ever increasing workload, and a government that has not been listening to us. We’ve been saying for years that general practice needs investment, more GPs, and more support to see as many patients as possible in a way which meets their needs.”

Martin Marshall, chair of the Royal College of GPs, said, “Ultimately, GPs, our teams, and patients want the same thing—access to high quality and timely care—and we share patients’ frustrations when this can’t be delivered. This is why we are calling on the government to introduce a bold new plan for general practice.”

Source: BMJ, 15 July 2022

See also: GP Patient Survey for England 2022 ([link removed])
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** New women’s health strategy for England aims to end decades of inequality

Ministers have vowed to tackle decades of “systemic” and “entrenched” gender health inequality in England with plans to introduce compulsory women’s health training for doctors, more cancer checks and “one-stop shop” hubs across the NHS.

Access to contraception, IVF, maternity support and mental health services will also be improved, the government has pledged in its first women’s health strategy. Baby-loss certificates will be offered to those losing a child before 24 weeks and a national fitness programme will encourage older women to build muscle strength and keep active.

The 127-page strategy says that “historically, the health and care system has been designed by men, for men”. Steve Barclay, the health secretary, said: “It is not right that 51% of our population are disadvantaged in accessing the care they need, simply because of their sex [...] The publication of this strategy is a landmark moment in addressing entrenched inequalities and improving the health and wellbeing of women across the country.”

Originally due last year, then rescheduled for the spring, the government’s 10-year women’s health strategy will be published by the Department of Health and Social Care (DHSC) today (Wednesday). Another government health strategy – on health disparities – was due to be published this week but is likely to be delayed until after the summer.

Almost 100,000 women took part in the consultation. Maria Caulfield, the women’s health minister, said some of their experiences were shocking. Thousands of women told the consultation that they “persistently needed to advocate for themselves” and had to push for further investigation in order to secure a diagnosis. The delays often have ramifications for their health and quality of life. Of those who responded to the consultation, 84% said they often feel ignored or not listened to when they seek help from the NHS.

Under the strategy, new research on women’s health issues will be commissioned to raise understanding of female-specific health conditions and “tackle the data gap” to ensure diagnoses and treatments work better for women. The women’s health section on the NHS website will be overhauled and expanded. The government’s women’s health ambassador, Dame Lesley Regan, said the strategy is an opportunity to “reset the dial on women’s health” after decades of NHS services “failing” women.

Source: Guardian, 20 July 2022

See also: ITV - Health Disparities White Paper paused until next PM is chosen ([link removed])
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** Scotland study: Cigarette-style labels on alcohol ‘can cut drinking’
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Alcohol packaging must be regulated or come with health warnings similar to cigarettes, say campaigners after a Stirling University study illustrated how beer and spirits were designed to appeal to young people.

Authors drew comparisons with laws that require cigarettes to be sold in plain packets behind screens without the glitzy labels and celebrity endorsements of alcohol. The study surveyed 50 drinkers across eight focus groups and was published in the Journal for Studies on Alcohol and Drugs.

Daniel Jones, of the university’s Institute for Social Marketing and Health, said: “Five main themes emerged from our data: the ubiquity of alcohol packaging; its appeal and ability to catch attention; its association with particular occasions and activities; its ability to inform perceptions; and its engagement of both visual and non-visual senses — taste, touch, sound and smell.” Jones highlighted the dearth of research around the significant promotional role of packaging, and how it may be better regulated, as “attractive features may limit the effectiveness of warnings”.

Participants recalled seeing alcohol featured in the media. Packs that stood out in shops were considered appealing for being different, interesting or aesthetically pleasing. Some participants reported purchasing alcohol products solely on pack appeal. Gift and prize promotions drew customers in, as did sponsorships linked to sports, festivals and television shows. Drinkers preferred exclusive-looking “limited edition” packaging over large price marks portraying the drink as value for money, as they felt value drinks were inferior.

Alison Douglas, the chief executive of Alcohol Focus Scotland, said: “Mandating health warnings on alcohol products would help to counter the attractiveness of packaging and address current low levels of knowledge of alcohol harm [...] The Scottish government has already committed to a consultation on alcohol marketing, expected later this year. We hope to see comprehensive restrictions introduced which include improving alcohol labelling.”

Source: The Times, 20 July 2022

See also: Medical Xpress - Study reveals impact of alcohol packaging on young people ([link removed])
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** International
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** US: FDA head faces scrutiny over missed regulatory deadlines for vaping product applications
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The head of the Food and Drug Administration (FDA) has called for a review of the agency's food and tobacco programs following months of criticism over their handling of the baby formula shortage and e-cigarette reviews, namely the recent backtracking on the ban of products from leading US vaping company, Juul.

"Fundamental questions about the structure, function, funding and leadership need to be addressed" in the agency's food program, FDA Commissioner Robert Califf said in a statement. The agency's tobacco centre, which regulates traditional cigarettes and vaping products, is facing challenges navigating policy and enforcement issues from "an increasing number of novel products that could potentially have significant consequences for public health," he said.

The FDA has also struggled to review millions of other applications from vaping companies, prompting multiple missed regulatory deadlines over the last two years. Califf again cited funding challenges, pointing out that the FDA cannot collect user fees from vaping companies who submit their products. The agency has asked Congress for that authority. "I don´t think anyone anticipated that there would be 6.7 million vaping product applications that came rolling in during a pandemic that was stressing the entire agency," Califf said.

Last week, the FDA announced it would miss another deadline to remove thousands of illegal e-cigarettes that use synthetic nicotine. FDA officials specifically asked Congress to give the agency authority over those products, which had used a legal loophole to skirt regulation.

Senator Dick Durbin, an Illinois Democrat, suggested Califf should resign if the agency can´t swiftly remove such products. Califf said the Reagan-Udall Foundation - a non-governmental research group created by Congress to support FDA´s work - would convene experts to deliver quicker evaluations for food and tobacco products.

Source: Daily Mail, 19 July 2022
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** US study: New research calls for a health equity lens in commercial tobacco product regulation
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University of Minnesota School of Public Health Assistant Professor Dana Mowls Carroll co-authored a recent commentary in Preventive Medicine on how commercial tobacco policies contribute to inequities, including the unequal and unjust burden of tobacco-related disease and death among racialised populations.

The researchers explained that policies allow the continued sale of menthol cigarettes—especially via targeted marketing—that increase the risk of commercial tobacco use among Black or African American (B/AA) and Indigenous American adults. At the same time, policies banning e-cigarette flavours to prevent young people from starting to vape have received considerable attention. These policies disproportionately benefit white youth, whose e-cigarette use is higher compared to B/AA youth. Although youth e-cigarette use prevention is critical, the level of support, urgency and publicity for banning e-cigarette flavours exceeds that for banning menthol cigarettes, furthering inequities in how regulation benefits various groups.

The writers assert that equitable opportunities for a healthy life can no longer be afterthoughts or secondary aims for policymakers. They call for a health equity lens in commercial tobacco product regulation, offering individual and system-level recommendations that put health equity at the forefront of regulation and research.

Source: Medical Xpress, 19 July 2022

See also: Preventative Medicine - Centering racial justice for Black/African American and Indigenous American people in commercial tobacco product regulation ([link removed])
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ASH Daily News is a digest of published news on smoking-related topics. ASH is not responsible for the content of external websites. ASH does not necessarily endorse the material contained in this bulletin.

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