Look at the bigger picture

I was recently interviewed by two members of the team carrying out a comprehensive performance assessment on one of the three local authorities within the area covered by my primary care trust (PCT) in West Berkshire.

It left me perplexed about how the process ended up focusing on small issues and missing the bigger picture by a country mile.

I had prepared for the interview by reviewing the work the NHS and the local authority had done together over the past few years. The results have been impressive. The life expectancy of both men and women across all social classes has increased.

The numbers of men and women having heart attacks and strokes have fallen, as has the numbers dying from them.

Fewer people are smoking in the area than ever before and the population’s mental health as measured by the numbers in acute psychiatric hospital beds is also improving.

This is a success story by any standard and owes much to the collaborative working by staff in the NHS and the council .

Nevertheless, this was not what the team wanted to talk about. They were concerned to know why the NHS and the council had failed to reduce the numbers of young women becoming pregnant under the age of 19.

Now I would be the first to admit that becoming a teenage mum is usually a bad idea.

The life chances for both the mother and the child are much reduced. So it is important to make sure young women and men have ready access to contraception and know how to get ‘the morning after pill’ (misnamed because it can be effective up to 72 hours after sex). And there is certainly more the NHS and the council can do locally to reduce the numbers of teenage pregnancies.

However, when you examine the actual numbers of women getting pregnant before their 19th birthday, they are pitifully small. During 2007-08 only 122 young women between the ages of 12-18 actually had a baby only 2% of those in this age/gender cohort.

So while the outlook for those babies and the young mothers is not good, it is hardly a problem affecting large numbers.

Compare this then with impact of childhood obesity.

It is estimated there are 3,300 12 to 18-year-olds in the area who are clinically obese. These individuals are not just a bit overweight, but significantly so.

Obesity dramatically increases the chances of getting diabetes.

Obese children go on to become obese adults where obesity is linked to increased prevalence of strokes, heart attacks and cancer.

Some research shows that obese adults can lose as much as nine years of life about the same as a moderate smoker.

We know even less about how to stop people from getting fat than we do about how to stop young girls from getting pregnant.

But at least it feels like the right challenge for councils and the NHS.

Nevertheless the comprehensive performance assessmentteam remained stubbornly disinterested in the impending health crisis of obesity that is currently engulfing 20% of all adults in the area and is projected to affect up to 50% by 2025. They were more interested in sex and young people.

As the consultation process concludes on the introduction of the comprehensive area assessment which is set to replace the comprehensive performance assessment in 2009, I can only hope that their inspection teams will be better prepared and more aware of the bigger-picture issues.

While sex might always grab the headlines, in reality it is the weight of the adults that ought to be the focus of the comprehensive area assessments in the coming years.

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