Prevention

IPH response to the consultation on fortification of flour with folic acid in Northern Ireland

maresa.fagan@publichealth.ie — Fri, 12 Jan 2024 15:02:51 +0000

IPH response to the consultation on fortification of flour with folic acid in Northern Ireland maresa.fagan@p… Fri, 12/01/2024 - 15:02

IPH response to the consultation on fortification of flour with folic acid in Northern Ireland

Food

Prevention

Womens Health

15 Jan, 2024

Downloads

IPH response to Amending the Bread and Flour Regulations

In August 2023 the Institute responded to the Department for Environment Food and Rural Affairs (DEFRA) consultation on Northern Ireland’s ‘Bread and Flour’ regulations.

The consultation followed an announcement in 2021 by the the UK government to fortify flour with folic acid.

The consultation report for ‘Amending the Bread and Flour Regulations 1998 and the Bread and Flour Regulations (Northern Ireland) 1998’ is awaited and will be published on the Food Standards Agency website: Consultation on Amending the Bread and Flour Regulations 1998 and the Bread and Flour Regulations (Northern Ireland 1998) | Food Standards Agency.

Blog: What next for fortifying flour in Northern Ireland to help prevent birth defects?

maresa.fagan@publichealth.ie — Fri, 12 Jan 2024 14:38:11 +0000

Blog: What next for fortifying flour in Northern Ireland to help prevent birth defects? maresa.fagan@p… Fri, 12/01/2024 - 14:38

Blog: What next for fortifying flour in Northern Ireland to help prevent birth defects?

Food

Prevention

Womens Health

15 Jan, 2024

The UK is in line to be the first country in Europe to fortify flour in a bid to reduce the occurrence of certain birth defects.

In this blog, Dr Jenny Mack, Consultant in Public Health Medicine, shares some insights on why this measure is being introduced in the UK and what this may mean for Northern Ireland.

Why has this measure been agreed by the UK government?

Folic acid plays a very important role in the development of the brain, skull, and spinal cord of the foetus. Despite decades of efforts to enhance the use of folic acid supplements, there are still many women in the UK who do not have enough folic acid in early pregnancy. Being deficient in folic acid means the woman’s developing baby is at risk of a neural tube defect (NTD). This is important, as NTDs can lead to serious health problems, including long-term damage to the nervous system, disability and unfortunately, death.

Evidence reviews conclude that more NTDS could be prevented if broader population health measures were introduced, specifically if flour was fortified with folic acid. This measure will help ensure that women with unplanned pregnancy, and those that have not taken supplements before they discover they are pregnant, can also be offered some protection for their baby. Adding folic acid to food products, a process known as ‘fortification’, has been implemented in around 80 countries across the world. In countries where folate fortification has been rolled out, NTDs have fallen.

In the USA, folic acid fortification of cereal grains was mandated in 1998. This was associated with a decline in NTDs which was maintained for more than a decade. At the same time, fortification led to an increase in folate levels amongst women of a childbearing age in the general population. This video produced by the CDC tells the story of how evidence influenced the policy decision in the USA.

A study in the British Medical Journal estimated that 2,000 pregnancies associated with NTDs would have been prevented by 2012 if the UK has adopted the same fortification regimen as the USA in 1998.

What is the potential benefit to health in Northern Ireland?

The UK government and devolved administrations have proposed the addition of 250µg of folic acid per 100g of non-wholemeal wheat flour. If these regulations are enacted fully, this would be a major step towards the prevention of a substantial proportion of NTDs. This is particularly important for Northern Ireland, where the population is at higher risk of NTDs due to higher levels of social deprivation, evidence of a less nutritious diet among women of childbearing age and some evidence of lower levels of folate in women who may become pregnant, when compared to other regions in the UK and in comparison to Ireland. Estimates of the incidence of neural tube defects are not routinely published in Northern Ireland, in part due to the absence of a standardised congenital anomaly register in the region. Estimates from Hospital Information Branch suggest that there were around 48 admissions, and tragically 6 stillbirths, attributable to NTDs in the region in 2018. However, due to small population size in Northern Ireland and no bespoke register, developing appropriate incidence estimates and assessment of trend needs further careful epidemiological analysis.

So why hasn’t this been implemented in Northern Ireland?

The UK government agreed to fortify flour with folic acid in an announcement in September 2021. Devolved governments in Northern Ireland need to amend their regional Bread and Flour Regulations to see the measure implemented in the region. It is now over a year since interested parties, including IPH, submitted a response to the Department for Environment Food and Rural Affairs (DEFRA) consultation on Northern Ireland’s ‘Bread and Flour’ regulations. A consultation report detailing the responses received and the government response was released on 17 January 2024. There were 23 responses from Northern Ireland to this consultation.
The report states that the UK government and devolved administrations have carefully considered the responses received and intend to proceed with the proposals as set out in the consultation, with the exception of the proposal to exempt flour used as a minor ingredient (less than 10% of the final product). A UK-wide monitoring group has been set up to develop an evaluation of the proposed implementation of amendments to the Bread and Flour Regulations, relating to micronutrient levels. The monitoring group is chaired by Food Standards Scotland and comprises colleagues from the Department of Health and Social Care; the Department of Health Northern Ireland; Welsh Government; Scottish Government; the Department for Environment, Food and Rural Affairs; and the Food Standards Agency in Northern Ireland. The group is considering monitoring at a UK level as standard and at the devolved administrations level where feasible, for both positive and postulated negative impacts of the policy. Political support for this measure exists, with Lord Dodds of Duncairn particularly active on the issue in the House of Lords and in the All-party Parliamentary Group on Folic Acid Fortification at Westminster.

What about Ireland?

In Ireland the topic of NTDs recently came into the spotlight with concerns over outcomes for children with spina bifida undergoing surgery. There has been some, but limited, discussion on issues of prevention, data monitoring and surveillance. The Minister for Health recently responded to a parliamentary question on the fortification and the prevention of NTDs. The Minister’s response indicated that before any policy position is reached on folic acid fortification, stakeholder consultation would be required, and that in the short-term other measures would need to be optimised, such as folic acid supplementation and dietary folate intake.

What measures are needed to further reduce NTDS on the island of Ireland?

Alongside fortification, IPH suggested the development of a Northern Ireland strategy to reduce NTDs at a population level. A strategy could help to co-ordinate a suite of preventative actions, including fortification, but also optimise the use of supplements, monitor incidence and enhance preventive approaches for higher risk pregnancies. IPH recommended investment in a monitoring system to assess levels of fortification, adequacy of folate levels in women who may become pregnant and incidence of NTDs. Baseline estimates have recently been established in other regions of the UK which will enable the impact of fortification to be evaluated.

There is much to learn from the New Zealand experience. Despite some failed attempts to progress the measure in 2007, Manatu Hauora (New Zealand Ministry of Health fully introduced mandatory fortification in August 2023, within two years of announcing government support in 2021. The government championed the legislation as a health inequity investment – capturing learning from fortification in Australia to show the additional benefit to indigenous women and protecting women, babies and families in underserved communities.

Links

Read: IPH response to the consultation on fortification of flour with folic acid in Northern Ireland

Additional Resources

Advice on planning your pregnancy https://www.nhs.uk/pregnancy/trying-for-a-baby/planning-your-pregnancy/

Information for women of child-bearing age on how to ensure you get enough folic acid when planning a pregnancy  Folic_Acid_2022.indd (hscni.net) https://www.safefood.net/healthy-eating/supplements

Blog: Becoming SunSmart - Reflections on skin cancer prevention in Ireland

maresa.fagan@publichealth.ie — Wed, 03 May 2023 13:27:46 +0000

Blog: Becoming SunSmart - Reflections on skin cancer prevention in Ireland maresa.fagan@p… Wed, 03/05/2023 - 14:27

Blog: Becoming SunSmart - Reflections on skin cancer prevention in Ireland

19 Jul, 2022

In this blog, Lauren Rodriguez, IPH Public Health Development Officer, reflects on the policy impact from a report IPH published in 2020 in partnership with NUI Galway.

This report, Children’s exposure to ultraviolet radiation – a risk profile for future skin cancers in Ireland, presented the first nationally representative data on sun protection behaviours, sunbed use, and sunburn among children aged 11 to 17 in Ireland [1].

Skin cancer is the most common type of cancer in Ireland. Estimates from the National Cancer Registry suggest that almost 13,000 cases of skin cancer are diagnosed each year. This number is projected to double by 2045.

With summer in full swing and Met Eireann issuing a heat weather warning, it is timely to reflect on the Institute’s work and contribution to government policy to reduce the risk of skin cancers.

Ireland’s first Skin Cancer Prevention Plan was published in 2019, as part of a suite of policies under the Healthy Ireland Framework. A ‘health in all policies’ approach to tackling skin cancer is included in the National Cancer Strategy 2017-2026 and this was further detailed within the 2019 National Skin Cancer Prevention Plan, the first action plan to specifically focus on skin cancer.

Understanding risk exposures in childhood

Within the National Skin Cancer Prevention Plan, IPH was named as a delivery body and tasked with an action to develop a profile of children’s sun safety behaviours, their use of sunbeds and their experience of sunburn. This led IPH to work closely with researchers at the National University of Ireland, Galway (NUIG) to configure questions for inclusion in the 2018 Health Behaviour and School-Age Children Survey – the questions were carefully piloted and revised before fieldwork began[2].

In June 2020, IPH and NUIG published the joint report, Children’s exposure to ultraviolet radiation – a risk profile for future skin cancers in Ireland. The report provided the first ever nationally representative data on school children and young people’s sun protection behaviours. It also provided baseline data to support monitoring of the government’s National Skin Cancer Prevention Plan 2019-2022. Since then, the report is one of the most downloaded publications on the IPH website with over 2,500 downloads.

Evidence for implementation

Implementation of the National Skin Cancer Prevention Plan is led by the HSE National Cancer Control Programme (NCCP), with an implementation subgroup focused specifically on children and young people. IPH contributes directly to this subgroup which also features input from national advocacy and charity organisations as well as public health professionals around the country. This allows the Institute to support the translation of research findings[3] into decisions on investment, like national campaigns, as well as discussions on legislative and policy changes.

The purpose of the subgroup is to contribute to the implementation of Action Area 3 of the National Skin Cancer Prevention Plan.

Some of the highlights of the group’s ongoing work include:

Engaging and directly consulting children and young people on SunSmart education materials and awareness campaigns
Developing an annual Healthy Ireland SunSmart awareness campaign aimed at parents, children and young people
Developing a pilot of SunSmart games and sunhats for Let’s Go Summer Camps, Dublin Northeast Inner City camps, as well as Sport Ireland camps
Developing a SunSmart policy on outdoor play for early learning centres
Developing an FAQ document developed for Public Health Nurses on sun protection for babies and children
Identifying opportunities to include messages about skin cancer prevention for babies, children, and young people in communications with parents. This included a sunhat for newborns in a ‘Little Baby Bundle’ pilot programme and an update to the My Child public health network manual
Developing and piloting SunSmart primary school lesson plans – junior and senior – and increasing awareness of UV risk and protection among young children attending Early Learning Centre settings
Launching the ‘Get SunSmart! Children’s Art Competition’ to encourage creativity and learn how to enjoy the sun safely among primary school children
Disseminating and promoting resources to support the curriculum in relation to skin protection for use in primary and post primary schools, including through the official Scoilnet portal.

The current national skin cancer prevention plan concludes this year. While work is underway to develop an updated plan for 2023, it is important to reflect on all that has been achieved to date, especially in relation to children and young people who are vulnerable to the environmental, social, and commercial determinants of skin cancer.

Further information and support

SunSmart resources for parents, children and schools can be found at www.hse.ie/SunSmart

A Health Warning on sunbed use can be found at https://www.hse.ie/eng/services/list/5/cancer/prevention/nccp-sunbeds-dl-p5-.pdf

References

[1] The author would like to thank colleagues at IPH and the HSE National Cancer Control Programme for their contributions to this blog including, Maria McEnery, Skin Cancer Prevention Plan lead & Cancer Prevention Officer and Aine Lyng, Cancer Prevention Officer.

[2] Költő, A., Harrington, A., Kavanagh, A., Tyrrell, L., and Nic Gabhainn, S. (2018). New Questions for the Health Behaviour in school-aged Children (HBSC) Study in Ireland: Pilot 2018. Galway: National University of Ireland, Galway

[3] Költő A, Rodriguez L, McAvoy H, Nic Gabhainn S. (2021). Sunburn, Sun Safety and Indoor Tanning Among Schoolchildren in Ireland. International Journal of Public Health.

IPH marks 25 years of working towards healthier populations

maresa.fagan@publichealth.ie — Wed, 15 Mar 2023 11:24:50 +0000

IPH marks 25 years of working towards healthier populations maresa.fagan@p… Wed, 15/03/2023 - 11:24

IPH marks 25 years of working towards healthier populations

Health Inequalities

Health Promotion

Prevention

7 Feb, 2023

2023 is a significant milestone for the Institute of Public Health, which this year marks 25 years of working towards healthier populations in Ireland and Northern Ireland.

Established prior to the signing of the Good Friday / Belfast Agreement in 1998, the Institute was set up to provide support on public health policy to the respective Departments of Health and Chief Medical Officers in both jurisdictions.

Our primary goal is promoting health and wellbeing, improving health equity, and reducing health inequalities on the island of Ireland.

A key aspect of our work involves assessing and reviewing current evidence to inform public policy in Ireland and Northern Ireland.

Over the past 25 years, the Institute has provided evidence and made recommendations on a wide range of public health issues, from the achievements and challenges of living healthily for longer, tackling health inequalities, tobacco control, alcohol policy, to new and emerging risks to health, such as, climate change.

Established as a North South body, partnership working is a key priority for the Institute, which collaborates with local, national and global partners in the health community.

Since 1998, significant progress has been made in key public health policy areas but considerable challenges remain and there is much to do.

Throughout 2023, the Institute will share some key milestones from the past 25 years to highlight its contribution to shaping public health policy and, ultimately, helping to create healthier populations on the island of Ireland.

Young men and suicide project: Executive Summary

webadmin — Mon, 06 Mar 2023 11:26:44 +0000

Young men and suicide project: Executive Summary webadmin Mon, 06/03/2023 - 11:26

Young men and suicide project: Executive Summary

25 Jan, 2013

Downloads

Young men and suicide project: Executive Summary

Young men and suicide project

his report was launched by the Men’s Health Forum in Ireland (MHFI) on 23 January 2013. The report highlights the main findings from the all-Ireland ‘Young Men and Suicide Project’ (YMSP). The aim of the project was to identify a range of possible means to promote positive mental health among young men on the island of Ireland. The YMSP began in March 2011.

IPH coordinated the project which was jointly funded by the National Office for Suicide Prevention in the Republic of Ireland and the Public Health Agency in Northern Ireland. The report was launched in Belfast by NI Health Minister Edwin Poots MLA and in Dublin by Minister of State Kathleen Lynch TD.

Young men and suicide project

webadmin — Mon, 06 Mar 2023 10:40:36 +0000

Young men and suicide project webadmin Mon, 06/03/2023 - 10:40

Young men and suicide project

25 Jan, 2013

Downloads

Young men and suicide project

Young men and suicide project: Executive Summary

This report was launched by the Men’s Health Forum in Ireland (MHFI) on 23 January 2013. The report highlights the main findings from the all-Ireland ‘Young Men and Suicide Project’ (YMSP). The aim of the project was to identify a range of possible means to promote positive mental health among young men on the island of Ireland. The YMSP began in March 2011.

IPH response to Seanad Consultation Committee on ‘Changes in lifestyle can prevent approximately one third of cancers. How does Government and Society respond to this challenge?’

webadmin — Tue, 21 Feb 2023 15:11:46 +0000

IPH response to Seanad Consultation Committee on ‘Changes in lifestyle can prevent approximately one third of cancers. How does Government and Society respond to this challenge?’ webadmin Tue, 21/02/2023 - 15:11

IPH response to Seanad Consultation Committee on ‘Changes in lifestyle can prevent approximately one third of cancers. How does Government and Society respond to this challenge?’

Cancer

Prevention

16 Mar, 2012

Downloads

IPH response to Seanad Consultation Committee on ‘Changes in lifestyle can prevent approximately one third of cancers

IPH responded to the Seanad Consultation Committee on the consultation topic ‘Changes in lifestyle can prevent approximately one third of cancers. How does Government and Society respond to this challenge?’.

Between 2010 and 2020 the total number of cancers in Ireland is projected to increase by 40% for women and by just over 50% for men (National Cancer Registry).

A focus is needed on developing social, economical and built environments that support healthy choices. IPH presented recommendations based on the international evidence-base as well as national cancer data and research.

IPH response to Road Safety Authority Ireland Road Safety Strategy 2013-2020

webadmin — Tue, 21 Feb 2023 15:03:51 +0000

IPH response to Road Safety Authority Ireland Road Safety Strategy 2013-2020 webadmin Tue, 21/02/2023 - 15:03

IPH response to Road Safety Authority Ireland Road Safety Strategy 2013-2020

Health Promotion

Prevention

27 Jul, 2012

Downloads

IPH response to Road Safety Authority Ireland Road Safety Strategy 2013-2020

The Road Safety Authority has responsibility for co-ordinating the development of Ireland’s Road Safety Strategy. The Government’s road safety target of no more than 252 deaths per annum by the end of 2012 was achieved in 2009, when the number of road collision deaths in Ireland fell to 239. The reduction in the number of fatalities was achieved through robust actions in terms of education and awareness, road engineering, and enforcement, including significant legislative milestones.

The challenge is now to ensure that the impact of these measures on collision levels is sustained and enhanced into the future through continuous education, enforcement and road engineering measures and initiatives. IPH welcomes the opportunity to respond to this consultation given the significant burden of injury, disability and mortality associated with road traffic collisions on the island of Ireland. IPH supports the development of evidence-based strategies and actions which can maintain a transport system, in which the safety of all road users is paramount.

Key points from IPH response

• IPH welcomes the opportunity to contribute to the development of evidence-based strategies and actions supportive of road safety.

• IPH acknowledges the significant progress made in terms of reductions in fatalities in recent years. However, the population health burden of injury, disability and mortality associated with road traffic collisions on the island of Ireland remains significant.

• IPH recommends that any future road safety strategy should be comprehensive with specific, measurable, attainable, relevant and time-bound (SMART) targets relating to the reduction of fatalities as well as the reduction of serious injuries.

• The development of indicators suitable to the monitoring of injury and disability could form a particular focus for the forthcoming strategy with a view to informing the development of meaningful targets in the future.

• The development of indicators suitable to the monitoring of particular vulnerable road users could be explored, with an emphasis on assessment of various aspects of social inequalities in injuries and deaths.

• Population ageing as well as an increasing birth rate is likely to result in higher numbers of vulnerable road users and specific provision should be made in the strategy to address their needs.

• The increase in cyclists on the road is welcome in terms of the positive benefits for public health associated with physical activity and air quality. Promoting the safety of cyclists should form a clear focus in the strategy and opportunities for synergistic and mutually supporting working with the implementation of the National Cycling Policy Framework should be realised.

• Policy and actions set out in the Road Safety Strategy should aim to be supportive of the Department of Health National Substance Misuse Strategy in terms of reducing alcohol-related harm on the roads. Opportunities for synergistic and mutually supportive working to reduce alcohol-related harm on the roads should be actively pursued.

• Improved understanding of the potential positive and negative harms associated with technologies used by drivers should form a distinct work programme in the strategy, with particular attention paid to appropriate data on mobile phone usage.

Systematic review of the impact of depression on subsequent smoking cessation during pregnancy

webadmin — Tue, 14 Feb 2023 12:34:41 +0000

Systematic review of the impact of depression on subsequent smoking cessation during pregnancy webadmin Tue, 14/02/2023 - 12:34

Systematic review of the impact of depression on subsequent smoking cessation during pregnancy

Children and Young People

1 Apr, 2017

Downloads

Systematic review of the impact of depression on subsequent smoking cessation during pregnancy

Link

http://www.rcsismj.com/wp-content/uploads/RCSIsmj-10th-Edition-20162017.pdf

Smoking during pregnancy is the most significant modifiable risk factor for adverse pregnancy outcomes. Tobacco use has a long-standing relationship with depression but has not been critically investigated in pregnancy. We systematically reviewed studies of the association between depression and subsequent smoking cessation during pregnancy.

Depression is associated with poor smoking cessation rates in pregnancy. Future research is needed to focus on depression and smoking status as an outcome of interest in pregnancy with repeatable and objective measures used for data collection.

IPH response to consultation on Dublin City Council’s Speed Limit Review

webadmin — Mon, 13 Feb 2023 12:00:32 +0000

IPH response to consultation on Dublin City Council’s Speed Limit Review webadmin Mon, 13/02/2023 - 12:00

IPH response to consultation on Dublin City Council’s Speed Limit Review

Health Promotion

Prevention

24 Aug, 2016

Downloads

IPH response to consultation on Dublin City Council’s Speed Limit Review

The remit of the Institute of Public Health in Ireland (IPH) is to promote cooperation for public health between Northern Ireland and the Republic of Ireland in the areas of research and information, capacity building and policy advice. Our approach is to support Departments of Health and their agencies in both jurisdictions, and maximise the benefits of all-island cooperation to achieve practical benefits for people in Northern Ireland and the Republic of Ireland.

IPH has been actively engaged in research and policy development relating to the interface between health, travel and the built environment. IPH published a review of the Health Impacts of Transport, Health Impacts of the Built Environment, and Active travel – healthy lives.

IPH submitted a response to the Road Safety Authority’s Road Safety Strategy 2013-2020 for the Republic of Ireland, in which we highlighted the importance of cross-sectoral working, the importance of supporting active travel and addressing social inequalities in road deaths and injuries. In Northern Ireland IPH responded positively to the consultation on the Roads Traffic (Speed Limits) Bill to introduce 20mph speed limits in designated restricted streets.

IPH presented evidence to the Regional Development Committee in the Northern Ireland Assembly supporting the case for 20mph speed limits on residential roads. An official report of IPH also submitted consultation responses in the context of Northern Ireland’s Active Travel Strategy and Draft Bicycle Strategy outlining the importance of enhancing levels of cycling and walking to increase levels of physical activity and improve public health.