In our continuing series on the 60th anniversary of the NHS, Health Correspondent Emma Brady discovers how public awareness in the West Midlands has changed over the decades.
When the smoking ban was introduced in England last July, it was greeted by cheers of joy from non-smokers and cancer groups, and cries of derision from pro-smoking groups and landlords fearful that their profits would plummet.
One year on, smokers are not trying to flout the ban but rather stand outside pubs, restaurants and clubs in all weathers.
Some thought it might not work, that the public would not change such ingrained behaviour. It may not have happened overnight but now smokers automatically go outside to light up.
Getting smokers to stub out their habit altogether is proving harder, although the ban provided a good impetus for people to quit.
But in the early 1960s – after a link between smoking and lung cancer was discovered in 1954 – smoke of another kind was causing a raft of public health problems.
At the time coal was still used to heat many homes and this, combined with vehicle fumes, regularly caused a noxious smog – combination of carbon and sulphur – to descend over cities, including Birmingham.
Professor Richard Griffiths, an expert in public health a Birmingham University, said: “I was a student here in 1963, and at that time most old houses in the city still used coal and you could easily lose people in the smog that it created.
“Obesity wasn’t an issue as people weren’t as well fed, and it was just before Doll and Hills discovered a possible link between smoking and cancer.
“Bronchitis was the big worry at that time, because the city’s smog contained carbon and sulphur particles and lots of people were dying from emphysema as a result.
“While I was a house officer at Dudley Road Hospital, we would have 40 people a day admitted with emphysema, and there was also a major flu epidemic around that time in 1968-69.”
Local authorities were responsible for most public health services until they were transferred to the NHS in 1974, including health visitors and district nurses.
Public awareness campaigns that are commonplace in the 21st century were not the vogue then.
Prof Griffiths, former regional director for public health in the West Midlands, added: “One of the early campaigns involved sending a caravan which went up the Ladypool Road to educate the balti house chefs on health and safety, how to cook their food safely and so on, because we knew they wouldn’t go to the College of Food, so we went to them instead.”
“Now obesity is the top public health priority, but it’s a very complex issue, it’s not as simple as getting rid of McDonald’s.
“As a nation we’ve become too reliant on drug therapies rather than look at ways of preventing ill health, and that includes taking better care of our bodies and watching what we put into them.
“Eating just 100 more calories a day than you burn will put on a stone in a decade, so with our increasingly sedentary lifestyle and high-calorie diet, it’s easily done.”
He added: “The fact there’s now a games console that’s aimed at making players move more - the Wii - is somewhat ironic. But playing tennis on Wii is still better than sitting on the sofa just watching a screen all day.
“We’ve got to learn how to use the power of choice, with our activities, our diet and social habits, as they have all played a part in creating this problem.”
Dr Rashmi Shukla, director for public health in the West Midlands, admits lifestyle choices such as drinking, smoking and poor diet are “likely to remain significant factors for a few years to come”.
The Choosing Health For The West Midlands Report revealed the region had the highest level of obesity in women, with 60 per cent being overweight or obese, and four per cent classified as morbidly obese.
Men did not fare much better, with 43 per cent overweight, 23 per cent obese and two per cent described as morbidly obese.
But the most worrying trend is that nearly 16 per cent of children in the Midlands have a body mass index between 30 and 40, putting them in the obese bracket - the third highest behind London and the North-east.
Alcohol was linked to 17.1 deaths per 100,000 men and 8.1 deaths per 100,000 women across the region, and the report also revealed binge drinking was more prevalent among professional and managerial roles than those with manual jobs.
Dr Shukla said: “When the NHS was first established it took a one-size fits all approach to public health, but we’re now able to offer more personalised care packages, and as a result I think people have taken ownership of their health.
“However we do need to become more conscious of what we’re consuming, what we’re putting into our bodies, and if we don’t I think we will see a further rise in lifestyle-related conditions like Type 2 diabetes in children, as well as their parents’ generation.
“I know a lot of people, predominantly middle-class individuals, who don’t really know how much they’re drinking. They think in terms of glasses rather than units, regardless of how big the glass actually is, which is where the problem lies.
“Smoking was actively encouraged in soldiers, to help them calm down during wartime, but when the link between smoking and cancer was discovered in the late 1950s, that’s when public health issues we face today began to surface.”
One unexpected benefit of the current credit crunch is that families are having to become more creative in the kitchen, as they are forced cook their own meals instead of ordering takeaways or eating out, in order to save money.
“We cannot underestimate the importance of regular physical activity and eating five portions of fruit and vegetables a day,” added Dr Shukla.
“If we can get more people cooking for themselves, rather than heating up ready meals and buying junk food, that could have a very positive outcome in the future, but at present obesity rates - particularly childhood obesity - are very worrying.
“We can’t change these behaviours overnight but if we can slow down the rate of childhood obesity, then we can realistically start at looking of ways to turn it around altogether.
“Adult obesity will impact on NHS facilities, but if childhood obesity is not tackled now, we will see even more pressure on these services in 10-15 years time.”
Outside the key priorities around diet, drinking and smoking, Dr Shukla admits rising rates of sexual infections and mental health problems also need to be addressed.
“The Government’s HIV awareness campaign, which hit doormats and television screens in the mid-80s with graphic images of tombstones and icebergs, was the first national initiative of its kind,” she said.
“At the time little was known about HIV and Aids outside the gay community, but organisations like the Terrence Higgins Trust began sharing information with health professionals on what the latest developments were in treatment and patient care.”
In 2004, more than 2,240 new cases of HIV were diagnosed in the region, with ‘hot-spots’ in Birmingham, the Black Country, Coventry and Stoke-on-Trent.
The stresses and strains of modern living have led to a rise in mental health problems, as people struggle to cope with “the hyper-stimulated environment in our 24-7 society”.
Dr Shukla added: “There’s a major stigma around anything connected with mental health, probably because public perception is of men in white coats and patients in straitjackets, which is a very outdated preconception.
“We need to understand the importance of social networks, friendships and family connections, because when you look at socially excluded individuals - who tend to present with multiple health issues - this can be an area that is lacking.
“What we have to remember is that a person becomes a patient when they contact an NHS service, but our focus - in public health - is to keep the population healthy because we want them to be people, not patients.”
The NHS West Midlands region has a population of more than five million people, covering five counties. On an average day:
About 60,000 people will visit their GP
About 4,500 people will be referred for an outpatient appointment
Nearly 1,700 patients will undergo planned surgery, 70 per cent of which will be done as day cases
A similar number will be admitted to hospital as an emergency
About 5,000 people will attend an A&E department and a further 2,000 or so people will make an emergency call for an ambulance
About 180 babies will be born ...and about 150 people will die