Paving the way with good intentions

We've just had a new pavement outside the pharmacy. Presumably there was a council budget in danger of having its under-spend trimmed, so we've been treated to posh block paving that's made our suburban road look like a grand Italian avenue. A strange use of our recently increased business rates at a time when the recession is biting, and our patients are bringing ever more scripts for antidepressants and hypnotics owing to their own financial concerns. In such challenging times, many people may also be comfort eating, or turning to booze and fags for some perceived release, even though many families could do without this increasing tax burden. Challenging times for public health then. Now I've never been a great proponent of No Smoking Day, which public health seems to view as an annual inoculation against the evil weed. Our experience has always been that it is the one day of the year when no one buys NRT or speaks to our advisers, perhaps because anyone who smokes will tell you that they know smoking is bad and they don't need a national day of shame to beat them over the head. If we're honest, we all know our unhealthy habits – but dress them up, so our cigarette is just a ‘crafty fag', the cream cake ‘naughty but nice', and the alcoholic drink ‘for medicinal purposes only'. Any overt health promotion around such behaviours cannot avoid the perception of nannying or hectoring – so what about ‘nudging'? For a while, the idea of ‘health nudging' – encouraging people to make healthy choices – was in vogue. This manifested itself by way of an implied health message such as salad on the menu at the burger bar, the bowl of fruit on the counter of the doughnut shop, or a happy-hour promotion on soft drinks, but unfortunately the evidence that this makes a difference is weak at best. After all, in those situations we've usually already made the choice – you don't go into a burger bar for a salad – although a bit of nudging away from the everything-deep-fried catering at pharmacy training events wouldn't go amiss. Better than nudging, then, is providing the opportunity to meet the need or desire to change, and that's why our continuing recession makes health interventions all the more important. The Lambeth pharmacies' award-winning alcohol intervention scheme, as reported in C+D last week, suggests this is ever more true, and the signs in our pharmacy offering "free lung health assessments" and highlighting the cash saving available by quitting smoking mean our Support To Stop advisers have never been busier. Providing this opportunity for patients could also be an opportunity for pharmacy, as maybe now is exactly the time to be demonstrating to public health that we can do more than count out tablets. Perhaps my customers could find the newly refurbished road outside our pharmacy is also paved with good intentions.

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