Is the difference in life expectancies across the city anything to do with how we as a city treat people, or is it just the result of us having burger-munching fag-smokers in Whitehawk and tofu-eating sandal-wearers in Hove? What I mean is - how much can we actually do to help people who can't be bothered to look after themselves properly?
- Richard Holmes

Hi Richard, Life expectancy has a lot to do with what are called the wider determinants of health: housing, employment, education and so on and also how we live our lives - what we eat, drink, how much we exercise, whether we smoke and so on. Interestingly the NHS probably only contributes to about 8% of life expectancy and more of it is to do with these broader determinants I mentioned. In Brighton and Hove standards of care at the hospital are pretty standard irrespective of where you live in the city.

Hi Doc,
Why do you think the health gap between rich and poor is growing?
- Mary

I think there are probably a lot of reasons. There has always been a gap and it is very difficult to close. For example whenever we introduce a service to help say people who smoke, we usually see a differential untake from 'the people who least need the service' that is to say more affluent groups. Similarly if you look at health services, particularly primary care, you often see that the more comprehensive services are in the more affluent parts of the city. This is commonly called the inverse care law - those who have get more and those who don't ...don't. It is something we really have to keep an eye on if we want to address it and it is not just enough to introduce a service across the city, it really has to be targeted at those who most need it. Our stop-smoking services tell us it takes typically 8 contacts to stop someone smoking in the east of the city and about 2 in the west. So it takes more resources, more time and a lot more effort to reduce these inequalities.

do you think people are too complacent about their health now? no-one gets aids and we can cure most stuff now so no one tries to be healthy!
- Betty

Hi Betty, I think people are getting more concerned about their health but there is a level of risk taking that people are prepared to take. It is a question of understanding that properly so we can address it.

Hi Tom,
Two questions, if I may:
1. What trends are emerging in terms of people's lifestyles that weren't there before that affect their health? I would bet smoking levels are down since the ban, but binge drinking is on the up?

2. What can we actually do about it? If, say, binge drinking is on the up, then how can you or anyone possibly influence this?
-Thanks,
Robert Moore

Hi Robert, first of all, smoking has gone down although we are seeing people reducing rather than quitting as pubs and clubs develop clever ways to help people smoke 'outdoors'. Alcohol consumption is going up and does need serious attention - it isn't just a culture of binge drinking, although that is increasing, but there are also a section of the the elderly population at home, drinking to excess alone.

Binge drinking is very hard to tackle, it is about education, encouragement, providing other opportunities, and better enforcement. In Scotland they are looking to introduce an age limit of 21 years for off licence alcohol sales and there might be similar innovative approaches to alcohol sales that we could look at.

alright mate,
do you think there's more sick and dying people becose its so hard to get a doctor or dentist?? it's a right fuss to sort all that out!
- skunky

Hi Skunky, interesting question, but in fact it is a lot easier than people think to get an NHS dentist in Brighton and Hove and there are vacancies. GP services have been a bit pressed in recent times but even there there are vacancies. A telephone call (01273 295490) to the Primary Care Trust will get you into the system and someone will be able to tell you.

Hi Tom,
It's great we are aware of these problems but what is being done about binge-drinking. My daughters friends seem to go out every weekend and come home in a terrible state. Some bars seem to encourage young women to get drunk offering them incentives and happy hours. It's wrong.
-Jo Harris

Hi Jo, it is a problem and we know from surveys that 44% of young girls aged 14-15 years report getting drunk in the last week. It requires a co-ordinated approach that involves education, good treatment services - like picking up alcohol problems at A&E departments and diversion into more meaningful activities, but also better enforcement. I think that this is something we should be looking at both nationally and locally.

The picture which is painted in Wednesday's article is very bleak. Do you think it is likely to get worse before it gets better?
-Ruth

Hi Ruth, yes, it does come across as a bit bleak. What the article doesn't cover is what is being done about it and we are spending more money than ever in trying to address issues of health, not just health care services. I am an optimist by nature, smoking is coming down, teenage pregnancy seems to be reducing, for the first time we have seen in surveys children report higher levels of healthy eating and exercise. So there is progress but I think in some areas - alcohol for example and sexually transmitted diseases, we have a way to go yet.

I've seen stories in some papers saying that Brighton is one of the healthiest cities in the country and in others saying its one of the least healthy? What's the truth?
-Johnny Trat

Hi Johnny, Brighton has been shown in some surveys to be a very happy place to live. In terms of some health measures it does well, in others not so. Our rates of suicide - despite being a happy city, have been the highest or second highest in the country, our alcohol related problems - alcohol related crime, violence, hospital admissions and deaths are in the worst 20% of the country consistently. So it really depends what aspects you look at.

Hi Dr Scanlon,
What do you think about the Fit For The Future process that have taken place across Sussex?
Have we now been lumbered with a sub-standard health service or is it a change for the better?
-Jeff

Hi Jeff, I think that Fit for the Future should deliver better services all round, concentrating experts where they are most needed. In terms of Brighton and Hove however it will not involve any major changes in services and it is more an issue for West Sussex and Chichester in particular.

Hi, What is the one thing we could all do to improve our health and increase our life expectancy?
-Andrew

Hi Andrew, really a lot of it depends on where we are born, what sort of education we get, our housing and later on what sort of job we get - outside of NHS control. Lifestyles do make a difference and the single biggest cause of preventable death is smoking so giving up the fags is first in line.

Do you think the increasing role of private companies in the NHS is beneficial to the taxpayer and ultimatley people's health?
-Thomas Fletcher

Hi Thomas, the short answer is that it remains to be seen. Private Finance Initiatives have been a key plank in the Government's approach to getting more money into health but we have to wait and see the long-term effects.

Thanks to all for a very interesting set of questions. The Primary Care Trust is very interested in engaging with the public more. There is an public event about health and health services next week if people are interested and details can be found at the Primary Care Trust (01273 295490).

Dr. Tom Scanlon
Director of Public Health