December 11, 2015

expert reaction to the publication of the Chief Medical Officer’s annual report

The UK’s Chief Medical Officer Professor Dame Sally Davies has published her annual report, this year focusing on women’s health and exploring common and taboo health issues. It emphasises the need to tackle obesity on a national scale in the hope of relieving strain on health services and improving quality of life for women.

Mr Richard Kennedy, past President of the British Fertility Society and President-Elect of the International Federation of Fertility Societies, said:

“We welcome the focus on women’s health issues in the Chief Medical Officer’s annual report in particular the reference to improvement in preconception interventions and highlighting obesity as a national risk. However we are disappointed that there is no reference to infertility and the continuing inequity in access to NHS funded assisted conception treatments across England and we call upon the CMO to ensure consistency in application of the NICE guidance.”

Dr Michael Bloomfield, Clinical Lecturer in Psychiatry, MRC Clinical Sciences Centre and UCL, said:

“The Chief Medical Officer’s recommendations on perinatal mental health are very welcome.  Given the potential impact of parental mental illness on the future wellbeing of children, improved access to psychiatric care will be good news – not just for mothers, but for their babies too.”

Prof. Sir Simon Wessely, President of the Royal College of Psychiatrists and Professor of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, said:

“It is good to see two important reports, the Confidential Inquiry in Maternal Death, and now the CMO’s report on woman’s health, focussing so strongly on physical AND mental health.  We warmly welcome the recommendations made  by the Chief Medical Officer on improving access to the full range of services needed for women with perinatal mental health problems and eating disorders, and in particular those addressing reducing violence against women.   Following these two examples no future report on women’s health can ever overlook mental health.”

Prof. Louise Howard, Professor in Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, said:

“This report highlights the need to address barriers to implementation of NICE guidance on antenatal and postnatal mental health care through more comprehensive training of staff and better integration of physical and mental health care. The inequity in access to specialist perinatal mental health services in different regions across England is also highlighted and I am very pleased that the CMO recommends that all women have prompt access to evidence-based interventions for perinatal mental disorders, and access to a local perinatal mental health service and regional mother and baby inpatient units.

“Mental health problems are more common than physical health problems in pregnancy and the postnatal period, but commissioners of maternity and postnatal care focus on physical health, with very limited access to perinatal mental health services in some parts of the UK. I hope this report will lead to improvements in access to care for the full range of perinatal mental health problems – mild to severe – and thus improve outcomes for women and their families. I am also very pleased to see recommendations on improving access to treatments for eating disorders, and education for health professionals and trainees and services for women who are victims of violence, including sexual and domestic violence, which is shockingly common and has devastating impacts on mental and physical health research.”

Prof. Mark Hanson, British Heart Foundation Professor of Cardiovascular Science at the University of Southampton, said:

“Scientific evidence has shown that the mother and father’s health and wellbeing have a serious impact on their offspring going so far in that a mother’s diet can alter the way the DNA of her child works and increases the risk of obesity; so it is positive the Chief Medical Officer is making it a high priority especially highlighting that planning for pregnancy is a key missed opportunity to give women health messages to improve their mental and physical health and that of their children.

“The baby’s development in the womb is such a key time period. We need to catch people before they become pregnant and give their child the best opportunity for good health. Many young people do not contact a health care provider while they are going through adolescence. It is only when they fall pregnant or are having trouble conceiving that they start to talk to their GP, and this can be too late to pass the best health on to the baby.

“Bringing pregnancy prevention and pregnancy planning together under one reproductive health umbrella and developing health care professional’s training would help women have children by choice rather than chance and preconception health could be simultaneously improved. Additionally changes in the way educational programmes and campaigns are delivered could also have a positive effect on people’s health.”

Prof. Adam Balen, Chair of the British Fertility Society, and Professor of Reproductive Medicine and Surgery, Leeds Centre for Reproductive Medicine, said:

“I welcome the Chief Medical Officer devoting her annual report to women’s health but I am very disappointed that there is no mention of infertility. 15% of couples experience infertility, which has many causes. There is a lack of awareness of the age-related decline in fertility and Dr Davies quite rightly states that we need to focus on preconception health but we also need to provide information and education to our young women and this should start in schools with the PHSE classes which Dr Davies refers to, although not in this context. This is why we are holding a high-level conference to discuss sex education and fertility awareness in schools. This event is being held jointly by the British Fertility Society and Royal College of Obstetricians and Gynaecologists on 15th April 2015. As Chair of the British Fertility Society I have agreed to chair this conference in response to the recent debate about fertility awareness and sex education in schools, which may need to be reviewed and extended to include more information about age-related fertility.”

Prof. Christopher Fairburn, Professor of Psychiatry & Director of the Centre for Research on Eating Disorders, University of Oxford, said:

“For the first time there is a single effective treatment that works across all the eating disorders – including anorexia, bulimia, and binge eating – and in all age groups. The treatment will simplify the work of clinicians and lead to the improved health of patients.”

Dr John Isaac, Head of Neuroscience and Mental Health at the Wellcome Trust, said:

“Eating disorders can be devastating and, worryingly, we are seeing a steady increase in the number of patients who are affected. CBT-E is a powerful demonstration of how careful development of new psychological therapies, supported by large-scale clinical trials, can bring treatment within reach. I hope that the introduction of this new service will make a difference to patients’ lives.”

Prof. Nick Finer, Honorary Professor, National Centre for Cardiovascular Prevention and Outcomes, UCL Institute of Cardiovascular Science, UCL, said:

“Prof Dame Sally Davies’ recommendation ‘that the Government includes obesity in its national risk planning’ is to be applauded and welcomed. Obesity and its related diseases is now (alongside smoking) the most pressing health issue to the nation affecting both men and women that some have predicted will lead to younger generations dying earlier than their parents. Estimates of the economic costs of obesity suggest they will bankrupt the NHS. Despite these risks we have seen inertia or refusal of government to implement measures from their own scientific advisors, bodies such as NICE, and worldwide expert opinion to help prevent obesity, mitigate its risks and consequences or implement evidence-based care provided through local authority or Clinical Commissioning Groups. Elevating the problem of obesity to a national risk could help to address the current laissez faire attitude to this huge angry growing health catastrophe. ”

‘Annual Report of the Chief Medical Officer: The Health of 51%: Women’ published on Friday 11th December. 

Declared interests

Mr Richard Kennedy: No conflicts of interest.

Dr Michael Bloomfield: No conflicts of interest.

Prof. Sir Simon Wessely: No conflicts of interest.

Prof. Louise Howard: I was lead author of the chapter on perinatal mental health I was not involved in the other chapters (on eating disorders and violence)

Prof. Mark Hanson: was the lead author on Chapter 5 Healthier mothers, healthier children: a new focus on preconception of the annual report. He is Co-chair of Working Group on Science and Evidence for the Commission on Ending Childhood Obesity, reporting to the Director-General of WHO, and Chair of FIGO Working Group on adolescent pre conception and maternal obesity.

Prof. Adam Balen: No conflicts of interest other than I am Chair of the BFS.

Prof. Chris Fairburn: No conflicts of interest

Dr John Isaac: No conflicts of interest

Prof. Nick Finer: I don’t really have any conflicts of interest but I can declare that I am a member of the Clinical Reference Group that advises NHS England on specialist commissioning of obesity services, a member of the Royal College of Physicians Working Party on Obesity, and a past member of NICE Public Health Advisory Group on prevent of obesity.