Risk assessment

Why did I get into the field of health education? Lots of reasons, surely, but here is one.

At the start of my teaching career, I lodged with a couple in Andover. I was struck mostly by the opportunity to research the enormous houshold population of spiders, but I was also intrigued by several discussions we had about risks to health. One of the couple, as I recall, had already lost both parents to cancer, and he was very anxious about eating anything containing any sort of additives. I arrived home one day to find a row had broken out over a packet of frozen fish, because the label reported that it contained caseinates (milk protein), and it wasn't going to be touched until we were absolutely certain what caseinates were.

Now, having some caution about what's in your food seems absolutely rational, even if you didn't have a very personal, emotional reason for being wary. However, I used to have these discussions about the evils of additives while watching this chap drink a decent-sized Scotch whisky accompanied by a cigar.

What I needed then, and didn't have, was a clear statement about what are the major causes of death, and what are the known factors putting you at risk of those different fates. I'm not sure we know how much cancer is caused by food additives, but my guess was the alcohol and tobacco were contributing a lot more to his risk of cancer than anything in his food.  

What I needed, in fact, might have looked a lot like this:
This is a picture from the NHS Atlas of Risk at http://www.nhs.uk/Tools/Pages/NHSAtlasofrisk.aspx. You can see what are the most important causes of death, refine it for sex and region and age, and see what we know about risk factors - the causes of the causes, as it were. I don't think we're always very good at making judgements about probability and risk, even when they aren't very emotionally charged, but at least we have some evidence to go on, and that's quite a nice presentation of it.

I do like the charts and the ability to play with them, but I would like to have seen a bit about the errors in those estimates. Also, what would be the size of a big grey circle that could be labelled 'unknown'?



Comments about SHEU

"We are planning next year's programmes around this information." Health Education Adviser

Health Education Adviser

"You and the team have the evidence to show how young people's behaviour has or hasn't changed over time." 
Tribute from a Health Education Co-ordinator to John Balding, presented at his retirement lunch, May 2005

Health Education Co-ordinator

"As a Deputy Head in a large secondary school I was involved in taking part in a city wide health and wellbeing survey over a period of six years. Completing the survey every two years grew in importance year on year, with the final cycle having a major impact on our SDP, PHSE curriculum, Ofsted outcomes and governor understanding.
Over the six year period we moved from a small sample in two tutor groups filling in a paper survey to two year groups completing an online survey. The reports produced give graphical analysis of a wide range of issues. As a result of the survey we increased the number of PSHE workshop days for students to address issues such as smoking, drug and alcohol awareness, anti-bullying workshops. The surveys helped Governors make a positive informed decision to allow Brook Advisory Clinic nurses on site to support students.
As a result of taking part and using the evidence provided we were able to offer more support for students which had a direct impact on improved attendance and outcomes."

Deputy Head Secondary School

"We use the data to inform whole school practice: Pastoral programmes for target groups of pupils; Items for discussion with School Council; Information to help us achieve the Healthy School gold standard; To develop and dicuss with pupils our Anti-Bullying Policy; Targeted whole class sessions with the Police Community Support Officers; To share pupil perceptions of all aspects of their school life with parents, staff and governers." 

Learning Mentor

"I would like to take this opportunity to thank you for your work regarding writing and compiling the sex education survey. The survey was well executed and the schools have found their individual reports very helpful. The results of the survey have enabled the Local Campaign Group to justify the need for young men's campaigns and given us invaluable insight as to the thoughts and experiences of this target group."

Teenage Pregnancy Strategy Manager

"On behalf of all the health promoters in Scotland I would like to say a big thank to you and your colleagues for your excellent work over the years. This includes not only your survey work but your role as a visiting examiner in Scotland and adviser on course development."
Tribute from a Health Commissioner to John Balding, presented at his retirement lunch, May 2005

Health Commissioner

"The service you provide is of national significance." Health Development Agency

Health Development Agency

"The Unit produces an invaluable body of knowledge... providing exceptional information across time and throughout the country." Kelloggs


"I have never looked at myself in this way before." Pupil


“(The SHEU survey) was very, very useful. It gave us reassurance we weren’t missing a trick. For example not many pupils in the sample year groups were taking illegal drugs, which re-enforced our opinions. But the survey also raised issues and flagged some things up. We discovered that some of our girls weren’t eating enough – the percentage of girls in our school not eating lunch the day before the survey was higher than the county average. There were other concerns too, specifically around cigarettes, alcohol and attendance.
The school used this data and took a number of actions to address it. More female peer mentors were put in place and the school asked NEXUS (the Extended Schools service) for help, so they developed a programme for girls which addressed their eating patterns, healthy eating, sex education and self-esteem issues.
We ran an anti-bullying group for Year 9 as a preventative measure, based upon data provided by our current Year 10 students.
The travel data revealed that a high number of pupils took the car to school so we involved the BIKE-IT scheme who ran assemblies, brought in their bikes (including one with a pedal-powered smoothie maker!), and raised awareness of health and green issues.
The information about how happy the students were with their lives raised some concerns as far fewer girls were as happy as the boys, so work was done around developing aspirations, role-models and self-esteem."        

Deputy Head, Secondary School