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					Focus Group 5

Me       What is the biggest health problem facing everyone today?

FG54     Are you talking about a single health problem in the sense of the
         disease or ailment, or the means of it being looked at?

Me       The ailment and it doesn’t have to be one. One or two you think are
         important.

FG57     Do you mean like cancer?

Me       That could be one. Is that an answer or were you just ..?

FG57     Well I don’t know, I’m not really a medical person and I’m not sure
         what the nation’s biggest problem is on a specific disease. I guess
         cancer is one of them or various forms of cancer.

Me       Which one of them do you recognise as being a problem rather than
         just statistically? What is the…

FG57     Lung? Breast? Breast in women, is the worst one is it not. Prostrate…

FG53     I think the worst one is presumably the most common, the ones that
         are most difficult to detect and the ones that are most fatal. One that
         I can think of is ovarian cancer which is actually very difficult to
         identify early and is, has a very low recovery rate, whereas there are
         other cancers which are easier to detect and are slower growing and
         probably the recovery rate is higher.

FG55     Bowel cancer comes into it, you catch it early fine but if you don’t

FG53     Certainly from that point of view, one of the main things that needs to
         be progressed is actually early detection of these things, which means
         screening.

FG57     I absolutely agree.

FG55     I’ve got MS, had it for 12 years so I think, what we’re talking about, I
         quite agree with you, but information. I think people ought to be
         instructed what MS is and what cancer is and what this, that and the
         other is. The more information you get, the better.

FG51     I was going to say mental health, because it’s something that people
         don’t readily go and seek help for until it’s probably a bit too late and
         a lot of people get affected by mental health issues, depression or
         whatever it is that goes with mental health and sometimes just got to
         seek because don’t know where to find it.

FG57     I think there’s also, still, even in this day and age, there’s something
         of a social stigma about it, a lot of people still seem to think it’s a
         weakness if you like and so you’ve got to have the “pull yourself
         together man” approach, which is not right

FG51     And I think that often affects a lot of young people as well, I think
         there are a lot of young people who are affected by mental health
         problems that sometimes, aren’t missed, but they are quite hard to



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       accept by their parents and others and their friends.

FG52   It comes under the title of “Stress” nowadays, doesn’t it?

FG51   Yes.

FG52   Got, sort of mental problems, people, suffering from stress, which is
       quite common.

FG57   Think another area of course is heart disease, quite serious.

FG58   Alzheimer’s would be mine, because I think it’s a very difficult thing to
       deal with and, not only for the person who suffers from it, but also
       the people who are trying to cope with it on their own and manage it.

Me     We’ve got a good broad selection there.

FG55   Well with me having MS, I’ve been depressed. I’ve been - anybody
       who ?has? walking stick or sat in a wheelchair, is very demoralised, I
       was 43 when I had MS, well something like Guillain-Barré Syndrome,
       but, wouldn’t know, but Guillain-Barré, three years later, MS. Tell
       you, MS could lead in to Parkinsons, whatever, don’t know, so okay
       go away in hospital, off you go. So it’s information, I think the long
       run, is good. The more people know about it like Parkinson’s, like
       cancer. Can’t get enough of it; mental illness, teenagers, everything.

BL     Is that information or ongoing support?

FG55   Ongoing support. I’m a support worker so people have got my
       number, they ring me up “I’ve got MS, what can I do?” so I say right,
       first thing call the County Council, get their pension sorted out, this,
       that and the other. I’ve got a leaflet in here where it says, when I was
       43 you are disabled for, and you think ‘for what’, and it says for life.
       That’s fantastic, horrible. You don’t want to know about it. So the
       more information you get about it/ How do you cope with it? I’m
       trying very hard.

Me     That leads on to my next question.

FG55   I’ll shut up now.

       No, no. I want to hear more of you. That is, what should the
       Government do to improve the health of the public? Not just the
       conditions you’ve talked about there but others you may think of. So
       to improve the health of the public what can the government, should
       the government do?

FG51   I think it’s screening.

FG52   More preventative, yeah.

FG57   Regular screening.      Every five years or something, should be
       obligatory to go to a clinic, the doctor’s, a hospital - get screened
       against lots of different things. Have you done this, have you done
       that? If it’s caught early then it’s easier to deal with.




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FG58   I quite agree with you, but I think there are a lot of people who are
       given that opportunity, will not use it __

FG57   That’s why it should be obligatory.

FG58   when you’re young you don’t ever consider you’re going to get a, b,
       or c

FG57   You just have to do it.

FG53   I think it’s also fair there are substantial numbers of people who
       actually don’t want to know. When I was working I used to have a
       medical every year, but I know there were a number of people that
       wouldn’t have it because they didn’t really want to know. I think they
       probably suspected there was something adrift, or they had a history
       of heart or whatever, but they didn’t go for their screening.

FG55   I go every year to the doctor. He said to me your, I get me pills, pills
       pills pills for this that and the other, so he said right, my next thing is
       next March. I go to him, takes my blood, takes my water, takes my
       blood pressure, everything, ?no more?, it’s ok so you can go, see you
       next year. So he started to monitor me, which I’m pleased with of
       course, but if more monitoring was done.

FG57   I have osteoporosis and I go to the Northern General Metabolic Bone
       Clinic, me and 50 elderly ladies. It’s pretty unusual for someone of
       my age - I was diagnosed about five years ago - to have osteoporosis
       and it was found out purely by chance. I went in for an X-ray for a
       bad back – I injured my back falling off a bike - and it was picked up
       purely by chance. If it hadn’t have been picked up, if at 75 years of
       age I’d fallen over and broken my hip they’d have said, “You’ve had
       osteoporosis for 20 years, sorry we can’t do anything about it now. If
       we’d have known about it 20 years ago, you could have taken these
       pills”, because I’m taking the pills now and I get a scan every year.
       But fortunately it was picked up purely by chance.

FG54   You’ve talked about what can the Government do and I think there’s a
       broader decision. They’ve got to provide the resources to put these
       various systems into being and keep them in being because it’s no
       use in any way, I think, human beings asked to be given an MOT, it’s
       not in garages, for the sake of argument, and certainly I don’t think
       the present set-up of hospitals and clinics could possible cope with
       dealing with everybody, checking them up not even on an annual
       basis but even every five years, they can’t cope now dealing with
       what you might term emergencies, and certainly I don’t think they
       could cope to put in a national system into being for looking for
       trouble, but I think they ought to.

FG53   I would have though that it was actually cost-effective to find trouble
       early.

FG52   Yes, definitely.

FG57   It’s a lot easier for me to take pills and pay for my prescriptions for
       20 years than to have two broken hips repaired in 25 years’ time, so I
       absolutely agree, it’s very important.




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FG52   Surely if you catch someone early and give them preventative
       medicine, it’s better than having them going and being hospitalised
       and operations. The cost is unlimited, isn’t it, if you have to keep
       going back in for operations, so surely it’s much better to scan
       someone, or find out a problem like this gentleman here? I’ve
       actually had a bone scan and I’m borderline but I’ve not been given
       any treatment. I’ve got to go back in a year.

FG57   But at least you know.

FG52   I’ve put myself on Vitamin D and whatever. I’ve always done the
       right things, I was very surprised to find that. It’s one of those things
       that happen.

FG57   It also from Social Services point of view, immobility. You’re only in
       hospital for the minimum amount of time nowadays, and then it
       becomes Social Services’ problem and again it’s a huge cost to the
       country. And it’s not always there, cost constraints.

FG53   The main problem with screening is actually, is being selective. I think
       It would be impractical to send everyone for comprehensive screening
       on a regular basis, so there has to be a system where people are
       encouraged to put their hands up and say ‘there’s something wrong
       with me’ assuming that they have some sort of symptoms. So there
       has to be some sort of self selection in a way.

FG57   Isn’t that the danger where, as soon as the symptoms start showing it
       might be too late?

FG53   Well it might be yes, but again none of us are experts of course,
       doctors, but obviously some things don’t show and some things do.

FG52   If there’s family history, perhaps those people could be channelled
       into that.

FG53   Yeah that’s one, if you go to the doctor with something, have a
       medical, the first thing they ask you is whether your parents were
       alive and if they’re not, what did they die of and how old were they,
       so the family history is an indicator.

FG58   I think you’re very tentative about going about something if you’re
       not quite sure if it’s anything or not. I’ve always got this worry that
       I’m wasting time, especially if there’s nothing to actually show and I
       just feel that things aren’t quite right, and I think that’s quite a big
       issue, but a lot of that’s to do with how you relate to your GP,
       whether you feel you’re going to get a very sensitive response to
       something. I’m not suggesting that my doctors make you feel you’re
       wasting time, but you don’t go into a surgery which is very full of
       people and you’ve got your limited 10 minute slot, and it’s quite a
       pressure. You don’t do it unless you really feel desperate.

FG53   I think the other thing is as you get older you wonder whether the
       things that you feel are actually just part of the normal ageing
       process or whether there’s something adrift.

FG55   Can I just say, I’m on a diet now before 2 months ago, 4 months, 3
       months ago, no, 3 years ago; I had a walking stick, hobbled, was


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       bent up, I changed my diet, because I’m on a diet. Walking alright
       and I’ve not got a stick, made me feel __ got a lot of pain, and I had
       to go to the doctor and say, “look, I’m on this diet” and he says “right
       I going to check it, check it, check it”, he says “this diet, my mother
       was on, she lived, ages, quite healthy, I knew about this diet”. I said
       “well, why didn’t you tell me about it?”. Not our remit to tell people
       about diets and things, it’s for the person that’s got it have to say
       help me and he will help you.

FG52   That’s a prevention thing isn’t it. If eating the right food helps you,
       that’s a good thing then.

FG55   I know but why didn’t he tell me, why didn’t my hospital say if you
       got this food you’ll get rid of your pain, I haven’t got (rid of the) pain,
       I’m still taking tablets for it, I can tell you it’s 50% better, a lot
       happier in my mind. He said to me “you won’t get rid of it, but if it will
       make your life easy, keep on this diet”, which I’m doing.

FG57   It’s the information that we should have.

FG55   Information yes, for goodness sake they ought to give it you.

FG53   There is another area that we haven’t touched on. Obviously we have
       talked about finding things that are already there. Arguably the
       government do something to prevent certain things happening at first
       place. If you are looking at smoking for instance. If there are certain
       elements of life style which have a high chance of leading on to some
       sort of disease, then maybe the government should be, well they are
       in certain areas, should actually be legislating to try and discourage
       people from doing those things which are actually damaging to them,
       or potentially.

FG58   But the biggest area is obesity, rather than smoking.

FG52   I would imagine there is more people smoking than are overweight

FG58   One of the biggest problems though to health problems in this
       country is obesity.

FG53   It is getting worse.

FG52   Go back to friends diet isn’t it.

FG58   It is going to get worse especially among children. So we are going to
       have a sicker nation, unless government tackles something like
       obesity.

FG57   There is no secondary obesity, you are not going to a pub on Friday
       night and come out fat, because everybody eating fish and chips but
       you come out with a bad chest because people are smoking.

FG51   Also information, people is not aware, and also it’s the poor people
       who tend to eat unhealthily, there isn’t the information there for them
       about what diet’s to eat, put their children on. This came out of Jamie
       Oliver thing and I don’t like Jamie Oliver, but I think what he did was
       really good. It just highlighted that poor people, are the ones that




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       always end up with little information.

FG52   Following on from that, Jamie Oliver’s menus into school hasn’t been
       a success because children wouldn’t eat it, and they’ve wanted to go
       fetch the other because the children weren’t eating anything.

FG58   Parents tend to send their children with something they know they
       will eat so they will send a bag of crisps and a chocolate bar because
       they know then they’ve eaten that whereas if they have a school
       dinner they’ve no idea, they don’t think they’re going to eat it and
       they just think it’s a waste of £1.50 or whatever it is now.

FG51   It what they eat at home as well.

FG54   Could I just come in on perhaps the other side of the coin that we’ve
       got the “you can lead a horse to water but you can’t make it drink”
       syndrome haven’t we. You can give people as much information as
       you want but if people want to eat a lot they will, if they want to
       smoke, they will, if they want to drink themselves insensible, they
       will, unless you have a regime which says “you will not” or there will
       be some form of sanction which you take I really don’t think you’ll
       reach everybody.

FG53   I think there are two other ways of approaching it; one is to ensure
       that food that is available is healthier. The other thing is to somehow
       making certain activities socially unacceptable. I think actually
       smoking has gone that way over the last few years. In fact it’s at the
       stage now where if you go into a pub or restaurant and there’s
       someone smoking, you really do notice it. You climb in someone’s car
       and they’ve been smoking and you really notice it. In fact there was a
       thing in the paper today that said if you smoke in your car you’ll find
       it harder to sell

FG58   I think that is only true of older people though. I think there are an
       awful lot of young ladies, especially, that smoke. Fantastic numbers of
       young people smoke, and of course with young people if you suggest
       it’s not the thing to do they automatically do it don’t they, that’s what
       a teenager does isn’t it.

FG52   I think most people start smoking because of that

FG58   Exactly, yes, because your mother says “don’t do it”

Me     I’m going to jump in here, because that is quite useful, what you’ve
       been talking about. Got here a little description of a health problem
       and a possible government intervention. I’ll just hand it out you can
       have read a read through it in your own time and then when I get
       round here I’ll read it out loud. So if you just want to have a look at
       that and think about it.

       This relates to one health problem and a possible scheme to tackle it.

       Banning Smoking in public places ………

       So what do you think of this policy?




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FG53   Do it tomorrow.

FG52   Right.

FG55   They won’t do it tomorrow.

FG57   They won’t because of the taxes and the lobby from the tobacco
       companies .

FG55   Like petrol.

Me     Why should you do it?

FG57   Just read that again, that’s why you shouldn’t do it.

FG58   It’s one word that really worries me, at the end, it will reduce all
       these problems; it’s the all in there, it’s not, because again a lot of
       poorer people who are a lot of the ones who smoke that have children
       that will now go back home and smoke, more in front of their
       children. That’s what worries me, if they’ve not got somewhere to
       smoke, there’s going to be a lot more children having passive
       smoking.

FG57   I think these people smoke at home and in their cars anyway. Just
       stand on the side of the street and watch young mothers with babies
       in the car and they’re smoking away. What an earth are these people
       doing, smoking in a car and there’s a baby on the back seat of the
       car. It’s unbelievable.

FG58   Yes I know they do, but what I’m saying is there would be a lot more
       that do it. There are some responsible parents that don’t smoke in
       front of their children but go out to smoke. I smoke, I am a smoker. I
       look after children, but I would never dream of having a cigarette at
       all while I got any children near me. If I’m at somebody else’s house I
       always smoke outside.

FG57   But a lot do, that’s the problem.

FG58   Yes, but what I’m saying is there is also that proportion of a lot of
       people that’s going to go back home and smoke a lot more because
       they can’t go to the pub or bar to go and have a cigarette.

FG52   You can’t smoke in lot of bars now anyway. In Ireland, the bars are
       empty because they are all standing outside smoking instead of
       inside. The landlord complains, you know the ones that go there for
       the company, unless they stand outside with their friends who smoke,
       they’ve no company. So it’s __ really because those want to smoke
       will not stop because they’re just addicted to it and how could you
       stop an addiction?

FG53   Well it’s very difficult, my partner used to smoke, it is very very
       difficult to stop.

FG52   Yes mine did.




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FG51   Well my husband used to smoke until the doctor told him, when he
       had very bad chest infection which is one of many, that if he did not
       stop he could no longer do anything for him, he had to stop smoking,
       he couldn’t’ really help him anymore. He just walked in the bedroom
       and said “it really is up to you” and he never smoked from that day
       on. Sometimes you need a short sharp shock. You need to ?lose
       something? __ ?or have that?

FG57   A very good friend of mine was similar, had a heart attack, slightly
       overweight, smoked perhaps 40 a day, he had a heart attack and his
       doctor said stop smoking or you will die and after 40 or 50 years of
       smoking he stopped.

FG55   I know I keep banging on about my illness and everything but, I went
       on the diet, I saw it on the internet, someone told me, have a look at
       this, try this. A person from South Africa who said, if you go on this
       diet your pain will go within three days. I thought poppycock. But
       within three days my pain went, but I dared not tell them, because,
       you know. But it did go, so I’ve the diet sheet there, get a photocopy,
       it’s a diet for MS and Arthritis. I searched for this, find them. Two
       things I wanted to say as well. Thing is about doing this, you’ve got to
       have will power and perseverance. Because the things on there you
       say, can’t do it. I’ve ?given this diet out? half a can a beetroot in the
       morning, you can’t have grapefruit, no citrus fruit, no dairy foods, no
       wheat, no nothing. I live on rice, no potatoes, so you push it to one
       side, went out once, I had a French loaf, light sautéed potatoes,
       crispy French bread, garlic bread, within an hour I was creased up in
       pain. I could tell, I don’t want any more of that. So you sort it out
       yourself, like you was saying, if I don’t have this. You take pills, you
       could say “well I take too many pills”, ok but if you miss one out,
       which I’ve tried, you know about it. I rest my case.

Me     Well in the case is smoking, is this policy a good idea?

FG54   What I’m just questioning is why are we debating it, because they’ve
       been doing it in other countries for years, banning smoking in public.
       50 years ago, I went into a cinema in Holland, and after the first
       feature up came the lights and the place was empty, couldn’t
       understand why, the odd person left here and there, they were all
       stood outside in the foyer smoking. They hear the warning bell and
       they all come back in again. That was 50 years ago. Why is this
       country apparently so far behind.

FG52   We are getting there by stealth aren’t we. There are hotels now where
       you can’t smoke, and certainly in cinema’s and theatres you can’t.

FG51   I think the government gets bogged down in human right issues
       because somebody will say “well that’s my human right to smoke in a
       pub” or whatever. I think well yeah but what about the human rights
       of somebody who doesn’t smoke? We get bogged down with the
       human rights issues. Which I think are a good thing, to stop certain
       practices coming into place, value people’s rights but I think
       sometimes it’s a bit ridiculous.

FG57   Well maybe it needs a brewery to be sued for 50 millions pounds for
       the death of a barmaid, and that will open the floodgates to huge
       lawsuits and as soon as that happens there isn’t one brewery, one


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       pub chain owner that will have smoking.

FG56   But smoking and drinking go together really don’t they and yet we all,
       we’re now going to have drinking all day long in some places so I
       would’ve thought that would make people smoke more possibly.

FG52   Roy castle was a passive smoker, he’d never smoked.

FG55   If you go to hospital, to be cured for something, you go in the main
       entrance, everyone’s wearing dressing gowns, you can’t understand
       it, can you?

FG58   And yet I thought that advertisement was brilliant that they did where
       the children ?actually have to smoke? I thought it was so good I
       would have thought that anybody would take on board and think this
       is what I am doing, this is what I am creating but it obviously doesn’t
       have the effect you would hope.

BL     May be discouraging people from smoking could be attacked in a
       different way; obviously there have been campaigns against smoking
       and the sort of passive smoking thing has come through in the last
       few years really. How do you persuade people not to smoke in the
       first place?

FG57   You can’t.

FG52   Price?

BL     Well there’s price, I think if you presented to people, saying that __
       people tend to smoke more, if you actually present to them in stark
       figures how much it costs to them.

FG52   I don’t think you can.

FG57   It’s £1850 a year after tax, and only if you smoke 20 a day.

FG53   But I’ve never seen that as part of a strategy.

FG57   £1850, now I’d rather go to the Caribbean for 2 weeks in the winter,
       go skiing for a week and maybe have two weeks in Cornwall for the
       same amount. And that is after tax money. For two people in the
       house, pre-tax you are looking at £5000 a year.

FG53   It’s interesting to contrast what it costs you with what you could have
       if you didn’t smoke, say your trip to the Caribbean for example.

FG51   I don’t think that would be a factor because as __ says it needs a
       short sharp shock to stop people. I used to smoke, even when I read
       those warnings there, can harm you, whatever, it’s not that it didn’t
       bother me but I’d smoke anyway. The only reason why I stopped was
       I got pregnant and then I couldn’t stand the smell and that was it but
       other than that I’d still be smoking today. Looking at that new thing
       about causing blindness and things like that, still smoke. It’s the will
       power. If something happens, say had a cough or heart attack or
       whatever, and then I think oh my god I’ve got to stop. But without
       that…




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FG56   But do you not think that also, people who have a lot of stress in their
       lives, I mean job stress or family stress.

FG58   And money worries.

FG57   And money worries yes.

FG56   I think we’re speaking from a certain view point here but there are a
       lot of less fortunate people to whom cigarettes is there way of
       release.

FG57   It’s an expensive release.

FG58   But you don’t see it like that. When you smoke you don’t even look at
       the cost of how much a packet. I wouldn’t know how much a packet
       costs. I just go in, get a load, put the card over and that’s it, and I
       don’t even think about the price.

FG56   But you also get the duty free ones, don’t you, the ones that people
       get, bring a whole load and sell them at a discount and things like
       that.

FG52   Then you’d smoke even more.

FG58   Yes

FG56   You don’t worry about the health issue to yourself then.

FG58   Oh god no, no, because I enjoy it. I actually enjoy smoking.

FG57   That’s exactly what my friend said.

FG51   I used to enjoy it.

FG57   Enjoyed it, I’m never going to give up smoking, I’d never go out
       anywhere unless I can have a cigarette, until he had a heart attack
       and the doctor said you will die and then he stopped. Focuses the
       mind wonderfully.

FG56   That is what it needs.

FG58   It depends when you want to enjoy life.

FG57   What smelling like a bonfire?

FG58   Lot of people who known me and not realised for years that I smoked.

FG52   Luck of the draw as well, I have a business and I sell cigarettes and I
       had an old farmer come in, he was late 80s when he died, old Ben, he
       smoked __+ something horrible, the strongest cigarettes you could
       get. And he was as fit as a fiddle. And I said this to him and he said
       well he had an outdoor life, so whether that was the case or not I
       don’t know. __ The luck of the draw, you could get run over
       tomorrow, some of us.

BL     Trouble is you can always find examples of people who have lived to a
       hundred who have been smoking can’t you but equally you can find a



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       lot of people who die when they’re fifty.

Me     Flouridation of Water…..

FG53   Why don’t they put it in?

FG52   Well perhaps they should then because seeing that all the dentists
       have gone private.

FG54   I am surprised that people in Sheffield have actually got their teeth
       filled, which dentist do they go to?

FG52   Dental hospital.

FG57   Is there a dentist anymore around here?

FG52   There are brilliant dentists in Sheffield.

FG51   I go to a Sheffield dentist, Hillsborough I go.

FG57   Do you?

FG51   Is it expensive, is it an expensive process to fluoridise water?

Me     No.

FG51   Why is it not done,

FG57   because the water companies are private and it saves a little bit on
       the bottom line.

Me     No it won’t affect the water companies at all, I think they are a little
       worried about getting sued.

FG51   For what? Spots on their teeth?

Me     Yeah.

FG52   Surely that’s better than a hole in your tooth.

Me     So there has been a change to the water act a few years ago
       whereby, I think there’s got to be a local referendum that takes place
       and if the people in the area are in favour of it then the health
       authority can asks the water authority to add it to the relevant
       pumping stations.

FG51   Ask or demand?

FG54   Demand.

BL     It will be up to the health authority, the health authority will base it’s
       decision on public consultation

Me     And they are covered legally then, because they have been told to do
       it




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FG53   In this context of improved health against some white patches on
       some teeth it’s a sort of no brainer really isn’t it? But, the question is,
       does the fluoridation, will it have any other effect on people. And if it
       is demonstrable that there is no other effect then go ahead and do it…

FG57   Yeah, just do it.

FG53   …but I think a few white patches on teeth is a bit trivial really.

FG57   Not if you’re an 18 year old lass, it’s not trivial that.

FG56   Isn’t the danger that though, that some people are so ready to try
       and apportion blame for anything that anything new like fluoride in
       the water would have to be examined so closely to prove that it
       couldn’t produce anything else otherwise there would be somebody
       somewhere who’d say “I have suddenly got a bunion and it’s due to
       fluoride in the water”, I don’t know, you do see so much in hospitals
       where you see people who come in and shout at nurses

FG55   Dare not make you well because if it goes wrong we’ll sue you. We’re
       living in a nation that sue is the word to say. You go to a shop, you
       pick up a pack of biscuits, it they’re not just right in chocolate, I’ll sue
       them, send it back.

FG53   Well what that needs is for a few judges to say, don’t be so daft and
       throw the cases out.

FG55   Well there you are, you don’t know until you try, it’s like taking pills,
       you don’t know until you take it, take these pills, that pill, take this
       one out, don’t know till you try do you? So I try things like that, I’m
       sorry.

FG57   When will this referendum be?

Me     Is there one scheduled?

BL     I think the a dates been advertised, I think it’s a bit dormant at the
       moment, I’m not sure.

FG54   There is an argument with fluoridation that you are force feeding
       drugs to people, this is what people don’t like, that they will have to
       have this, whether they want it or not. Usually, it’s resistance to
       change.

FG55   No one likes change. Full stop.

FG54   The point you raised earlier on about the availability of dentists is
       very closely related to this than anything else. The furore there is in
       the paper, when just recently, in Leicestershire, the dentist has just
       said they won’t do anymore. So you have the ridiculous situation
       where people travel miles and miles to get an NHS dentist.

FG57   Happening pretty much the same in Bakewell isn’t it?

FG54   You’ve come back to what we mentioned about in another context
       about resources being available, I would venture to suggest that
       somewhere in here one of the concerns of the public about public



                                                                                12
       health matters isn’t really, apart from individuals being concerned
       about individual problems, generally people are concerned is whether
       the resources are there, if they want them. Too often than not we are
       talking about, from the basic difficulty of getting to see your GP,
       hospital waiting lists, hospitals closing wards because they haven’t
       the money to staff them this time.

FG55   When I was first diagnosed, I went to bed on Saturday night, o.k.
       fine. Woke up next morning. Couldn’t walk, talk, say anything, I
       thought I had a stroke, within ¾ hour I was in hospital, so it’s not
       saying that, I was in Sheffield, Hallamshire. So, __ scan, everything,
       by 4’o clock I’d had so many pins on my head you wouldn’t believe.
       So you can’t really say that no one looks after you, they do.

FG53   I think the problem is not so much with emergency medical services,
       it’s with electives.

FG55   You mean everyday?

FG53   Yeah, I think it’s where you have a waiting list for things that are not
       fatal.

Me     But do policies such as this one, fluoridation, are they a good idea?

       Yes (all?)

FG53   The point is in any policy, okay in this one we’ve rightly identified the
       white patches on some teeth, that is a down side for it but there are
       very few things in life which are totally good for everyone and you
       have to look, surely, for the best results for the majority.

Me     This is a simplified version of 60 years of research across the world;
       so there’s always the odd study sometimes __ possible link with x, y,
       z – I think there’s been the odd link with Osteoporosis. The odd link
       with stomach cancer. But when they have been examined in its
       entirety, these links are just found to be false, it’s sort of an
       abhorrent result.

FG53   I do wonder sometimes, read so much about links between this and
       that, I wonder whether they are statistically linked rather than. They
       will do the analysis and find what appears to be a statistical link, but
       they may not have included all the various factors. Even if they do
       find a statistical link they can’t explain why it is only a statistical link.

FG58   I think you accept anyway that if you’re given a tablet to make
       something better, it may upset something else. It’s like taking
       something that upsets your stomach isn’t it, you sort of adjust it by
       taking it at the right time or you’re given something to help with that,
       to help with the acidity or something. I think you do accept that.

FG53   But if you look at the instructions on the side of a packet of pills these
       days, most of it ?is so you can see? what the side effects are, or could
       be.

FG58   You’d never take them would you?




                                                                                 13
BL     If you have an illness, you’ll take something accepting a certain
       amount of risk. If you don’t have an illness and you’re told this might
       prevent you getting something that you may or may not get, will you
       accept as greater level of possible side effects or less level or doesn’t
       matter? __+ ?I can see is? something that cures something or
       something that might prevent something.

FG51   You would probably take it more warily, be watching out more. Think
       you’d try it.

Me     Got one more question and it’s sort of related to both of these which
       we’ve looked at; banning smoking in public places and adding fluoride
       in water. So when you look at those two schemes side by side, do you
       see anything similar in any respect? Or do you just look at them and
       think, those are just two possible policies.

FG53   In terms of, there are two things really, first thing, fluoridation there
       is no choice, apart from the initial “do you want it or not”. As far as
       the smoking is concerned you do have a choice. Fluoridation of water
       is completely involuntary, you have to drink water so therefore you
       get the fluoride. As far as the smoking is concerned there’s still a
       degree of choice about it.

FG57   Drink bottled water I suppose.

FG52   A lot of people now go over to Buxton and fill great big bottles of this
       water from the spring. Yulegrave things not on the main thing is it,
       that’s on a spring. Quite a lot of people in outlying areas have got
       spring water so they couldn’t be affected.

FG53   But for the majority the water comes out of the tap.

FG52   A lot of people have this obsession with water, they won’t drink tap
       water, buy __ everybody walking around with bottles.

FG55   I only drink bottled water, I buy water.

FG52   Good. Supposed to be pure.

FG58   I never drink bottled water, what a waste of money.

FG55   Try it.

FG58   Not if you’re in certain parts of the world.

FG55   I could say, smoking, what a waste of money. You have a choice, I
       have a choice, my choice is to drink pure water.

FG56   Severn Trent say that the water is better than bottled water, you
       don’t know how long the bottle water has been stuck on the shelf. It’s
       months and months isn’t it, whereas at least with a tap it’s coming
       straight.

FG57   Straight out of a river __ With all it’s little bugs in it.

FG56   Yeah, it probably builds up your immunity better.




                                                                             14
FG54   What you are showing though is the conflict between the individuality
       and personality, choice. Have two people, have two things, this is
       what you get large scale of course, conflict between different
       viewpoints so that you are never going to have any policy that will
       please all the people all the time. That’s probably accepted that the
       best thing the government can do is to be in the interests of most
       people, most of the time.

Me     Anyone else, looking at those two policies side by side, do you see the
       links or commonality there?

FG57   Yeah I see commonality, public good, general public good. Fluoride in
       water, it will help the vast majority. Ban smoking in public places, it
       will help the majority, even the smokers, because they will cut down.

FG58   No.

FG57   You may not personally but some do, it was introduced in California,
       can’t smoke anywhere in California, cigarette consumption dropped
       dramatically. Same in Italy, you wouldn’t think that in Italy, but
       they’ve banned smoking in public places in Italy, you can’t smoke in a
       bar or restaurant in Italy and cigarette sales have dropped
       dramatically.

FG58   But you smoke somewhere else, I just been away to my sisters. I
       hardly smoke there, 2 or 3 a day. As soon as I got back on Monday
       afternoon, my goodness I’d smoked about 15 in three hours. You just
       do it somewhere else.

FG51   You were saying people would just go home and smoke a lot more
       there, maybe they do that anyway. So whether they get banned from
       smoking in public places, they will smoke at home anyway, it is lot
       easier to sit in your lounge and just pick up cigarette and smoke, and
       then if you’ve got children around you…

FG58   Yeah but what I was saying was that those good people that don’t
       smoke in front of the children, that will go out and smoke, then that
       will send them back to smoke more in front of the children.

FG57   But generally cigarette sales do come down when they ban smoking,
       proven from all over the world.

FG58   I feel from the other point of view that both those policies are a bit
       very much Big Brother, somebody telling you, you’ve got to do it.

FG57   If somebody knows something that is going to help you, shouldn’t
       they tell you about it, shouldn’t they…

FG58   Coming back to what you were saying before about your rights.

FG57   Is this like seatbelts in cars, some people didn’t like it when they
       came in, now everybody wears a seatbelt, feel naked without a
       seatbelt. Airbags, are you going to say, well I don’t want these
       airbags going off I want to go and buy a car with no airbags.

FG56   You can’t.




                                                                           15
FG57   Well first of all you can’t, unless it’s cheaper. It’s all public good, at
       the end of the day it’s saving lives.

FG53   It’s drinking and driving as well, that didn’t become socially
       acceptable…

FG57   When I was a lad, when I first started driving at 17. Go out and watch
       the Beatles up in Buxton Pavilion Gardens on a Saturday evening,
       ?drive? and have a few beers up at the Duke of York up in Burbage,
       never think about drinking and driving. But now, drink and driving is
       completely socially unacceptable, so attitudes change.

Me     Final question then, just to round it up. If you got to vote on these
       going ahead, and I’m not going to ask you to vote, yes or no, don’t
       want to know, not bothered. If you were asked to vote, and you just
       got to put your card in the box, what would be the two main factors
       that would help you to make up your mind when voting for these.
       What would be the two issues? I going to ask you one by one.

FG57   For me, it would be a general issue and personal issue. The general
       issue, both have the long term benefit to public, without any doubt.
       (Fluoridation) will improve your teeth and smoking, we all know what
       smoking is about. Personally, I hate going into places where there are
       smokers and I don’t have any choice. Like going into a pub, meeting
       somebody in a pub, you come out stinking of smoke. You can smell it
       on your own breath in the morning. I’m amazed we don’t put fluoride
       in the water already, I thought there was, so I would be very happy
       to have fluoride in the water from a personal point of view. So from a
       general point of view I think it should go ahead and from a personal,
       selfish, point of view, I would vote for both of them.

FG51   First one would be the children, for me, in that they don’t have a
       choice and also they are the future. So in this case, banning smoking,
       that would really be worth it. Children that are growing around
       smoke, they get chances of being ill constantly and also children
       having teeth, because after the milk teeth fall out the teeth that you
       get you die with, so they need looking after. The second thing would
       be the financial cost of it in the future, in terms of treating future
       generations of passive smokers, and treating teeth and gums
       diseases. So children and money, adults can make their own choices.

FG56   Smoking with me is personal really because when I taught, small
       children, the number of children by the time I was leaving who now
       seem to be suffering with asthma and chest infections, I’m not sure
       they were all related to smoking, was quite frightening. Also my
       husband has asthma, so anything which relives anything like that has
       to be good in my eyes. Fluoridation is a memory, again when I was
       teaching, and the school dentist used to come around, I taught in
       north east Derbyshire, and the number of children that had to dental
       treatment because their was a problem with the water there and sort
       of horror on the parents face when they had to take them to the
       dentists so that would be an excellent help to parents and children
       alike. Both small memories.

FG53   I think the overriding thing is that there is a public benefit
       demonstrable, a public benefit for both of them. Neither would affect
       me because I don’t smoke directly myself and my teeth are gone


                                                                              16
       already. But I agree I don’t like going into a room where people are
       smoking, it seems to have got even more obnoxious over the years
       simply because probably there are fewer places where people do
       smoke and therefore you notice it more when they do, those are the
       two key things.

FG58   Obviously, I’d vote against both of them. One: because of freedom of
       choice and two: because the money could be spent on better
       preventative methods.

FG55   I would vote for fluoridating the water. That seems to be a very good
       thing. The smoking, we all pay taxes, I think we’d pay even more
       taxes if they didn’t get taxes from smoke, so we are going to lose. No
       matter what happens.

Me     So you don’t know?

FG55   I don’t know, I’m a don’t knower.

FG     That’s fine, that’s a legitimate answer.

FG54   I don’t smoke; I did once, merely to find out whether I liked it or not,
       when I was young, it had no effect on me whatsoever so I didn’t
       bother pursuing it. It wasn’t any cost of money because at that time it
       was a shilling a packet of twenty. It didn’t really bother me. But as I
       stand at the moment, I don’t smoke so it wouldn’t’ effect me. I think
       what our friend over there said about an enhanced awareness of the
       effects of smoking is true as you get older. If I can remember living,
       breathing and waking up in a RAF dormitory full of men, most of
       whom smoked. It did not bother me at all. I really can’t remember
       any concern, I’ve been trying to do so. Probably now, I’m older,
       wiser, then yes, it does register and I do know more about it, so that
       one (smoking) I’d go along with. Fluoridation, I would like to know
       more about that because the implication on the limited information
       that’s there is putting the chemicals in will solve the problems but
       decaying teeth is not just caused by what’s in the water. People
       crunching boiled sweets, eating too much sugar, that sort of thing. So
       that one (fluoridation) I’d defer my decision.

Me     You’re entitled to do that, no problem.

FG52   On the water, I think perhaps, a yes, anything that prevents
       deterioration of teeth has to be good. Smoking issue, I think not all
       public places, obviously pubs, but definitely where people are eating,
       and definitely hotels. I have been to quite a few in London, at least 3
       or 4 times the fire bells have gone off at night, everybody has to be
       grabbed about and go. It will be usually been down to somebody
       smoking in a room which it isn’t funny when you wake up in a hotel
       and have to go out with your coat on and your night clothes on. So I
       don’t think perhaps a total ban but certainly more restrictions on,
       banning of smoking, but not a total ban.

Me     O.k. That’s brilliant, Thank you very much.

Key




                                                                            17
?word? Uncertain about word

___          Word inaudible

___+         Several words inaudible

(comment)    Comment from notes for clarification




                                                    18

				
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