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National health strategy launches to mixed reviews

Health campaigners have expressed disappointment at the government’s failure to include national targets for reducing inequalities in health in its long-awaited white paper on public health, Saving Lives: Our Healthier Nation.

Concern has also been expressed at the public health strategy’s continuing ‘NHS-centric approach’, and the playing down of the role local authorities could play in improving public health.

Saving Lives confirms the findings of the Acheson inquiry – that the widening wealth gap has led to inequalities in health that have resulted in disadvantaged people suffering most from poor health. (See healthmatters issue 35; pages 2, 6, 7.)

The white paper says this is being addressed by ‘national initiatives on education, welfare to work, housing, neighbourhoods, transport and the environment’, but then goes on to place responsibility for finding solutions at a local level.

‘Communities can tackle poor health, which springs too, from a range of wider, community factors – including poverty, low wages, unemployment, poor education, sub-standard housing, crime and disorder, and a polluted environment,’ it suggests.

Geof Rayner, chair of the UK Public Health Alliance (UKPHA), said the government had been wrong in rejecting health campaigners’ calls for national targets on health inequalities, claiming it was not feasible ‘on technical grounds’.

The World Health Organisation’s Health 21 strategy has explicit targets for reducing health inequalities between nations, Rayner explained. ‘If it is feasible for the WHO to have national targets, then surely it is not beyond the wit of our government to have targets for England.’

The NHS Confederation, which represents health authorities and trusts, expressed concern that while the NHS continues to be under intensive pressure to cut waiting lists and improve clinical services, efforts to improve overall public health will continue to be neglected.

UKPHA joint chief executive Donald Reid added that while health authorities had been given the lead role in setting public health process and outcome targets at a local level, they were not being made accountable for failure.

He said: ‘Promoting the public’s health is the NHS’s most important task, but will health authority chief executives be told to give priority to public health over waiting lists?

‘What will happen if local public health targets are not met. Will HA chief executives’ performance pay suffer? HA chief executives have to be held to account.’

But the white paper’s setting of bold targets for reducing deaths in England from cancer, heart disease and stroke, accidents and suicide has been widely welcomed. Deaths from cancer, accidents and suicides are to be reduced by 20% by the year 2010, and deaths from heart disease and stroke are to be cut by 40%.

The decision to replace the Health Education Authority (HEA) with a new research based body, the Health Development Agency (HDA), has also been seen as a bold step. For many health campaigners the HEA has been unable to fully shake of the health promotion culture of The Health of the Nation, the health strategy pioneered by the previous Conservative government, which placed responsibility for ill-health firmly at the feet of the individual.

The creation of the HDA on January 1 next year will result in the new agency being charged with ‘maintaining an up-to-date map of the evidence base for public health and health improvement… commissioning such research and evaluation as necessary’.

HEA chair Yve Buckland (who will chair the HDA) said the new organisation would be ‘working at the cutting edge of developments’. But this would only be relevant if its efforts were ‘capable of practical application by those working on the frontline to improve health’.

Other key points in the Saving Lives strategy include the establishment of new consultant posts of public health specialist, and the training of children in health skills (including resuscitation techniques) from the age of 11. Funding of £2m is to be provided to place 400 defibrillators in public places, and train adults how to use them to save heart attack victims.