Interview

Making a sure start in the job

Can the government take action on health inequality? Labour’s second minister for public health speaks to healthmatters

Public health seem to be perpetually overshadowed by the spectre of waiting lists. How do we make it more prominent — how do we put health inequalities at the centre of things?

I think there have been a couple of problems. One is that for a long time people didn’t talk about health inequalities or public health or about the links between ill health and social inequalities. Between the Black report and Acheson report there was a void, and at a national level the government talked about health variations rather than health inequalities. I think since the election we have very clearly put health inequality and the link with poverty and poor housing and all the other social causes of ill health back on the public agenda. This is in context of 20 years of it not being discussed.

The second is that traditionally the NHS has not seen prevention and promoting health as a priority. What we need to do is two things, one is to continue to ensure that public health and health inequalities are put back on the top of the agenda–but from a broad multi-disciplinary point of view. The second is also to make sure that the NHS means both working with other partners in the community, and also at the individual level as well, which might mean smoking cessation services provided through primary care but also midwives and people working in secondary care.

Unlike environmental issues, public health problems are all broken up. We have campaigns about hearts and diseases but seeing things in disease terms obscures underlying connections. How can we move to a bigger picture of health?

In fact, I think people do see the connections in their own lives. Perhaps the best example is Sure Start. These schemes, focused on families with children under four, have got clear responsibilities to improve health but also to improve child development and to improve educational support through child care and improve the development of children across the board, very much focused on what the parents themselves think. Secondly, they are involved in really close partnership working and are very much rooted in the local community.

I see Sure Start as about, in the long run, tackling child poverty–because although we say it’s either health related or it’s educational related and so on, in the long run Sure Start is about preventing this generation of children being in poverty in 20 years time, giving them the best start in life so they are not themselves in poverty in 20 years time. And that’s about income but it’s also employment, health and education as well.

UNICEF says the UK is positioned low in international rankings for child poverty.

We clearly have a very serious problem in terms of child poverty. At the time of the election there were four million children in poverty and that has gone up really very dramatically in the last 20 years. By the end of this parliament we will have taken one million children out of poverty and we predict over the next 20 years to have abolished child poverty altogether. So we clearly have a long way to go and I think Sure Start is about action to tackle that.

Can we stay with inequality for a moment? You have been discussing this in the Modernisation Action Teams. How prominent is this issue in the national plan?

One of the six teams working on the detail of the national plan is on prevention and inequality and Alan Milburn is extremely keen that we pick up the issue of inequality across all of the work–not simply when we talk about prevention but also to look at inequality when it comes to access to treament as well, and that the NHS doesn’t just look at the people who come through the door for treatment but also the people who never make it through.

How far will the recommendations of the Acheson Report be taken on board?

Well, I think we have already taken forward a lot of the Acheson issues. Child poverty is a clear example of one of the things that the Acheson report flagged up as one of the key recommendations. I think in terms of specifically upstream causes, and I think that will be picked up by the NHS working in partnership with other organisations, also building on the work on the downstream causes as well. We’ve obviously done a lot of work on smoking but also picking up some of the additional issues around diet.

I was talking to a primary care group who complained of the collision between things coming down from the top–national service frameworks and so on–and what they’re trying to do in their own work. What advice would you give them?

It is how to find a framework which encourages local innovation at the same time as having national standards which tackle the ‘postcode lottery’. What you want to do is ensure that people at the local level–whether it’s people in the local community, whether it’s in the local authorities, whether it’s in primary care groups–are empowered to deliver changes and improvements, but at the same time to have national standards, so that people don’t feel there are any postcode lotteries, but equally that you have national networks to spread best practice and to spread good ideas as well.

What about health improvement plans (HimPs)? They haven’t really set the world on fire. They are tangential to local authorities and are very much a delivery mechanism for the health service.

I think a lot of local authorities are doing some excellent work in promoting public health working closely with health authorities, but are often just working their own areas. There are examples particularly of Health Action Zones. I know there are some where they are ensuring that, for example, people in families where someone has asthma, are prioritised for housing improvements and some of the Sure Start areas are linking housing with families who are in most need.

I think that HimPs have huge potential. We’ve already made a lot of progress through partnership working and obviously we have a long way to go – and there will be teething troubles inevitably, just as there are at the national level.