Labour’s public health policies

Shadow Cabinet Sub-Group – Society (March) Public Health

This document was published by the Daily Mail, but it appears to be genuine.

This paper looks at four big drivers of population health that are the focus of much public health, policy, and which must be priorities for the next Labour Government:

  1. Physical activity
  2. Food consumption
  3. Alcohol consumption
  4. Tobacco consumption

For each, it sets out a proposal for an ambition for the next Labour government, along with a range of possible policy commitments to improve public health in these areas.

In choosing to focus on these four issues, the paper does not attempt to cover other important topics in public health policy, which are nevertheless being addressed in our wider policy review work, including a range of services that are considered part of public health policy, such as sexual health services, cancer screening or drug treatment programmes; other drivers of population health such as air quality or water quality: immunisation; the broader context of social and economic policy, which is an important underlying determinant of public health; and mental health, where there are strong links with a range of public health issues. Public mental health is being addressed by the Taskforce on Mental Health in Society (see Box 2).

The problem

The environment in which we live, and the way we live our lives, has a profound impact on our health. Many health problems have environmental and behavioural causes, with levels of physical activity, and the consumption of food, alcohol and tobacco among the key ones. So improving our health as a nation will require action on these issues.

Better public health policies are needed if the NHS is to survive

This is not only important for improving health. Left unchecked poor public health will impose substantial costs on the health service and the wider economy. NHS England estimates that the NHS faces a £30bn funding gap by 2020 (against a flat real baseline), and even optimistic estimates of savings from possible productivity improvements within the NHS fall well short of filling this gap

So improving public health will be an essential part of ensuring the NHS remains sustainable for the next generation. Demand will rise faster if people do not do what they can to prevent avoidable illnesses themselves, and the long-term capacity of the NHS to treat everyone who needs it will be at risk without a focus on prevention as well as cure.

In particular, pressures on the NHS are not only generated by a growing and ageing population, but also by a rise in the prevalence of conditions and chronic diseases related to the way we live our lives. For example, the substantial recent growth in the level of those who are overweight or obese has begun to translate itself into the increases in the levels of diabetes – with the total number of adults with diabetes in England projected to rise from 3.1 million in 2012 to 4.2 million by 2030. Unless firm action is taken to halt the rise in diabetes, the proportion of the NHS budget spent on treating the condition and its complications Is likely to rise from approximately 10% now to 17% by 2035/36 – which is totally unsustainable. And when the indirect costs of diabetes are added in, such as inability to work and the costs of caring, the total cost to the UK is set to rise from £23.7 bn in 2010/11 to £39.8 bn in 2035/36.

Better public health policies are needed to empower people and protect children

People make choices every day that affect their health but they are not always able to make those choices under circumstances of their own choosing and making healthy choices can be especially difficult if people are not supported in doing this.

And this is especially true for parents and children. Nothing is more important to parents than their child’s health, yet this can be made all the harder by commercial pressures and advertising. Too often the system seems stacked against parents who want to ensure their child eats healthy, nutritious food.

Better public health policies are needed to tackle health inequalities

As well as improving overall population health, public health is especially important for tackling health inequalities. There continues to be a substantial and persistent gap between the health outcomes for different social groups – for example, the large geographical and social gradient in life expectancy at birth ranges for men from 74.0 years in Blackpool to 82.9 in East Dorset, and for women from 79.5 years in Manchester to 86.6 in Purbeck.

One Nation frame

Helping people improve their health and that of their family is central to Labour’s mission. We want government to be on people’s side, supporting them in making healthy choices and improving their health.

Children’s health is an area where a robust role for government is sometimes required, given that children do not necessarily have the same capacity or freedom to make choices as adults. In particular, children’s health is an arena where there should be limits to markets – and where government has a crucial role to play in supporting parents who are trying to do the right thing.

And government must take a proactive approach to tackling health inequalities such as differences in life expectancy or Infant mortality. We cannot be One Nation when health inequalities are so wide.

The Tories

The Tories cannot provide the answers on public health. Too often they are unwilling to stand up to vested interests or are ideologically opposed to Intervening In markets. Their capitulation to Big Tobacco over standardised cigarette packaging, not long after employing tobacco. More generally, there has been real reluctance on behalf of the Coalition Government to develop strategies and plans to improve the health of the population. Their decision to rely solely on industry self-regulation and voluntary initiatives (the ‘Responsibility Deal’) is widely seen to have been ineffective and can penalise companies who want to do the right thing. This process has largely lost credibility as professional bodies have withdrawn from it due to the domination of the agenda by commercial interests.

The Tories are also in denial about the health impacts of their wider social and economic policies, from unemployment and job insecurity to indebtedness and reduced financial support for families- And there is little leadership across Whitehall on public health: the way in which Michael Gove has downgraded the children’s health agenda within the Department for Education has been particularly damaging, with the abandonment of successful initiatives such as the Every Child Matters agenda and the Healthy Schools Programme.

Tackling health inequalities: Lessons from the Marmot Review

In 2008, Labour commissioned the Marmot Review of Health Inequalities, Fair society, Healthy lives, which identified six key policy objectives for tackling health inequalities:

  • Give every child the best start in life
  • Enable all children, young people and adults to maximise their capabilities and have control over their lives
  • Create fair employment and good work for all
  • Ensure a healthy standard of living for all
  • Create and develop healthy and sustainable places and communities
  • Strengthen the role and impact of ill health prevention

There were also two key lessons in the Review for public health policy that we strongly endorse:

The first is the principle of ‘health in all policies’ – putting health concerns at the centres of our programme for government. Good health is not created by the Department of Health, nor by the actions of the NHS; it is the product of many separate policies and activities in not just government departments but in communities, schools, workplaces and homes across the country. Successful policy must build a systematic approach that mobilises all of the relevant government departments, local authorities and community and voluntary groups to contribute to a broadly based approach to improving the health of the population.

The second is the principles of ‘proportionate universalism’. Our key goal is to reduce health inequalities but focusing solely on the most disadvantaged will not make a big enough difference. We need to take universal action on what are the major problems affecting our health, but with a focus and intensity that is proportionate to the level of disadvantage In different communities and groups

National ambitions and policy options

In order to improve the health of the population measurably in the course of one parliament Labour needs to develop a dynamic public health programme that can be swiftly implemented.

This paper concentrates on four major public health priorities that would form a central part of that programme. In each case we think action should be guided by a new ‘national ambition’, backed by some eye-catching policy proposals. Those ambitions would be the focus of a partnership approach between government, communities and individuals themselves.

On proposals, as public health policy is concerned with environmental and behavioural factors, rather than simply health services, possible actions here relate to a variety of different policy areas. At this stage they are presented as options for discussion.

1.   Physical activity

Physical activity is the thread that runs across a range of public health policy and outcomes. Lack of physical activity and sedentary lifestyles are associated with a wide range of physical and mental health conditions: daily physical activity is associated with an approximately 30% lower risk of colon cancer, an approximately 20% lower risk of breast cancer, and a 20-30% lower risk of both depression and dementia. And physical activity can also be a catalyst for other lifestyle choices and changes, such as alcohol and food consumption.

Labour had a strong record In promoting physical activity – and particularly promoting Sport for children and young people In 2002, Just 25% of children undertook two hours of PE and sport in school, but by the end of our term in government this had been raised to 93%. We also created 422 School Sports Partnerships and 2,300 School Sport Co­ordinators covering every school. The Tory-led Government ripped up this legacy, scrapping School Sports Partnerships and squandering the opportunity to build on the Olympic legacy. They also axed Labour’s school sport targets and as a result more than half of children now fail to get at least two hours of physical education every week.

Proposed ambition:

*   An ambition to get half of the population physically active by 2025, working with schools, business and community organisations. (We are currently looking at the best definition of physically active for this purpose).)

Policy options for discussion:

i.     Capitalising on the primary childcare guarantee and other extended schools initiatives, more opportunities should be created for children to participate in sport and be physically active at school. This should include a goal that all school pupils are taught how to swim and how to ride a bike safely

ii.   Reinstate the goal of all children doing a minimum of two hours PE a week, and introduce tougher protections for school playing fields

iii. A special lottery fund should be established to finance the construction of small-scale community sports facilities such as skateboard parks, BMX tracks, netball and basketball courts

iv. We should give focal authorities an expanded remit lo support physical exercise in communities. As part of this, we should look at how we can better ensure that local communities have the opportunity to use sporting facilities in stale and private schools outside school hours and terms.

2. Food and Obesity

In England, 62% of adults and 28% of children aged between 2 and 15 are overweight or obese. The health consequences of obesity alone are estimated to cost the NHS more than £5 billion every year and cases of malnutrition are on the rise.

Labour in Government introduced new school food standards, the Healthy Schools Programme, and extended the provision of free fruit and vegetables to school children. By contrast, the Tory-led Government has removed the obligation for academies and free schools to abide by nutritional standards and abolished the Healthy Schools programme.

Proposed ambition:

  • An ambition to reverse the growth in cases of malnutrition and to improve the health of children, including reducing childhood obesity.

Policy options for discussion:

  1. We should introduce regulations to limit the levels of fat, salt and sugar in products marketed substantially to children
  2. Food marketing to children via television should also be curbed by a 9pm watershed for the marketing of products high in fat, salt or sugar, along with a review of controls on internet content aimed at children
  3. A standardised system of traffic lighting of packaged food in respect of its nutritional content should be introduced and backed by regulation.
  4. Supermarkets and shops above a certain size should not be permitted to stock confectionery and other unhealthy foods adjacent to check out tills

3. Tobacco

Tobacco is the largest cause of preventable illness and death. There are about 10 million adults who smoke cigarettes in Britain, around 20% of the population. Every year smoking causes around 100,000 deaths and it is also a major driver of health inequalities – smoking rates are markedly higher among low-income groups (33% amongst people in routine and manual occupations).

ONS surveys show that two-thirds of smokers want to quit. Helping someone quit is not only good for their health, but their finances too: if they smoke 20 cigarettes a day, then helping them quit puts over £2,000 back in their pockets each year.

The proportion of adult smokers fell from 28% to 20% between 1998 and 2010, due to a series of national initiatives including the ban on smoking in enclosed public places and the raising of the legal age for buying tobacco from 16 to 18. Other significant steps forward were tough legislation on vending machines and tobacco advertising at point of sale, while we also expanded NHS Stop Smoking Services, supporting hundreds of thousands of smokers to quit.

Proposed ambition;

  • By supporting people to quit smoking and helping young people avoid starting, an ambition to reduce smoking prevalence to 10% by 2025. Over the longer-term we should have as a goal that children born in 2015 will become the first smoke-free generation for hundreds of years

Policy options for discussion:

  1. If not already in place, standardised packaging of tobacco products and a ban on smoking in cars with children will be introduced immediately
  2. A push to encourage tobacco education programmes, including peer-based programmes, in secondary schools
  3. There should be a new Initiative by HMRC, in conjunction with police forces and regional offices for tobacco control, to stem the trade in Illegal tobacco
  4. The Labour Party should commit to becoming the country’s first ‘tobacco-free’ political party, rejecting sponsorship or donations from the tobacco industry or their front organisations.

4. Alcohol

After tobacco, alcohol is regarded as the next most important avoidable risk lo population health. Excessive drinking is associated with a wide range of chronic disease including liver disease, cardiovascular disease and cancer, as well as with crime and disorder. It Is estimated that up to 35% of all A&E attendances and ambulance costs may be alcohol-related, and that up to 70% of A&E attendances at peak times on the weekends (between midnight and 5am) may be alcohol-related.

The Tory-led Government initially committed to introduction of minimum unit pricing, and then reversed their position. On the other hand, the Government has committed itself to reduce total population alcohol consumption by one billion units per annum.

Proposed ambition:

  • An ambition will be set to reduce the overall population consumption of alcohol in addition to reducing the proportion of the population who consume above the recommended level

Policy options for discussion:

i.   A pricing mechanism, such as minimum unit pricing or an alternative, should be developed both to reduce the availability of high-alcohol, low-price ‘booze’ which is used for pre-loading, but also to halt the shift in alcohol sales from pubs to major supermarkets

ii.   The promotion of alcohol through the sponsorship of sport should be phased out during the course of the Parliament

iii. The positioning of alcohol retail space in supermarkets should be regulated – for example, being limited to a single defined area on each premise / physically distant from the front doors

iv. A review of licensing should be undertaken to promote a new power to raise a charge to cover the cost of additional staffing required to maintain public order and safety where needed: strengthen powers to refuse or withdraw licences to sell alcohol on public health grounds and enhance the voice of local communities in licensing decisions

Mental Health

BOX 2 – Taskforce on Mental Health In Society

Good mental health doesn’t start in hospital or the treatment room; it starts in our workplaces, our schools and our communities. So we need a mental health strategy outside as well as inside the National Health Service.

For that reason, the Taskforce on Mental Health in Society, led by Stephen O’Brien was set up to explore how society needs to change to prevent mental health problems and promote good mental health, and how we can better support those affected by or recovering from mental health problems in society.

The Taskforce is therefore looking at mental health in some of the major contexts in which we live our lives: home, community, school and workplace.

Three findings have consistently emerged from the work they have done in these areas:

  1. Population mental health: A wide variety of social factors can affect mental health, so interventions to address these and build resilience to them can promote good mental health and help to prevent mental health problems
  2. Early Intervention and action. Early help and support to tackle problems upstream is far better both for the individuals and families affected and for the country as a whole than allowing problems to develop
  3. Supporting those living with mental health problems: There already exist inspiring examples of how people living with mental health problems can be supported to live full and flourishing lives, but we need a radical shift in attitudes, policy and practice if we are to make this a reality for all

The Taskforce is looking at how these principles apply in homes, communities, schools and workplaces, both at the current problems that exist and the opportunities to be grasped if we act. They will report in Spring 2014.