Government White Paper on Public Health
1. The Socialist Health Association promotes health and well-being, social justice and the eradication of inequalities through the application of socialist principles to society and government. It is a voluntary group that is affiliated to the Labour Party and seeks to influence the Party’s policies to reflect socialist principles.
2. The Association welcomes the opportunity to give evidence to the Health Select Committee on the Government’s public health White Paper – Choosing Health: making healthy choices easier on:
2.1.1. Whether the proposals will enable the Government to achieve its public health goals;
2.1.2. Whether the proposals are appropriate, will be effective and whether they represent value for money;
2.1.3. Whether the necessary public health infrastructure and mechanisms exist to ensure that proposals will be implemented and goals achieved.
3. By and large the Association welcomes the government’s proposals. However, it notes that the White Paper focuses predominantly on one domain of public health – people’s individual lifestyles. It does not address the important underlying determinants of health – such as income, educational attainment, housing and social networks. It is also weak on the prevention and health protection domains that add so much to the public’s health through effective immunisation and population screening.
4. The SHA wishes to draw attention in particular to the following concerns:
4.1. It is not appropriate to treat health as a consumer good. The more privileged in society have easier and greater access to consumer goods. If health is to be a consumer good, then it is likely the health inequalities will widen, and the overall health of the population will decrease. The rich and healthy are known to adopt healthy lifestyles more quickly than more disadvantaged groups. For example, smoking prevalence is now 10-15% in social classes 1 and 2 and 40% in social class 5. And the gap in life expectancy between rich and poor is increasing.
4.2. Putting the Department of Health in charge of achieving the government’s public health goals is not advisable. Instead, the SHA stresses the need for a cross-government Cabinet Minister for Public Health with the authority to engage with all departments of government. The Department of Health has the responsibility to improve health care. Improving health is the responsibility of all arms of government and the leadership must be in place to ensure that they all play their part.
4.3. The role of local authorities must be greatly strengthened. Indeed we believe they should have the lead responsibility to tackle health inequalities, so the proposal to use the national PSA targets and local area agreements more rigorously is welcome. The SHA also strongly supports the appointment of Joint Directors of Public Health working to both PCTs and local authorities. This would “join up” scarce public health capacity and provide leadership for the Local Strategic Partnerships that should be in the forefront of the attack on health inequalities.
4.4. It is welcome that the NHS is to become an exemplar employer, but this duty should be extended to all statutory bodies and they should all work to achieve clear national standards.
4.5. The ban on smoking in all enclosed public places should be unconditional. The current proposals will impact adversely on those least able to choose health – employees and customers in bars and pubs located in disadvantaged areas of the country. There is no difference in the health risks from breathing environmental tobacco smoke whether the person is eating or drinking.
4.6. It is unlikely that voluntary agreements with the food and drinks industries will succeed. The damaging consequences of high consumption of coloured fizzy drinks and processed foods, such as obesity and diabetes, are well known; as are the adverse consequences of alcohol abuse that include violence, crime, drink driving and social disorder. The food and drinks industries have already had sufficient time in which to improve their products and amend their marketing strategies but have failed to do so. There is thus no alternative, in our view, to much stronger regulation in the fields of both alcohol and processed food. Restricted advertising, clearer labelling and with alcohol a sustained programme to try to combat the epidemic of binge drinking, must be on the agenda.
4.7. Children need more protections and support than are outlined in the white paper; for example, the proposal to roll out the Healthy Schools initiative to all schools should be brought forward and made mandatory for all schools as quickly as possible.
4.8. There is little in the white paper about improving mental health and well-being. Mental well-being is an important factor in health inequalities and chronic mental illness leads to poor quality of life. Local government and PCTs have a key role in promoting well-being that is currently restricted by insufficient resources and capacity.
4.9. Some of the proposed innovations – such as Spearhead PCTs and health trainers – do not have a firm evidence base. Data show that there are more poor and disadvantaged people outside the Spearhead PCT areas than within them and work based solely on spatial and geographical areas will not address the issue of inequality systematically or sufficiently. Health trainers are not evidence based and this initiative risks wasting resources. It is important to pilot such proposals to ensure that they can fulfil their aims and do not have unanticipated outcomes that widen rather than narrow health inequalities.
4.10. Finally, the SHA believes that government must do much more to raise the level of debate about quite how unhealthy UK society is, utilising a range of marketing strategies.
5. The Chair of the Socialist Health Association, Dr. Paul Walker, will be pleased to attend the Committee hearing and provide further detail on these issues to the Committee.
6. This is a corporate response prepared by the Executive of the Socialist Health Association.