Good health and wellbeing for all
Dawn Primarolo delivers the FPH Annual Lecture
3 December 2007
Good health and wellbeing for all – not just some – was at the heart of Government policy, Minister of State for Public Health Dawn Primarolo told the audience at the Faculty of Public Health's 2007 Annual Public Health Lecture.
The Faculty itself was part of a proud tradition of selfless effort to improve the public's health, she said.
Much improvement in public health had been brought about through what the Nuffield Council on Bioethics called ‘quite interventionist policies', she said, but in the 21st century ‘no one person or policy is going to solve the problems of childhood obesity or stop the phenomenon of binge drinking.' This went right to the heart of issues of state responsibility versus individual choice. ‘We need a sophisticated approach where we intervene in many ways and at multiple levels to improve public health.'
GOVERNMENT INTERVENTION
It was also essential to demonstrate clear evidence of individual risk as part of finding the solutions, with smoking a case in point. ‘Smoking is the single greatest cause of preventable illness, and an issue where there was a clear case for Government intervention to protect the health of the nation.' People had wanted legislation to restrict smoking in public places, and this had been borne out by the extremely high levels of compliance, she said.
RAISING AWARENESS
It was therefore essential to raise awareness of risk – as with smoking – in every in every aspect of life, and use a variety of levers, from legislation at one end to empowering individuals at the other, she said.
Strategic levers were an essential component - staying healthy would be one of the eight clinical pathways examined by Lord Darzi in his major review of the NHS next year. Another strategic lever was better joint working across Whitehall , she said, acknowledging that government departments were often ‘hardly paragons of virtue in partnership working.' This was changing, she promised, highlighting the effective joint working on alcohol by the Department of Health and the Home Office.
OUTCRY IN THE PRESS
The Safe, sensible, social alcohol strategy targeted not only young binge but the harmful drinkers who may not want to hear the messages, and this had caused particular outcry in sections of the press, she said. The Government wanted to promote a culture of sensible drinking, and to this end the Home Office had a new Public Service Agreement, which meant they would be held to account by the Treasury on measures to reduce alcohol-related harm.
‘Strategic interventions can be directly responsible for bringing dramatic health benefits,' she said, and immunisation programmes which saved thousands of lives were a case in point. ‘It is the role of the Department of Health, along with its arms length bodies and other Government departments to provide the strategic vision for public health.'
The Government was about to publish its 2008-09 NHS Operating Framework, which would identify public health as a top NHS priority. But it would take the full spectrum of local organisations ‘from PCTs to local authorities, from schools to businesses' to turn those strategic aspirations into reality, she said.
ORGANISATIONAL BARRIERS
Organisational boundaries had all too often meant that complex public health problems had been neglected because no one had clear responsibility for them, she acknowledged. A range of levers like Local Strategic Partnerships were addressing this, and barriers were further being broken down by joint appointments of Directors of Public Health between PCTs and local authorities.
Assessing need was fundamental to improving the health of local populations, she said, and one area where the need was clear was that of the working age population. ‘The stark facts about the UK working population are that 175m working days are lost to sickness absence every year, equating to a staggering £13bn cost to the economy.' The case for investing in health by all stakeholders was therefore clearly robust, and both businesses and schools had to be encouraged to get involved in public health, she said. The National Healthy Schools Programme was playing a key role in this, with nine out of ten schools now involved.
FOCUS ON LEADERSHIP
The final group of levers were those that directly affected individuals. The public health workforce could be strengthened by focussing on the leadership of key individuals, and catalysing the scale of change necessary would require transformational leadership. The Department of Health was supporting this through two different programmes of leadership development – the National Public Health Leadership Programme and the Leadership for Health Improvement Programme.
Broadening the public health workforce was about involving those whose core business was not health but who could have a huge impact, such as teachers and built environment professionals, and the Faculty clearly had a key role to play here, she said.
Sometimes it was only legislation that could protect people from public health threats like contamination and infectious disease. The new Health and Social Care Bill would update outdated legislation in this area, but the legislative ‘one size fits all' approach was rarely enough to tackle the complex public health issues that arose from individual lifestyle choices.
The personalised approach was the key to tackling issues like obesity, such as in the Government's new pilot Physical Activity Care Pathways, delivered through GP practices.
‘NANNY PRIMAROLO'
Quoting the recent Nuffield Council on Bioethics report, she said that public health was the ‘efforts of society as a whole to improve the health of the population and prevent illness'. In large sections of the press, however, the emphasis was on individual freedom and accusations of ‘nanny statism', or to quote Terry Wogan recently, ‘nanny Primarolo.' The biggest challenge of all, therefore, was to present the public health agenda in terms of stewardship.
‘The clear question is how to have interventionist public health policies based on individuals' perceptions of acceptable risk,' she said. ‘Just as you would not try to construct a house with only one spanner, so we shouldn't tackle complex public health issues by legislation alone, important as that is. We must continue to provide the compelling evidence based vision for the future of public health.'
Public health practitioners had benefited both through the bigger picture analysis of the Faculty's work and their own front line experience. The challenge was how to ensure that public health expertise was mainstreamed into every aspect of people's lives, she said, so that all were engaged in efforts to improve the health of the population – whether in the NHS, the voluntary sector, local government or the workplace.
Your role, as we grapple with these huge issues is vital,' she stated. ‘The time has come to move public health on, so that it is not just something that's added on after all other considerations have been made, but is the first thing considered before a school is built, a transport network is designed or food is marketed. That way everybody, not just some people, can be healthy, wealthy and wise.'
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