MEMORANDUM BY UK PUBLIC HEALTH ASSOCIATION
(PH 23)
SUMMARY
The UKPHA is a voluntary organisation, an independent
advocate for healthy public policy across all Government Departments
and throughout all developed governmental arrangements. Evidence
is gained from our active membership in the regions, who work
in all sectors, including health, local government, voluntary
sector and regional development. Their experience shows that promoting
the health of the public requires concerted and co-ordinated action
at national and local levels, and that in order to promote the
health of the whole population it is vital to address the wider
determinants of health and particularly elimination of the inequalities,
which continue to divide our society. Improvement of the public's
health requires tackling the causes of inequalities, especially
in income. Structural targets should be set nationally, across
Government to achieve this. Targets should be measurable and effective.
A Commission to monitor progress should be established, involving
the non-governmental sector as well as the public authorities.
Locally Plans should be brought together (under the Community
Plan, or similar) and led by the elected local authority, so as
to be accountable to their local communities. Structured involvement
of the voluntary sector should be required. Partnership and joint
planning should be integral to decision-making, not an additional
extra.
1. BACKGROUND
1.1 The UKPHA is an independent, UK-wide
voluntary association, bringing together 1,000 individuals and
organisations to promote the public's health and to develop healthy
public policy at all levels of government and across all sectors.
We act as an advocate, linking the experiences of people living
in disadvantaged communities, with the decision-makers who have
the powers to improve all our lives.
1.2 UKPHA stems from the Public Health Alliance,
which combined with the Public Health Trust and Association for
Public Health in its new form. This was both to bring people together
(the public health movement has suffered from fragmentation) and
to create a response to new challenges (emerging from a UK Government
with devolved Parliament and Assembly structures). We run NLCB-funded
projects, including one commencing this summer on poverty and
health and we hold the Annual Public Health National Conference.
(This is in Bournemouth on 27-29 March 2001. In 2002 it will be
in Glasgow.)
1.3 Our mission was agreed through consultation
with all members. UKPHA is thus based on its voluntary membership,
providing strong regional (and national) presences throughout
the UK. We aim to be a unifying and powerful voice. We promote
health—positive promotion, wider than the NHS alone. We
emphasise public, not just individual nor private. We want to
eliminate inequalities in health and promote sustainable development,
to improve the health and well-being of all.
2. EVIDENCE
2.1 The co-ordination between central government,
local government, health authorities and PCGs/PCTs is currently
weak. There is a plethora of schemes and initiatives, worthy in
their own right, but overlapping and requiring tremendous effort
at local level to keep up with "Initiative fatigue"
is widely reported.
2.2 "Joining up" Government Departments
and their approaches at national level would help to overcome
the simultaneous delegation to many different local bodies and
the requirement (in varying strength) for the latter to work together.
Enhancing the role of a Minister for Public Health, so as to be
independent of existing Departments and with responsibility for
overseeing progress across Government, might enable local initiatives
to become more effective.
2.3 Promoting public health also needs to
be central at all levels. The role of the Director of Public Health
should regain its independent status, perhaps even based in the
local authority, given the streamlining of health authorities
and the delegation of powers to PCG/Ts. Generally it is unclear
how public health will fit into increasingly fragmented PCG/T
developments. The UKPHA is running a project on primary care and
public health to assess this.
2.4 The inter-operation of Health Action
Zones, Employment Action Zones, Education Action Zones, Health
Improvement Programmes and Community Plans (as well as New Deal,
Surestart, and other schemes) is complex and varies from place
to place. The absence of coterminosity of health and local authorities
(in England, that is) makes effective joint planning more difficult
still. (Boundaries of Government Regional Offices and Regional
NHS Offices are also still not the same everywhere.) It is suggested
that all local Plans should be brought together (preferably under
the Community Plan, or similar), and should be led by the elected
local authority, so as to be accountable to their local communities.
Structured involvement of the voluntary sector should be required,
as part of joint planning. Monitoring of joint planning should
be conducted thoroughly, such as through senior management performance
indicators. Partnership and joint planning should be integral
to decision-making, not an additional extra.
2.5 Current public health policy correctly
analyses the wider factors, which determine all our health. The
(English) White Paper Saving Lives: Our Healthier Nation built
on the previous Government's Health of the Nation and crucially
identified the need to improve the health of those who were worst
off. Actions resulting from the White Paper have been energetic
on single issues and the structural identification of inequalities
has proved harder to carry out. Evidence from UK research and
international reports suggests that the gap between rich and poor
is wide and still growing, globally and nationally, and that it
is only the intervention of free health and social care services
which prevents the death rates of children born in poor areas
from escalating still further away from their counterparts in
richer areas. Eliminating child poverty in the next 20 years will
be essential for reducing the health gap; substantial redirection
of resources is needed to turn this commitment into reality, and
to ensure that communities start to be healthy enough in the first
place, for future children to be born and to grow through early
years into health adults.
2.6 In order to promote the health of the
whole population it is therefore vital to address the wider determinants
of health and particularly elimination of the inequalities, which
continue to divide our society. Improvement of the public's health
requires tackling the causes of inequalities, especially in income.
Structural targets should be set nationally, across Government,
to achieve this. For example, it is possible that setting a target
for reducing low birth weight would be a useful approach, as a
combination of actions would be needed to produce this result.
Any targets which are set should be measurable and effective—and
should be put into effect and measured. In order to ensure that
targets are meaningful and that measurement is carried out, reported
on, and evaluated, it is suggested that a Commission to monitor
progress could be established. This would need to involve the
non-governmental sector as well as the public authorities. At
regional level there could be similar monitoring of regional and
local targets, and similar involvement of appropriate public and
voluntary agencies in the monitoring activities.
2.7 The UK Public Health Association believes
that the contribution of the voluntary sector is vital, as a constructive
voice of independent advocacy. The UKPHA plays a leading role
in the recently-established Forum of Health Non-Governmental Organisations
(which was established earlier this year as a specific outcome
of the White Paper Saving Lives). The Forum is intended to develop
regional-level Fora, and to work closely with parallel developments
in Scotland and Wales, and in due course Northern Ireland. The
UKPHA has well-established branch structures in Scotland and Wales,
and was pleased this month to be involved in the establishment
of a Public Health Alliance in Northern Ireland along the same
lines. It is anticipated that these structures will be well-placed
to link with Forum or similar approaches in these devolved parts
of the UK.
2.8 Similarly, at regional level in the
English regions, our members will expect to work closely with
both the Regional Development Agencies (who have started to develop
Health Reports of their own) and with the Health Development Agency
(who are appointing regional posts at senior level). Developing
public health across the UK requires maintaining links across
all these bodies. Movement towards coterminosity of agencies and
co-location of staffing might be seen as sensible and practical.
The UKPHA has developed joint work with the Local Government Association
(in England; and similar links with the respective associations
in Scotland and Wales); a joint Conference with the LGA in January,
a joint Response to the White Paper Saving Lives, and a joint
planning initiative with LGA and HDA on local government and health
this summer.
2.9 The UKPHA's participation in the Secretary
of State's NHS National Plan process (though membership of the
Modernisation Action Team on Prevention and Inequalities) has
also helped to develop links with other agencies. A seminar is
planned, together with the Faculty of Public Health Medicine and
the Royal Institute for Promotion of Health and Hygiene, to respond
to the NHS Plan, early this autumn. The UKPHA provides the secretariat
for the Common Agenda Group of NGOs, who have submitted to the
Inquiry separately, and for the All Party Parliamentary Group
on Public Health and Primary Care.
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