MEMORANDUM BY THE DEPARTMENT OF HEALTH PUBLIC
HEALTH (PH1) (contd.)
EXECUTIVE SUMMARY
1.1 Health in Britain improved dramatically
during the 20th Century. For example, life expectancy for a baby
girl born in 1900 was 48 years and 44 years for a boy (England
and Wales). By the millennium, life expectancy had increased to
80 years for a girl and 75 years for a boy.
1.2 But the health of the people of Britain
is not as good as that in many other developed countries. Britain
rank's only 14th in the latest WHO survey of health life expectancy,
behind Spain and Italy.
1.3 The benefits of improving health have
not been experienced equally across society. Health inequalities
in Britain are wide and growing. For example:
(i) life expectancy at birth for a boy is
over nine years less in the lowest social class compared to the
highest, for a girl over six years less;
(ii) among men of working age, 17,000 premature
deaths would be avoided each year if the death rates of all were
the same as those in professional and managerial jobs;
(iii) coronary heart disease death (CHD)
rates in men under 65 vary between health authorities, with the
highest almost three times that of the lowest;
(iv) infant mortality rates vary between
health authorities - the highest rates are three and half times
that of the lowest rate.
(v) Death rates from coronary heart disease
among first generation South Asians aged 20-69 are about 50 per
cent higher than the England and Wales average.
(vi) Stroke death rates are more than 50
per cent greater among those born in the Caribbean.
1.4 Such marked inequality—such unfairness
- is not inevitable. If other countries such as Sweden can both
be healthier overall and avoid marked health inequalities, then
so should Britain. We can—and should—do better.
Determinants of health
1.5 The determinants of health are well
recognised. For example, communities with the poorest health tend
to have:
(i) greater exposure to the root causes of
disease eg poverty, unemployment, poor housing, limited educational
opportunities and attainment, physical and social isolation;
(ii) high rates of smoking, poor nutrition
and sedentary lives;
(iii) restricted access to and poorer quality
services including poorer access to high quality health care.
1.6 Promoting health, preventing ill health
and tackling ill health requires action on all three fronts. Often
it is not the Department of Health or the NHS whose decisions
and actions have the greatest impact on health. The implication
is that co-ordinated action is required between nationally, regionally
and locally between those Departments, agencies and organisations
whose decisions affect the health of local communities. In the
past, this co-ordination has been difficult to achieve.
Government Action
1.7 Improving health and reducing health
inequalities are among the Government's highest priorities. This
high priority has been reflected in the Government's actions:
— It has created the post of Minister
for Public Health.
— It has published and is implementing
the public health White Paper Saving Lives: Our Healthier Nation
- after consulting widely on a public health Green paper.
— It has published and is implementing
the smoking White Paper Smoking Kills.
— It commissioned and published an
Independent Report on Inequalities in Health from an expert
committee chaired by Professor Sir Donald Acheson. It has accepted
the committee's findings. Reducing Health Inequalities: An
Action Report was published with the White Paper.
— One of the five challenges the Prime
Minister has set the NHS is to re-focus the health system on the
prevention of disease and the reduction of inequalities. This
will be an important theme that runs through the National Plan
for the NHS due to be published in July 2000.
— It has created new mechanisms (eg
Government Intervention in Deprived Areas group) and new units
(eg the Social Exclusion Unit) to develop effective policy for
tackling the root causes of disease in Britain's most disadvantaged
communities.
1.8 It is tackling the root causes of disease
directly eg by aiming to eliminate childhood poverty, by tax and
benefit reform, by the introduction of a national minimum wage;
by raising educational standards and opportunities for all; by
improving public transport and by protecting the environment.
Priorities
1.9 Priority has been given to the major
killers and the common causes of morbidity. The priorities identified
in Our Healthier Nation are (a) coronary heart disease
(CHD) and stroke (b) cancer (c) mental health and (d) accidents.
Targets have been set in each of these areas.
1.10 National Service Frameworks setting
national standards for prevention and treatment have been published
for CHD and mental health. A national plan for cancer is due to
be published later this year. Particular priority is being afforded
to preventing CHD and cancer by tackling smoking and improving
nutrition. The marked social class differences in smoking
and diet are believed to account for a substantial proportion
of the differences in death rates between the disadvantaged and
the better off.
1.11 It is now known that birth weight and
health in childhood have important influences on health in later
life. The health of female infants also influences the health
of the next generation. As a result, pregnant women, infants
and children are another priority. This is reflected in the
Department of Health's commitment to Sure Start, and other
initiatives such as programmes aimed at Britain's high rates of
teenage pregnancy.
Public Health: Structures and Delivery
1.12 The renewed emphasis that the Government
is placing on prevention and inequalities, the new policies it
has developed and the priorities it has identified require more
effective methods of implementation.
1.13 Some changes to delivery structures
and ways of working have already been made. For example:
— The Health Act 1999 extended an existing
duty of co-operation from the National Health Service Act 1977
for health and local authorities to work together to secure and
advance the health and welfare of their communities. It also requires
Health Authorities to produce Health Improvement Programmes.
— Primary Care Groups / Trusts have
been established with three roles—one of which is to improve
the health of their local communities.
— A Health Development Agency has been
created to develop and disseminate an "evidence base"
for the practice of public health.
— A Food Standards Agency has been
established to ensure that the public can be confident in the
safety and quality of food.
— Health, Education and Employment
Action Zones have been created to tackles the root causes of disease
in disadvantaged communities.
1.14 But we do not believe these changes
yet go far enough. The Department of Health supports the National
Strategy for Neighbourhood Renewal and wants to see the NHS play
its full part in Local Strategic Partnerships. Tackling prevention
and inequalities must become "mainstream" activities
for the NHS, and the NHS has much more to do if the most disadvantaged
are to have access to high quality health services that equals
the access of the better off.
1.15 Although this is a good start, more
change is necessary. That is why one of the key questions that
the Prevention and Inequalities Modernisation Action Team is how
public health delivery structures can be strengthened. It is anticipated
that their recommendations will be reflected in the National Plan
for the NHS.
This Memorandum
1.16 This Memorandum describes the role
that the Department of Health plays in promoting improvements
in the public health. It explores the relative roles and inter-relationships
between initiatives for tackling inequalities, reducing social
exclusion and promoting better health (sections 3 and 4); explores
the specific role of key players within public health (sections
5-10); evaluates the impact of these on reducing health inequalities
(section 11); and considers how this country compares with others
(section 12).
| 
