Annex B
MEMORANDUM BY THE DEPARTMENT OF HEALTH PUBLIC
HEALTH (PH1) (contd.)
Protection of Public Health
1. Introduction
2. Air Pollution and Health
3. Anti-Microbial Resistance
4. Chemical Hazards
5. Hospital Acquired Infection
6. Housing and Health
7. Ionising Radiation
8. The National Focus
9. Oral Health
10. The Public Health Laboratory Service
11. Radiation—Electromagnetic Fields
12. Risk and Risk Communication
13. Role of the Consultant in Communicable
Disease Control and Regional Epidemiologist
14. Other Environment and Health Issues
1. INTRODUCTION
There are many associations between ill health
and the physical environment in which people live. Poor air quality,
exposure to harmful chemicals or radiation, cold damp or poor
quality housing, and a host of other related hazards can all pose
serious risks to human health.
DH works closely with others within and outside
Government to tackle potential hazards and to ensure that the
public is protected from unacceptable levels of risk.
Apart from specific risks, some of which are
referred to below, DH actively supports the Government's Sustainable
Development agenda. The Government published its Sustainable Development
Strategy in May 1999 and published a follow-up report in December
1999 setting out 15 headline indicators and over a hundred others.
This will be the baseline against which future progress is measured.
DH has been successful in ensuring that health features strongly
in the Government's Sustainable Development Strategy and in making
links to DH policies.
2. AIR POLLUTION
AND HEALTH
Air pollution has a significant effect on health
in the UK. The Committee on Medical Effects of Air Pollution (COMEAP)
has advised that between 12,000 and 24,000 deaths are advanced
each year and between 14,000 and 24,000 hospital admissions are
either caused de novo or advanced as a result of exposure
to air pollution. It is also becoming clear that long-term exposure
to air pollutants damages health. Indeed, one piece of research,
soon to be published, commissioned by DH, estimates that the cost
of long-term exposure could be as much as £60 billion per
annum. The National Air Quality Strategy is a UK Government policy
that aims to ensure that everyone is able to enjoy a level of
ambient air quality in public places which poses no significant
risk to his or her health and quality of life. The current Strategy
establishes policy until between 2003 and 2008.
3. ANTI-MICROBIAL
RESISTANCE
The Government's response, given in December
1998, to the House of Lords Select Committee on Science and Technology's
report Resistance to antibiotics and other anti-microbial agents
published earlier that year indicated its intention to take forward
a comprehensive strategy to tackle the problem of anti-microbial
resistance. The key elements of the strategy were outlined and
the Government gave a commitment to a tranche of activities to
support it.
Details of that strategy are set out in the
UK Anti-microbial Resistance Strategy and Action Plan, published
by the DH on 10 June 2000. It is a base for the use of individual
departments and organisations in building up their own action
plans. It takes into account the recommendations of the Standing
Medical Advisory Committee (SMAC), in its report The Path of
Least Resistance, recommendations from the World Health Organisation's
(WHO) former Division of Emerging and Other Communicable Diseases
Surveillance and Control, the recommendations of the European
Conference on The Microbial Threat in Copenhagen in September
1998, and the World Health Assembly Resolution of May 1998.
The strategy recognises the need for action
across a wide range of interests and by many organisations and
individuals. Since microorganisms do not recognise geographical
boundaries and are increasingly spread through international travel
and commerce, it also recognises the need for the UK to play its
part internationally, as well as at local and national levels.
4. CHEMICAL HAZARDS
DH provides funding and support to the National
Poisons Information Service (NPIS). The NPIS is a UK-wide service
providing information, training and advice to NHS health care
professionals on the diagnosis, treatment and management of patients
who may have been poisoned.
Also, more generally, in order to safeguard
public health, Ministers require authoritative, independent scientific
and medical advice to underpin policies involving health. The
use of independent experts on the Chief Medical Officer's (CMO's)
advisory committees provides such clear and robust advice. DH
provides the secretariat for the committees on carcinogenicity
(COC) and mutagenicity (COM) of chemicals, air pollutants (COMEAP)
and oversees the committee covering environmental radiation (COMARE).
DH Ministers have regulatory responsibilities
too in certain areas of chemical use. Under the Control of Pesticides
Regulations, DH Ministers' approval is needed for authorising
pesticide products in the UK and DH Ministers are also part of
the UK licensing authority for veterinary medicines.
Although the policy/regulatory role for chemicals
in water, soil and waste lies with DETR and the Environment Agency
(EA), DH had traditionally provided the health advice, in line
with its wider public health responsibilities and the role of
CMO as medical adviser to a number of Government departments.
This can mean providing definite advice on emerging issues such
as the potential carcinogenic and reproductive risks of chlorinated
water; advising on safe levels of contaminants in the event of
accidental contamination of drinking water; dealing in an informed
way with correspondence on eg endocrine disrupters, fluoridation;
and commissioning research in these areas.
DH also take the lead on major issues of public
concern, eg on the reports of increased congenital anomalies around
landfill sites, or the Camelford water contamination incident,
where there is public/political pressure which DH Ministers are
unable to avoid. Public perception is that advice to Government
should be expert and impartial and DH is able to fulfil this role.
5. HOSPITAL ACQUIRED
INFECTION
Numerous research studies worldwide have shown
that Hospital Acquired Infection (HAI) increases average length
of stay in hospital. A national prevalence study in 1993 showed
that, at any one time, 9 per cent of hospital in-patients have
an infection that they acquired since admission to hospital. Not
all HAI is preventable, nor it is likely to become so in future.
But there is general agreement that, overall, good infection control
practice and application of current knowledge could significantly
reduce its incidence, cost to the NHS and impact on patients.
The Government takes the problem of hospital
acquired infection very seriously. Arrangements for the prevention,
management and control of hospital acquired infection need to
be improved and action on this is already in hand.
Tackling hospital acquired infection has been
set as a high priority area for the NHS and the need to deliver
improvements features as a "must-do" for the NHS in
the current National Priorities Guidance.
New standards on infection control were issued
in November 1999 against which NHS Trusts had to assess their
performance by 31 March 2000. NHS Trusts and Health Authorities
have to report results of their self-assessment to Regional Offices
by 31 July 2000. The Audit Commission and the Commission for Health
Improvement will monitor compliance.
A Health Service Circular (HSC 2000/002), sent
out on 11 February, sets out a programme of action for the NHS
with a timetable to:
— Strengthen prevention and control
of infection in hospital.
— Secure appropriate health care services
for patients with infection.
— Improve surveillance of hospital
infection.
— Monitor and optimise anti-microbial
prescribing.
Regional Directors of Public Health, working
with Regional Directors of Performance Management, are responsible
for ensuring that the NHS has robust infection control arrangements
(including the implementation of clinical governance arrangements
and achievement of the Controls Assurance Standards) in accordance
with the timetable set out in HSC 2000/002.
6. HOUSING AND
HEALTH
On average, there are 30,000 excess deaths each
winter, many are thought to be to due to cold and damp housing.
Every opportunity is being taken to raise awareness amongst doctors
and other health professionals of the links between poor housing,
particularly fuel poverty, and ill-health. DH is working closely
with other Government departments at Ministerial and official
levels to help develop a strategy for combating the causes of
fuel poverty. An important part of this work is to explore research
options for improving our understanding of the factors that contribute
to ill health.
Also, DH officials are working more generally
within Government and outside to support initiatives on housing
which are likely to produce health gains. For example, a number
of local projects are being funded through the HAZ Innovations
Fund, and officials are collaborating with the project leaders
to help focus on health related measures.
7. IONISING RADIATION
Both natural and man-made sources of radiation
contribute to human exposure and can constitute a hazard for human
health.
Ionising radiation is estimated to be responsible
for about one per cent of all deaths and about four per cent of
deaths due to cancer. The greatest contribution to these estimates
is that from exposure to natural radioactivity from radon. Some
of this exposure is remediable by making structural changes in
houses.
8. THE NATIONAL
FOCUS
The National Focus provides a key co-ordination,
advice and information role in support of the NHS and DH response
to unusual or complex chemical incidents—those likely to
have a major impact on public health, attract national media attention
or span regional boundaries. The National Focus provides a 24
hour, 365 day a year chemical incidents hotline to receive notification
of incidents, and alerts officials at the UK Departments of Health
to the public health aspects of major chemical incidents and provides
briefing as necessary. The Focus acts to ensure liaison between
all relevant organisations and sources of advice in the UK and
elsewhere.
The Focus also works with other interested agencies
to facilitate multi-agency national public health surveillance
of chemical incidents to identify the frequency and characteristics
of chemical incidents in the UK, including identifying the chemicals
most commonly involved. Through its work, the National Focus seeks
to identify elements of best practice and disseminate these to
strengthen the NHS response and preparedness in the longer term.
9. ORAL HEALTH
There is still unacceptably wide inequality
in the levels of tooth decay in children. The fluoridation of
the water supply can substantially reduce the amount of tooth
decay in children from similar backgrounds. In the White Paper,
Saving Lives: Our Healthier Nation DH announced that we
had commissioned an up-to-date expert scientific review of fluoride
and health. The review, which is being carried out by the NHS
Centre for Reviews and Dissemination at the University of York,
is due to report shortly. If it confirms that there are benefits
to dental health from fluoridation and that there are no significant
risks, we intend to introduce an obligation on water companies
to fluoridate in areas where there is strong local support for
doing so.
In this context we are considering transferring
from Health Authorities to local authorities the requirement for
undertaking public consultations before water authorities are
asked to fluoridate an area.
Improving oral health plays an important part
in our plans for modernising NHS dentistry, which are due to be
published later this summer.
10. THE PUBLIC
HEALTH LABORATORY
SERVICE
The Public Health Laboratory Service (PHLS)
protects the population from infection by maintaining a national
capability of the highest quality for the detection, diagnosis,
surveillance, prevention and control of infections and communicable
diseases. The PHLS addresses these problems through the co-ordinated
activities of its network of microbiology laboratories, its reference
laboratories as well as its research and development programme.
11. RADIATION—ELECTROMAGNETIC
FIELDS
There is widespread exposure to electromagnetic
fields (EMF) from the rapidly expanding use of mobile phones.
Economic and social pressures will continue to fuel this expansion.
The technology is too new to be certain that its use will not
result in effects on health and there is considerable potential
that even a low probability of harm would have widespread public
health implications. There is considerable public concern about
this issue and the Department of Health (along with DTI) set up
the Independent Expert Group on Mobile Phones who published their
report recently. The Group's recommendations, which include further
research, are presently under consideration. It is intended to
launch a comprehensive research programme, funded by Government
and industry, in the autumn.
Public concern about electromagnetic fields
from power lines remains; specific issues such as interactions
between aerosols and fields from power lines, have been addressed
in the DH's Radiation Research Programme.
The Government has supported a European Recommendation
to limit public exposure to EMFs, published in 1999. It is intended
to safeguard the health of people exposed to sources of EMF (power
lines, radio and TV transmitters, electric transport systems,
shop and library anti-theft devices etc). The way in which the
Recommendation will be implemented in the UK is currently under
consideration.
Consideration continues of the relevance of
precautionary/prudent avoidance policies in the siting of new
sources of EMF such as power lines and transmitters and in the
licensing of new and existing communications technologies.
12. RISK AND
RISK COMMUNICATION
Risk and risk communication form a vital part
of the DH's policy initiatives in OHN. Clear communication
about risks to public health is of vital importance. The Department's
Framework on risk was published in OHN. It refers to ensuring
high quality assessment of science and greater public participation
in risk deliberation—areas currently being explored with
DH advisory committees.
13. ROLE OF
THE CONSULTANT
IN COMMUNICABLE
DISEASE CONTROL
AND REGIONAL
EPIDEMIOLOGIST
Following two large hospital infection outbreaks
in the 1980s, which were the subjects of public enquiries, a committee
chaired by Sir Donald Acheson published its report, Public
Health in England, in 1988. It recommended the establishment
of a new medical consultant post to improve the level of activity
and expertise in the surveillance, prevention and control of communicable
disease and infection. The post of Consultant in Communicable
Disease Control (CCDC) was therefore introduced.
Every health authority now has a CCDC, working
with public health medicine colleagues who also contribute to
communicable disease surveillance prevention and control. Each
Health Authority's (HA) Director of Public Health takes overall
responsibility for the function. The responsibilities of a CCDC
cover the population, including those in hospitals. CCDCs, together
with other public health medicine colleagues, also have responsibilities
within the local authority and normally have responsibilities
exercising statutory powers and duties in respect of the control
of communicable diseases on behalf of the local authority. Every
region has a Regional Epidemiologist (RE) who provides expert
support to all professionals involved in communicable disease
control such as HA public health medicine colleagues and hospital
infection control teams. Further guidance on the arrangements
for communicable disease control and the roles of the CCDC was
issued in 1991 and updated in 1993 as an Annex to HSG(93)56.
The NHS Executive has contracted with the PHLS
to provide a Regional Epidemiology service in each region. Regional
Epidemiologists (REs) are employed by, and managerially accountable
to, the PHLS. The service provided in each region is managed and
monitored by the Regional Director of Public Health (RDPH). The
lead Regional Director of Public Health for communicable disease
provides a strategic link between the individual RDsPH, the RE
Service Budget Holder and the PHLS (Communicable Disease Surveillance
Centre).
14. OTHER ENVIRONMENT
AND HEALTH
ISSUES
In addition to the examples given above, the
DH takes a leading role across many other environment and health
issues with the overall aim of protecting public health. For example:
— Providing health advice to other
Government departments, such as DTI on chemicals in consumer products.
— Leading on public health issues at
the national level for any radiation incident or emergency, working
closely with other departments and the National Radiation Protection
Board (NRPB) to maintain 24-hour readiness.
— Noise pollution; health effects of
ultra-violet radiation, such as those arising from exposure to
the sun.
— The implications for human health
of climate change.
As well as its UK work, DH plays an active role
in international work on environment and health, and has close
links with organisations such as WHO.
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