APPENDIX 56
Memorandum by the Department of the Environment,
Transport and the Regions (PH 93)
INTRODUCTION
1. The Department of the Environment, Transport
and the Regions (DETR) welcomes this opportunity to describe its
role in improving public health, both directly through its own
policies, and indirectly through the activities of its related
bodies and its sponsorship of local bodies with major public health
responsibilities.
2. DETR's connection with public health
is rooted in history. The great advances in public health in Victorian
times and the early 20th Century stemmed from activities-on part
of individuals and organisations-that would today be under the
general sponsorship of DETR. Now as in the past, local government
is a key driver for improving public health, and as the sponsoring
department DETR provides the framework for delivering many local
public health services.
3. DETR endorses the widely held view that
public health is about much more than the delivery of medical
services through the National Health Service and the Department
of Health. Protecting and improving the nation's health means
taking a much broader approach. Together with our agencies, we
are major proponents and deliverers of the preventative element
of the government's strategy for better health and reducing health
inequalities. Our work is a crucial complement to that of the
Department of Health and the NHS, addressing the wider determinants
of health through policies-to take just a few examples-on regeneration
and renewal, on housing standards and fuel poverty, on clean air
and water, on safe transport, and on safe and healthy workplaces.
Our initiatives in all these and other areas are examined later
in this memorandum.
WHY DETR'S BUSINESS
IS CENTRAL
TO PUBLIC
HEALTH
4. DETR's overall corporate aim is:
"To improve everyone's quality of life,
now and for the future, through:
thriving, prosperous regions and
communities
safer, healthier surroundings;
and
prudent use of natural resources".
5. Closely linked to this aim is the cross-cutting
theme of sustainable development. The UKs' strategy for sustainable
development has at its heart the simple idea of ensuring a better
quality of life for everyone, now and for generations to come.
One of the four aims of sustainable development is "social
progress which recognises the needs of everyone", and this
in turn as a key component "improving the health of the population
overall". The Government's main indicator of improvement
in the overall health of the population is "expected years
of healthy life". Thus public health and its improvement
are at the heart of sustainable development, and hence at the
heart of DETR's policy objectives
6. Once one accepts that health is in part
the product of where people live and their environment, the choices
they make, and the health-related services they receive, it follows
that the role of DETR, with its agencies, is very important, even
where our specific impact cannot be measured in precise terms.
Some examples of major DETR policy areas with a public health
impact are described below.
(a) Environment
Most broadly, a clean and healthy environment
is essential to public health and quality of life, and is a key
component of sustainable development. It is the primary aim of
the Environment Agency, which DETR sponsors, to protect and enhance
the environment and to contribute towards the delivery of sustainable
development, through the integrated management of air, land and
water. The way in which the Environment Agency, as a Non-Departmental
Public Body sponsored by DETR, delivers quality of life and sustainable
development was set out most recently in its fifth Corporate Plan,
published in November 2000.
(b) Transport
The integrated transport White Paper A New
Deal for Transport: Better for Everyone published in July
1998 made clear our aim of integrating transport policies with
those on health. Transport policies impact on health in a number
of ways through issues such as air quality, noise, road casualties,
social exclusion and the encouragement of walking, which are covered
separately below.
(c) Water Quality
DETR is vigilant in protecting people's health
from unsafe drinking water. Quality compliance is achieved through
audit and enforcement action by the Drinking Water Inspectorate,
so that in 1999 compliance with drinking water standards was met
in 99.8 per cent of around 2.8 million tests. New regulations,
tightening the standards further, were laid before Parliament
in December 2000.
Investment in the sewerage infrastructure in
recent years has substantially reduced contamination of bathing
waters, and in 2000 a record level of 95 per cent compliance with
EU standards was achieved. Further investment is in hand to meet
the target of 97 per cent by 2005. DETR has also put in place
programmes to improve the quality of shellfish waters, with the
objective of bringing them all up to at least Class B under the
system applied by the Food Standards Agency to classify shellfish
harvesting areas for food safety purposes.
(d) Air Quality
Air pollution affects people's health directly.
It can hit the most vulnerable in our society particularly hard,
especially those who suffer from asthma or heart and lung diseases.
Measures to improve air quality therefore produce direct health
gains. DETR is responsible for the Air Quality Strategy which
sets health-based objectives for eight air pollutants which can
have significant effects on health. Local authorities are taking
steps in pursuit of the objectives for local air pollutants through
local air quality management arrangements. DETR is also responsible
for national and EU legislation which controls emissions from
sources of air pollutants, including industry and transport. The
major transport investment announced in July 2000 in Transport
2010: The 10 Year Plan, will help deliver further improvements
in air quality.
Transport taxations takes account of the emission
and health dimensions of different fuels and vehicle technologies.
DETR advises HM Treasury on the design of fiscal structures which
encourage vehicle users to buy and use cleaner fuels and vehicles.
Incentives to date include lower duty rates on cleaner fuels,
lower rates of vehicle excise duty (VED) for lorries meeting stringent
pollution standards, a new structure to be introduced for lorry
VED to strengthen the environmental signals built into VED rates,
and a new structure of VED for new cars, and for company car tax,
based on carbon dioxide emission levels, to start in March 2001
and April 2002 respectively. Alongside fiscal steps, DETR has
announced a £69 million package of measures over the next
three years to promote vehicles which are cleaner and more fuel
efficient, with better health characteristics.
(e) Land quality
We also have a health role in relation to contaminated
land. Contamination of the land on which people live, work, play
and grow food can lead to unacceptable intakes of heavy metals
and organic chemicals left behind by past industrial activities
or waste disposal. In other cases, soils may contain high levels
of asbestos, and landfill gases can create risks of fires and
explosions in buildings. In April 2000, DETR introduced a new
statutory regime for contaminated land. This regime gives local
authorities and the Environment Agency strengthened duties to
identify problem sites and to require them to be remediated to
protect human health and the wider environment.
The Regional Development Agencies also have
responsibilitiesand wide powersto bring derelict
land of this kind back into use.
(f) Health and safety
A key priority for DETR is the reduction of
deaths and injuries caused by accidents and occupational ill-health.
Work-related accidents and illness cost 2.1-2.6 per cent of GDP
each yearequivalent to between
£14.5 billion and £18.1 billion. In June
2000, we issued, jointly with the Health and Safety Commission
(HSC), a key strategy statement on the action we will take, in
concert with other stakeholders, to improve health and safety
over the coming years. Revitalising Health and Safety has
at its heart challenging targets, reflected in the Public Service
Agreement targets set as part of the 2000 spending review. The
Government, the HSC and local authorities will work together to
cut the incidence of deaths and major injuries, reduce the rate
of work related ill-health, and cut the rate of working days lost
from work-related injury and ill-health.
Occupational health is a major part of Revitalising
Health and Safety. In July 2000, the HSC and the Health and
Safety Executive launched a new long-term occupational health
strategy for Great Britain, Securing Health Together. This
sets targets for reducing ill-health for both workers and the
public, cutting the number of working days lost to work-related
ill-health, and fostering a culture of rehabilitation at work.
Road safety is a particular priority. Although
the number of deaths and serious injuries on our roads has fallen
dramatically in the last 20 years, there are still about 3,400
people dying on our roads every year (about one in four of all
accidental deaths). In March 2000, we launched a new road safety
strategy with a target of reducing deaths and serious injuries
by 40 per cent by 2010 compared with the 1994-98 average. This
target incorporates a reduction of child deaths and serious injuries
by 50 per cent. There are also health inequality implications
for road safety. For example, research shows that children from
poorer families are five times more likely to be killed in road
accidents when out walking than children from other families.
We are also concerned that children from minority ethnic groups
also suffer disproportionately from road accident injuries. DETR
is committed to finding solutions to these problems.
The Queen's Speech on 6 December 2000 announced
that a bill would be drafted to provide for safer travel on the
railways, in the air, at sea and on the roads, and would take
forward proposals for revitalising health and safety at work.
This will be the vehicle for further improvements
in the transport safety regime in the UK.
(g) Noise
Another factor that can influence public health
is the prevalence and level of noise. Noise is a particular problem
for urban dwellers, and DETR is responsible for developing strategies
to combat it, including sponsoring research to understand the
problems better and evaluate possible solutions. Thus on noise
nuisance at night, the Department recently published a consultation
paper, following a review of the Noise Act 1996, setting out further
options for local authorities to use in tackling noisy neighbour
problems.
Noise from various types of transport activity
can also cause distress. Even though overall noise levels from
aircraft have decreased over the past 20 years, DETR is committed
to finding practical ways of further improving the quality of
life for people who live around airports. New proposals for enhancing
aircraft noise control are now under consideration following a
consultation exercise launched in July 2000. The Department is
implementing measures to reduce road noise from motorways and
other major routes, including the use of quieter road surfaces
where opportunities arise. Contracts for all new roads and most
resurfacing schemes now specify the use of quieter road surfaces
as a matter of course and by 2010 these surfaces will be installed
on over 60 per cent of the strategic road network, including all
concrete stretches. Present-day welded railway track is quieter
than previous jointed track, but DETR is working with other EU
Member-States on railway noise reduction issues.
(h) Radon
The Department has a long-established programme
to tackle the risks from radon, a naturally occurring radioactive
gas, which is the second most important cause of lung cancer after
smoking. Following completion of the campaign to offer a free
measurement to every household in England with a greater than
5% probability of being above the radon "action level",
the emphasis of the programme changed to encouraging radon remediation
works. Pilot studies have been carried out with three local authorities
in order to help and encourage householders to take action to
reduce radon levels in their homes. Under a new programme building
on experience from the pilot studies, the Department is now working
in partnership with 31 local authorities to reduce radon levels
in homes in radon-affected areas across the country.
(i) Planning
Land use planning largely originated with concern
for public health and it has maintained that link. Planning policy
is concerned with encouraging healthier lifestyles by, for example,
promoting greater use of walking and cycling as safe transport
modes (see below) and securing sufficient provision of open space
and recreational provision in, especially, urban areas. It also
has benefits in terms of social inclusion which may indirectly
promote better health, for example by ensuring that jobs, shopping
and services are located where they are easily accessible to those
who do not have access to a car.
(j) Housing
Good quality housing is a major contributor
to good public health. DETR's Housing Policy Statement, Quality
and Choice; A decent home for allthe way forward for housing,
published in December 2000, confirms the comprehensive strategy
set out in the Housing Green Paper for improving the condition
of the country's housing stock. It includes a range of investment
and ownership options for local authority housing which will help
achieve the target of bringing all social housing up to a decent
standard within 10 years. These options are backed up by a significant
increase in resources: by 2003-04, capital investment in housing
will have risen to more than £4 billion, compared with planned
spending of £1.5 billion in 1997-98. The extra resources
will also increase the delivery of good quality affordable housing
where it is needed. £250 million will be invested over the
next three years in the Starter Home Initiative, which is designed
not only to help key workers such as nurses, teachers and police
afford homes in areas where their services are vital, but also
to promote sustainable communities.
The Supporting People programme to be launched
in 2003 is designed to improve the quality of support services
to vulnerable people by focusing provision on local need. In addition
to £138 million implementation funding over the next three
years, £137 million is being provided through the Safer Communities
Supported Housing Fund to generate additional services for specific
groups including drug and alcohol users and young people at risk.
The Housing Policy Statement set out a range
of actions to improve the condition of stock in the private sector,
including proposals to give local authorities more freedom to
assist owners of poor quality private housing. The disabled facilities
grant programme, which funds adaptations to enable disabled people
to remain in comfort and safety in their own homes, will increase
by £15 million (20 per cent) from 2001-02. DETR funding for
Home Improvement Agencies, which provide practical help and advice
to elderly, disabled and vulnerable home-owners, is also being
increased by over 25 per cent.
DETR's recognition of the close relationship
between housing and health is illustrated by the decision to replace
the housing fitness standard as the basis for action to deal with
unacceptable housing conditions. The standard no longer reflects
a modern understanding of the health and safety risks within dwellings,
and we have published a new, evidence-based rating system for
assessing the severity of such hazards. We will be introducing
legislation to allow authorities to use the rating system as the
basis for their enforcement decisions as soon as the opportunity
arises.
(k) Regeneration
Improving health features as one of the key
outcome areas for the Department's regeneration programmesalongside
raising educational attainment, tackling worklessness, reducing
crime and improving the physical environment. New Deal for Community
(NDC) and Single Regeneration Budget (SRB) partnerships are encouraged
to develop their long term strategies around delivering change
in these key areas.
Over the three-year period to 2003-04, DETR
is spending over £6.5bn to regenerate communities and combat
social exclusion, mainly through the NDC (£1.2bn) and the
Regional Development Agencies (RDAs) (£4bn). These programmes
support health-related projects where these are part of a local
regeneration strategy for the area, and DETR has emphasised the
importance both of improving health through integrated regeneration
strategies, and of reducing inequalities in health and access
to health and social care. Where appropriate, regeneration partnerships
involve the local Health Authority at a strategic level and Primary
Care Groups and local service providers at a more operational
level in putting together projects. They also link with and reinforce
targeted health related initiatives such as Healthy Living Centres
and Health Action Zones.
The eight RDAs and the London Development Agency
manage the Single Regeneration Budget and the physical regeneration
programme and have a remit to take an integrated approach to deal
with economic underachievement in the regions. The RDAs have worked
with regional partners to develop regional strategies which address,
amongst other things, health issues. The RDAs' various budgets,
including SRB, are being brought together into a Single Budget
from April 2002 to improve their ability to deliver the regional
strategies. Also £150m of extra funding has been made available
to the RDAs for 2001-2002, and substantially greater sums for
the following two years.
(l) Neighbourhood Renewal
The National Strategy for Neighbourhood Renewal
Action Plan launched on 15 January 2001 will be a blueprint for
action over the next 10-20 years on tackling deprivation and raising
standards, including standards for health, in the most deprived
areas. The new Neighbourhood Renewal Unit, which will be charged
with implementing this strategy, will be based in DETR but will
have a cross-cutting remit to join up relevant activity throughout
government and the rest of the public sector, as well as the voluntary/community
and private sectors. A new Neighbourhood Renewal Fund, worth £800
million over three years, will help target services at the most
deprived areas.
(m) Building Regulations
DETR is responsible for the Building Regulations,
which apply in England and Wales (other comparable sets of regulations
apply in Scotland and Northern Ireland and are the responsibility
of the devolved administrations there). The Regulations apply
to the construction of most new buildings and other defined kinds
of building work. The regulations play a key part in securing
the health, safety and welfare of building users, by addressing
such issues as structural safety, fire safety, as well as energy
efficiency and access and facilities for disabled people. Of particularly
direct relevance are the provisions with regard to hygiene, ventilation
and dampness.
Several reviews of the technical requirements
of the regulations are presently in hand. They include ones addressing
energy efficiency (with implications both for climate change and
the welfare of building users); sound insulation (both against
external noise and against noise from within the building); drainage
and waste disposal (where there are issues of sustainability as
well as the more obvious relevance to public health); and requirements
with regard to heat producing appliances, where satisfactory provision
for the removal of products of combustion is essential to prevent
carbon monoxide poisoning. Requirements on access and facilities
for disabled people were extended to new homes from October 1999,
and the requirements of the regulations on access and facilities
for disabled people in non-domestic buildings are currently under
review.
(n) Green Spaces
Access to countryside and open spaces reduces
stress and promotes wellbeing. Providing well managed public open
spaces, including children's play areas and recreational and sporting
areas, gives people the opportunity to have a healthier life style.
A DETR Minister is responsible for overseeing the development
of a vision and proposals for the sorts of parks, play areas and
open spaces we want to see created in the future and how they
should be managed. DETR is also responsible for policies for the
countrysidewhich is of course an enormous recreational
assetincluding helping all sections of the community enjoy
the countryside. The recent White Paper Our countryside: the future,
a fair deal for rural England sets out measures to improve transport
and mobility to ensure access to services in rural areas. These
include support for community transport and other measures to
improve personal mobility as well as increased financial support
for rural public transport.
(o) Walking and cycling
The Department of Health recommends that all
adults should participate in at least 30 minutes of moderately
intense physical activity, such as brisk walking, five times a
week. DETR is responsible for the promotion of walking and cycling
as forms of transport in England. It is one of the aims of Transport
2010 to make them more viable, attractive and safer, and the new
road safety strategy includes a chapter on how we aim to improve
the safety of pedestrians, cyclists and horse riders. The Urban
White Paper Our Towns and Cities: The Future published in November
2000 calls for patterns of development that make walking and cycling
more attractive options. The Department promotes and encourages
walking and cycling in various other forms of guidance which it
issues.
7. There are many other areas where DETR
makes an important contribution to public health. The provision
of good quality public transport helps to provide greater mobility
and reduces isolation. Public transport links to medical facilities
are also important in cases where medical intervention is required.
Policies that stimulate the development of healthy and secure
urban environments, and effective waste disposal, also contribute
to general health and wellbeing.
8. At the macro level, DETR has the UK Government
lead on climate change, which could lead to an increase in water-borne
infections, food poisoning, heat-related illness and deaths and
even vector-transmitted disease. The UK Government has played
a leading role in global efforts to tackle climate change and
will continue to do so. UK scientists, many of which receive funding
from DETR, have been at the forefront in the development of the
global climate models for climate prediction that underpin the
policy debate. DETR has also co-operated with the Department of
Health on their assessment of the national implications of climate
change on human health within the framework of the DETR-funded
UK Climate Impacts Programme.
HEALTH INEQUALITIES
9. The Memorandum to the Select Committee
by the Department of Health, and memoranda from other expert organisations,
provide evidence of the existence of health inequalities in the
UK. DETR acknowledges the connections between health inequalities
and other aspects of social policy, and is willing to work with
relevant partners in addressing these complex issues.
10. One particularly important issue is
the link between death rates and deprivation. Recent Office of
National Statistics figures show that for those aged 20 to 64
who met three of the four criteria for deprivation (that they
are in social class IV or V, live in rented accommodation, have
no access to a car and are unemployed) mortality rates are double
the national average. The urban characteristics of deprivation
are also striking. Of the 60 high mortality rate areas, 49 are
in areas classified as "coalfields", "manufacturing
centres", or "ports and industry". Such areas have
many of the characteristics of deprivation and a large proportion
of the population with a limited long-term illness. Our Towns
and Cities is thus a key step in the fight against health inequalities.
11. Improvements in several of the general
policy areas referred to above will help reduce health inequality.
For example, better public transport will increase mobility, and
provide better access to facilities, including health facilities,
for the less well off. The major package of proposals in Our Towns
and Cities also bears more directly upon health inequalities,
given the intensity of deprivation in certain urban areas. The
new indices of deprivation published by DETR in August 2000 provide
more pointers to the nature and distribution of deprivation in
England. One of the six "domains" aggregated together
to form the overall indices measures health deprivation and disability,
and identifies people whose quality of life is impaired by either
poor health or disability. It recognises that while poor health
is closely inter-related to other aspects of deprivation, it is
also an important aspect of deprivation in its own right. Premature
death is the ultimate manifestation of this, but chronic ill health
and disability also greatly impair the quality of people's lives.
12. DETR has a number of policy initiative which
are specifically aimed at addressing health inequalities. To take
just two examples:
We lead the wider Government efforts
to tackle the problem of fuel poverty. This is thought to be a
major contributor to the annual excess winter death toll amongst
older householders, and may increase the risk of respiratory illness
amongst the young. DETR is working the social landlords to improve
the heating and insulation of council properties, and the new
Home Energy Efficiency Scheme is designed to help older households
and others particularly vulnerable to cold-related ill-health,
living in the owner-occupied or private rented sectors. The scheme
provides grants of up to £2,000 for packages of insulation
and heating improvements, including central heating systems for
low-income older households. Local referral networks are used
to reach householders, involving health professionals, social
workers and others active in the community.
Those sleeping rough are especially
vulnerable to health problemsmental illness, drug and alcohol
problems and extremely high early mortality ratesand some
will have become rough sleepers as a result of such problems.
The Rough Sleepers Unit has a target to reduce the number of people
sleeping rough in England by at least two thirds between June
1998 and April 2002. Help in finding accommodation, tackling drug
and alcohol problems and building a new life will have important
benefits in public health terms, as will the emphasis on preventing
more people becoming rough sleepers.
The Rough Sleepers Unit is in particular
undertaking a project designed to improve access to primary health
care for people sleeping rough, who generally have very poor physical
health and experience difficulties getting the help they need.
ORGANISATIONAL ISSUES
13. DETR believes that the way to ensure that
public health is tackled in the round is through effective "joined
up" policy making and delivery of health related services
at every level, rather than through changing the machinery of
government. DETR ministers and officials work alongside those
of the Department of Health in policy formulation relevant to
health. Examples include air pollution (where the Expert Panel
on Air Quality Standards has a joint DETR/Department of Health
Secretariat), noise, environmental chemicals, radiation (the Secretary
of State for the Environment, Transport and the Regions, and the
Secretary of State for Health each has statutory responsibilities
in relation to the authorisation of radioactive discharges by
the Environment Agency), sustainable development, and fuel poverty.
DETR and Department of Health officials have also worked together
to produce the first housing strategy for older people, which
aims to provide an ongoing focus for addressing and responding
to their particular housing and social care needs.
14. DETR recognises that the proliferation
of initiatives and "zones" to deal with specific issues
can produce overlap and confusion. The integrating role of the
Regional Development Agencies in managing the Government's regeneration
programme and the Single Regeneration Budget has already been
described. We also support the setting up of the Regional Co-ordination
Unit (RCU), and the new measures it introduced in November 2000
to improve the co-ordination of area based initiatives.
15. The RCU's action plan, published in
October 2000, reiterates the NHS Plan commitment to establish
single, integrated public health groups across NHS regional offices
and the Government Offices for the Regions. More generally, RCU
and Government Office officials are exploring with Department
of Health colleagues how the Government Offices can contribute
to implementing the NHS plan and reducing health inequalities.
This is closely linked to other Departments' work, not least DETR's
own, in supporting the health improvement agenda and it will also
do much to address social exclusion. Areas where it is anticipated
that closer working in the regions will have an impact include
children and young people's services including teenage pregnancy
and parenthood, older people services, community involvement and
development, economic and social regeneration and more generally
the broader development of Local Strategic Partnerships (see below).
The RCU is also taking an interest in the commitment in the Modernising
Government White Paper to review the co-terminosity of NHS and
Government Office boundaries in 2002.
16. DETR also supports measures to simplify
and clarify responsibilities at the local level. We believe it
is essential for local authority and health authority officials
to work together in the field of public health improvement. The
Health Act 1999 already provides local authorities and health
authorities with powers to carry out functions on behalf of one
another, by agreement. The Local Government Act 2000 contains
a new power which provides councils with the powers to extend
this partnership approach to other bodies, in addition to the
NHS. The Local Government Act 2000 also requires local authorities
to work together with other bodies to produce strategies for promoting
the wellbeing of their local communities. These community strategies
will be developed by Local Strategic Partnerships to look at all
aspects that contribute to quality of life, to agree priorities
for action and to co-ordinate the work of partnerships dealing
with particular neighbourhoods or specific issues.
17. The work of Local Strategic Partnerships
and the development of community strategies should enable local
service deliverers to secure public health improvements more effectively.
DETR is encouraged by the enthusiastic reaction to these new provisions
and is not convinced that institutional solutions, such as transferring
Directors of Public Health from the health authority to a local
authority, is necessary to deliver significant public health improvements.
The structure DETR is promoting gives local leaders freedom to
work in partnership, to make whatever organisational changes they
consider necessary to improve the delivery of services.
18. DETR welcomes the establishment of the
Health Development Agency (HDA). We believe the Agency can play
a major role in disseminating guidance based on evidence and best
practice, and in facilitating public health improvements. DETR
worked with the HDA's predecessor's the Health Education Authority
on the publication Making THE Links, which provides guidance
to public health practitioners on integrating sustainable transport,
health and environmental policies. This is an excellent example
of joint work which DETR commends to the Select Committee. DETR
is a member of the Policy Advisory Group of the HDA, and is currently
exploring a number of proposals for making an active contribution
to the Agency's future work. DETR is also represented at a senior
level on the National Governing Board of Public Health Observatories.
19. DETR has established a "health
agenda network" within the Department itself, to bring together
officials whose different policy responsibilities bear upon the
public health. This network, whose meetings are attended by Department
of Health officials, is also a useful sounding board for consideration
of public health issues in DETR. We also undertake work jointly
with the Department of Health in the international arena. DETR
and DoH Ministers are parties to the Charter on transport, environment
and health agreed at the WHO Europe conference on environment
and health in June 1999. DETR and DoH officials took a prominent
role in the development and drafting of the Charter and are now
actively involved in promoting its implementation.
20. DETR has an important role as a sponsor
of research and supplier of information and guidance. As well
as the Indices of Deprivation mentioned previously, the Department
produces much guidance of relevance to public health practitioners,
for example local sustainable development indicators. As part
of the cross-government drive towards modernising the policy making
processes, it is reviewing its procedures for assessing evidence
and commissioning further research. DETR acknowledges that there
is sometimes frustration at the local level if guidance provided
by different departments is not properly targeted or co-ordinated.
It is also therefore making much greater efforts to ensure that
"joining up" occurs at a national level.
CONCLUSION
21. This Memorandum has sought to describe
the extent of DETR's involvement in delivering the Government's
public health improvement programme. It has attempted to illustrate
that public health improvements can only be delivered effectively
by action across Government, at all levels of government,
and by means which are not often or always recognised as
`public health' initiatives.
22. The Department would be happy to explore
any of the issues raised in this Memorandum in more detail.
January 2001
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