MEMORANDUM 30
Submitted by the Health Development
Agency (HDA)
INTRODUCTION
1. The Health Development Agency (HDA) welcomes
the opportunity to submit the following evidence to the Home Affairs
Select Committee. The HDA is a Special Health Authority, working
to improve the health of people and communities in England, in
particular, to reduce health inequalities. In partnership with
others, it gathers evidence of what works, advises on standards
and develops the skills of all those working to improve people's
health. The role of the HDA is different from that of its predecessor,
the Health Education Authority, whose primary purpose was education
of the public on health issues, including drugs. The Health Education
Authority was cited in Tackling Drugs to Build a Better Britain
(1998) as one of the mechanisms for supporting the delivery of
the national drugs strategy.
1.1 As part of its wider remit for developing
the evidence base for public health, the HDA is currently collating
and assessing published and unpublished reviews of the evidence
base for drug education and prevention, particularly in relation
to reducing health inequalities. This work will be completed by
May 2002 and complements an international collaborative project
(Brown and Hosman, 2001), which is currently reviewing the international
evidence base for drug education and prevention.
1.2 The Health Development Agency's response
will focus on the following points:
1.2.1 The evidence base for the Government's
drugs policy
1.2.2 The contribution of the Government's
drugs policy to health improvement and tackling health inequalities.
1.2.3 Public health systems to support drug
education and prevention and the capacity and capability of the
public health workforce to deliver the Government's drugs policy.
The evidence base for the Government's drugs policy
2.1 At present the evidence base for policies
on drugs does not meet established quality standards for scientific
evidence. In this respect drugs policies in England, Scotland,
Wales and Northern Ireland are no different from those in Europe,
North America and internationally.
2.2 Most initiatives and innovations in
the drug education and prevention field are not evidence-based
and have not been subject to evidence-based evaluation. Initial
findings from the HDA's review show that there are very few systematic
reviews of drug education and prevention activity. In other words,
there are very few peer-reviewed journal articles, which employ
a rigorous methodology to compare different types of drug education
and prevention interventions and their outcomes. Even when we
cast the net wide to include published literature reviews, meta-analyses
or syntheses, the body of evidence for effective drug education
and prevention with vulnerable groups in the UK is small.
2.3 There is an understandable time lag
between completion of research studies, acceptance in peer-reviews
journals and, therefore, any resulting published systematic reviews.
Recognising this time lag, the HDA will also be trawling databases
to identify and assess "grey" literature, such as reports
of evaluations on drug education and prevention interventions
in the UK, to identify interventions that look "promising".
2.4 In developing other evidence bases,
including those for tobacco, alcohol, teenage pregnancy and sexual
health, the HDA is able to examine relationships between effectiveness
in these areas and the implications for drug education and prevention.
The contribution of the Government's drugs policy
to health improvement and tackling health inequalities
3.1 We do not know if drug use is more prevalent
amongst vulnerable groups because very few studies have been broken
down in terms of social class and other indicators of vulnerability.
But there is a body of knowledge that those who are "worst
off" are more vulnerable to the negative effects of drug
use. One of the most effective ways of reducing inequalities is
by tackling child poverty, and the Government's drugs policy emphasises
supporting the most vulnerable groups of young people. Apart from
local Drug Action Teams, the main bodies and projects, which have
tried to link research with practice in relation to effective
drug education and prevention with vulnerable groups include the
following:
3.1.1 The University of Central Lancashire's
Ethnicity and Health Unit of the Faculty of Health;
3.1.2 The Home Office Drug Prevention Advisory
Service's Vulnerable Groups Consortia;
3.1.3 The Department of Health's additional
Health Action Zones funding for addressing drug education and
prevention needs of vulnerable groups and its related evaluation
and dissemination of good practice project, based at Bradford
Health Authority;
3.1.4 The independent voluntary organisation,
DrugScope's "Right Approach. Quality standards in drug education
(1999)" and DrugScope's LocateNet database, which maps UK
young people's drug prevention projects and any resulting evaluation;
3.1.5 The National Healthy School Standard,
which contributes to reducing drug-related school exclusions,
as well as other education and health issues;
3.1.6 The Department for Education and Skills'
(DfES) Connexions Service, which provides personal advisers for
all young people, including vulnerable young people, between the
ages of 13 and 17;
3.1.7 UK Anti-Drugs Co-ordination Unit and
DfES programme to support young people who have graduated from
drug treatment programmes into training and employment;
3.1.8 The National Children's Bureau Drug
Education Forum's "Drug Education for Children and Young
People in Public Care" project.
3.2 All these initiatives, plus the many
promising interventions commissioned and delivered at a regional
and local level, have helped to fill some of the gaps in the knowledge
base with regard to vulnerable groups. Some, but not all, of these
initiatives have been a direct result of the Government's drugs
policy.
Public health systems to support drug education
and prevention and the capacity and capability of the public health
workforce to deliver the Government's drug policy.
4.1 The Government's drugs policy relies
on good partnership working between key stakeholders, including
young people, at a local and neighbourhood level, particularly
when tackling drug-related crime. The proposed restructuring of
the NHS (Shifting the Balance of Power Within the NHS, 2001) will
provide opportunities for greater ownership of the agenda for
drug prevention and tackling health inequalities. Regional Directors
of Health and Social Care will have a responsibility for supporting
health and social services activity at a local level, in particular,
by ensuring strong links with the agendas of other government
departments. Primary Care Trusts and Care Trusts will provide
support to Drug Action Teams and, by supporting newly emerging
Local Strategic Partnerships, will ensure that drug prevention
priorities are, included in, and supported by, local community
strategies and Health Improvement and Modernisation Plans. Inevitably,
changing landscapes for the public health workforce can reduce
their ability, in the short term, to contribute effectively to
the government's drugs policy. This can exacerbate existing difficulties
in recruitment and retention of suitably trained or experienced
workers to deliver some of the programmes highlighted in the government's
drugs policy.
4.2 In conclusion, the HDA will ensure that
the evidence base for drug prevention and tackling health inequalities
is accessible to a wide range of stakeholders. The evidence base
will inform guidance for commissioners of drug prevention services.
However, the shift towards evidence-based practice should not
have the effect of stifling innovation. Innovation is a vital
part of a dynamic and evolving evidence base particularly in relation
to tackling health inequalities and the wider determinants of
health.
September 2001
REFERENCES AND
BIBLIOGRAPHY
Acheson, D (1998). Independent Inquiry into
Inequalities in Health Report. London: The Stationery Office.
Brown, C and Hosman, C (2001). International
Classification of Prevention Trials. Society for Prevention Research
(work in progress).
DH (2001). Shifting the Balance of Power in
the NHS. London: The Department of Health.
DH (2001). Tackling Health Inequalities. Consultation
on a plan for delivery. London: Department of Health.
DfES (2000). Connexions. The best start in life
for every young person. London: DfES.
DfES/DH (1999). National Healthy School Standard.
Guidance. London: DfES
DrugScope (1999). The right approach: quality
standards in drug education. London. DrugScope.
Meyrick, J., Burke, S., and Speller, V (2001).
Public Health Skills Audit 2001. Short Report. London: Health
Development Agency.
Health Development Agency (2000). Health Improvement
Programmes (HimPs) 1999-2000. Conclusions and recommendations
of the Health Development Agency's National Review. London: Health
Development Agency.
Tackling Drugs to Build a Better Britain (1998)
Government White Paper. London: The Stationery Office.
White, D and Pitts, M (1998). "Educating
young people about drugs: a systematic review", in Addiction,
93(10), 1475-1487.
September 2001
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