Memorandum by The Royal Society for the
Promotion of Health (WP 04)
INTRODUCTION
The Royal Society for the Promotion of Health
is the UK's largest and longest-established public health body.
We were founded in 1876 by a group of reformers including Edwin
Chadwick and Florence Nightingale. Since our foundation, our aim
has been to promote improvement in human health through education,
communication and the encouragement of scientific research. We
are a multidisciplinary body, and we consulted extensively across
our membership in order to prepare our response to the Choosing
Health consultation in 2004.
The Royal Society for the Promotion of Health
is an independent and self-financing organisation. We receive
no government money and we represent no special interest. We hope
our submission will be of value to the Committee in its work and
will be happy to present oral evidence if called to do so.
1. Will the proposals enable the Government
to achieve its public health goals?
(i) We feel that the following White Paper
commitments will make a particularly effective contribution towards
the achievement of these goals:
— The new cabinet subcommittee to ensure
joined-up working across departments.
— The commitment to six-monthly progress
report on key indicators.
— The proposals for developing health in
the workplace.
— The commitments to significant amounts
of new money in research and innovation.
— The financial commitment to local workforce
capacity building.
(ii) The following are unlikely to enable
government to achieve its objectives:
— More self-regulation for the food industry,
particularly given that Melanie Johnson MP has already publicly
taken the food industry to task over its footdragging on salt
content in food, and that the Salt Manufacturers' Association
has tried to stop the Food Standards Agency's public health awareness
campaign on salt.
— A partial smoking ban in public places.
We see no clear indicator as yet of how the government will judge
the effectiveness of this policy. Accepting that not all enclosed
public spaces are to come under the present ban, we are not content
with a blanket exemption and would prefer to see a temporary deferral
which would be reviewed every three years. This would place the
burden of proof onto the smoking lobby for any continuation.
— Making "we will work closely with
the Portman Group" and liberalising licensing laws the twin
pillars of future alcohol policy.
(iii) The following, which could help government
achieve its goals, have been largely overlooked by the White Paper:
— The role of the built environment in
promoting healthy lifestyles, both of urban planning to reduce
fear of crime and promote walking, and of "designing health
into" individual buildings.
— The Wanless Review made the case for
greater investment in public health to allow for significant savings
in acute and chronic NHS care. As over 65s occupy around 2/3of
NHS beds it seems clear that in order to secure the "Wanless
gains" a significant proportion of the investment in public
health will need to be targeted at people in middle age and upwards.
There are seven nice photographs of older people in the White
Paper (eight if you include John Reid) and although many older
people will certainly benefit from the general commitments it
makes, there is almost nothing in the White Paper which is specifically
targeted at older people. For this reason we have some concerns
that the approach outlined in "Choosing Health" may
not in fact get us off to a very sound start in terms of shifting
the balance of funding from reactive to preventive health interventions.
2. Are the proposals appropriate and effective
and do they represent value for money?
To a certain extent this Committee's enquiry
is posing questions which cannot yet be answered. The White Paper
sets out a broad approach with a wide range of objectives, and
indicates that a delivery plan is to be developed for early 2005.
We believe that the Health Select Committee might be in a better
position to make judgements about the appropriateness and cost-effectiveness
of the government's proposals once a delivery plan has been published.
We believe that the most cost-effective measures
government can take generally involve use of its regulatory powers.
Where government does not wish to use these powers it may find
itself obliged to spend more money on social marketing and reactive
interventions. For example there will be less positive health
impact of a social marketing campaign to promote healthier eating
if it is fighting for people's attention against the "background
noise" of commercial advertising for junk food.
We believe the following White Paper commitments
are likely to be particularly cost-effective:
— Developing the extended schools scheme.
— Using the enormous power of the NHS
as an employer, a service provider and a procurer to take a lead
on sustainable development, tackling inequalities and building
health literacy.
— Encouraging a greater role for health
in the workplace.
3. Do the necessary public health infrastructure
and mechanisms exist to ensure that proposals will be implemented
and goals achieved?
Some of what the government is proposing is
completely new—for example the new cadre of health trainers,
so neither infrastructure nor mechanisms exist as yet. We hope
that the Committee will revisit these questions in six or nine
months' time when it will be possible to hold the government more
clearly to account on these matters.
January 2005
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