Memorandum by Manchester Health Inequalities
Partnership (WP 12)
1. INTRODUCTION
1.1 The Manchester Health Inequalities Partnership
(HIQP) is one of the seven Thematic Partnerships that comprise
the city's Local Strategic Partnership. It includes representatives
from several departments of the City Council, the three Manchester
PCTs, the Community Network for Manchester, the NHS acute sector,
and local universities.
1.2 This document sets out some brief comments
on Choosing Health: Making healthy choices easier. In the time
available it has not been possible to prepare a comprehensive
response: this paper simply sets out some of the key points made
by the HIQP in its consideration of the White Paper.
1.3 The White Paper's priorities for action
closely mirrors the key local public health priorities set by
the HIQP; consequently the comments set out below are largely
structured around these priorities rather than around the chapter
headings.
2. OVERALL PERSPECTIVE
2.1 In many ways the White Paper is disappointing.
Its dogged insistence on focusing on choice rather than the socioeconomic
determinants of health runs counter to the HIQP's recommendation
in its response to the consultation, although it is true that
to some extent such determinants are addressed by other areas
of government policy. In addition, the proposals are weak in many
areas where the HIQP was urging bravery and radicalism. However,
there are some parts of it that are very welcome.
3. SPECIFIC PRIORITY
AREAS OF
WORK
3.1 Tackling tobacco. The proposals around
smoke free public places are woefully inadequate. They do not
go far enough and the timescales for implementing the proposals
are absurdly long. There is some evidence to suggest that in Manchester
they may in fact contribute to a widening of health inequalities
within the city, as the city centre and gastropubs go smoke free,
and the local pubs in more deprived communities stop serving food.
The creation of "drinking only" establishments may also
go counter to the drive towards a more Continental drinking culture,
and so encourage binge drinking. We believe that these proposals
will widen social health inequalities, so run counter to the government's
public health priorities. They are therefore not appropriate;
they will not be effective; and nor will they represent value
for money. The Regulatory Impact Assessment published alongside
the White Paper illustrated that the net economic benefit from
completely smoke free public places is significantly greater than
from the proposed policy position. We strongly recommend that
the Committee should urge Government to reconsider this policy
and implement a total workplace smoking ban by summer 2006.
3.2 Food and health. The commitment to fund
more community food initiatives is welcome, although details are
sketchy; the advertising restrictions are welcome though not sufficient;
but it is disappointing that the government has failed to be more
robust in challenging and regulating the food industry, and there
is no indication of new resources coming to local areas to support
developments. We believe that voluntary approaches to advertising
restrictions and product development will have little impact:
it would be considerably more effective in meeting public health
goals for the government to act now to tighten regulation of the
food industry.
3.3 Physical activity. The White Paper is
generally weak on promoting physical activity: it is to be hoped
that the promised Physical Activity Action Plan will be an improvement.
More guidance is promised, and investment in schools sport and
PE, but there is little sense of a coherent strategy. In particular,
the government has shied away from the area that seems most likely
to be effective in increasing levels of physical activity: using
whatever measures necessary to get people out of their cars for
most journeys. A range of anti-car and pro-alternative measures
will be needed, including ones that impact on people financially,
to increase active travel and help people build activity into
everyday life.
3.4 Accidents. Unsurprisingly when the prevailing
dogma is one of choice, the White Paper has almost nothing to
say about accident prevention at all; it is not even one of the
key priorities for action. RoSPA will be commissioned to establish
an accreditation scheme to sustain best practice, and there is
to be a national standard for cycle training—but no new
resources to run more classes, which is the problem in Manchester.
There is nothing on reducing traffic speeds nor any new investment
in home safety, education programmes, or falls prevention services.
Given that accidents are the leading cause of death among young
people, we believe that this is a missed opportunity. Government
should act to review national speed limits such that most roads
in built up areas have a 20 mph limit: this provably saves lives,
even over short timescales, and is known to be extremely cost
effective.
3.5 Sexual health and teenage pregnancy.
It is possible that sexual health services will see the biggest
change as a result of the White Paper, with new resources promised
and hints about changes to the way sexual health services are
delivered. Little is said about teenage pregnancy, short of a
commitment to "support[ing] Teenage Pregnancy Partnership
Boards to strengthen delivery of their strategy in neighbourhoods
with high teenage conception rates." There is little about
prevention. In particular, insisting that adequate sex and relationships
education is provided in all schools (they can currently largely
opt out) will be essential. The government has always shied away
from this, and does so again in the White Paper.
3.6 Alcohol. Overall, investment in treatment
appears strong, but there is little to excite those interested
in prevention: no regulation of high volume vertical drinking,
nothing (other than education campaigns) to encourage more responsible
drinking, and a tobacco policy that may make things worse. We
strongly believe that the government should make the promotion
of public health a key objective of licensing policy, and that
current licensing proposals should be reviewed accordingly. Current
policy seems very likely to run counter to attempts to reduce
binge drinking and general levels of alcohol consumption, with
all the health consequences of this.
4. OTHER COMMENTS
4.1 PCT funding. PCT funding is mentioned
briefly and inadequately: "We shall continue and if possible
accelerate distribution towards need" (emphasis added). Manchester
has been campaigning for PCTs to reach their target allocations
by 2010: at the current pace of change it could take some PCTs
more than 20 years to reach the level of funding identified as
their "fair share" of NHS resources. Most of the "losers"
are in deprived areas, and most of the "winners" in
more prosperous areas: hardly helpful in achieving reductions
in health inequalities.
4.2 Health trainers. We welcome the idea
behind health trainers, but whether these will emerge as a significant
and valuable part of the workforce will ultimately depend on whether
they are adequately resourced and trained to provide the intensity
and type of support required. What is not needed is a group of
volunteers trained to tell people where the nearest leisure centre
is. What is needed is people with the skills and the time to work
closely with individuals and families, identifying on a one to
one basis what it is that is preventing them from choosing a healthy
lifestyle, and supporting them to address whatever issues need
to be dealt with. This may initially apparently have little to
do with health—it may be about dealing with debt, or low
self-confidence, or lack of skills. However, without these factors
being addressed no amount of signposting people to services or
"persuading" them to change their lifestyle is going
to be helpful or sustainable.
5. CONCLUSION
5.1 The White Paper contains one or two
key initiatives that, if adequately funded, could be interesting
and innovative ways of encouraging individuals to change their
behaviour patterns in ways that will be beneficial to their health.
However, on many occasions it shies away from taking the sort
of radical action we urged when responding to the consultation.
It also tends to assume that those other areas of government policy
that deal with the main determinants of health are acting in a
health positive way, rather than challenging them to do better.
5.2 For most of the strategies associated
with the local public health priorities there is little in the
way of innovation. Ultimately what was touted during the consultation
phase as being "the most exciting opportunity for public
health in 20 years" has ended up being disappointingly thin
on radical social changes to improve health and reduce inequalities.
January 2005
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