Memorandum by Heart of Mersey (WP 14)
Thank you for the opportunity to respond and
give evidence to the Health Committee on the Government's Public
Health White Paper.
Heart of Mersey (HoM)* welcomes the White Paper
"Choosing Health: Making healthy choices easier"
as an important start to a Governmental commitment to "promote
physical and mental wellbeing and prevent illness".
In Merseyside, we have particularly high levels
of coronary heart disease (CHD) in some of the most socially and
economically disadvantaged communities in England. HoM is a combined
response across this region to address the causes of CHD. As a
regional intervention programme HoM can pool resources to address
coronary heart disease prevention. For example, HoM is able to
develop research to support its interventions, to work towards
ensuring healthier food is available to our local population and
to support more smoke-free public places.
HoM is able therefore to make its own contribution
to some of the priorities highlighted in the White Paper.
In general, HoM sees the White Paper as making
an important start on key public health issues but feels that
too many of its actions focus on the individual.
Our brief responses to your specific questions
are detailed below:
1. WHETHER THE
PROPOSALS WILL
ENABLE THE
GOVERNMENT TO
ACHIEVE ITS
PUBLIC HEALTH
GOALS
We feel that there are serious limitations in
the proposals.
Firstly in regard to food.
Heart of Mersey has recently published a Food
and Health Strategy for Greater Merseyside. [53]The
strategy identifies the role HoM can play in "upstream"
interventions such as in food procurement, in work with the food
industry including caterers and in contract specifications. In
addition HoM seeks to involve our local community through promotional
campaigns.
However, we are unable to influence the Common
Agricultural Policy (CAP) where so many key decisions are made
in food subsidies and support for farmers. Heart of Mersey urges
that a major reform of the CAP is required in which food production
is clearly related to the health needs of the consumer.
There is a huge contrast between allocations
in the CAP budget and the dietary targets of the World Health
Organisation (WHO) and the Food and Agricultural Organisation
(FAO) and illustrate the urgent need for reform. In particular
there should be a switch from animal-based to plant-based production
and towards more sustainable production.
Whilst a major omission in the White Paper,
HoM believes that it is essential that this "European"
dimension is considered in the planned Food and Health Action
Plan.
We congratulate the Government on the moves
it has already made towards clearer food labelling and controlling
the marketing on "junk" food to young people. However
HoM believes that more regulation is required if we are to be
successful in controlling some of the advertising excesses of
the food industry and we fully support the Children's Food Bill
and its commitment towards better food and a healthier future.
Further, HoM believes that national legislation
is required to support a reduction in salt, fat and sugar in all
processed food products manufactured and sold in the UK.
Finally, in supporting the public sector to
carry out its role as a corporate citizen, HoM urges the Government
to develop nutrient-based guidelines for public sector procurement.
Secondly, concerning tobacco.
Heart of Mersey organised a coalition of Greater
Merseyside Local Authorities and NHS Trusts to write to the Rt
Hon John Reid just prior to the publication of the White Paper
supporting the case for national legislation to prohibit smoking
in enclosed workplaces.
We are therefore pleased that tobacco has received
a high profile in the White Paper and support the Government's
continuing action to further curtail the advertising and production
of tobacco products. HoM believes this has helped to reduce the
prevalence of smoking and supports those smokers who have given
up. However HoM is concerned that the proposed legislation
on smokefree legislation is half-hearted and potentially ineffective.
We believe that the evidence on the detrimental health effects
of secondhand smoke is unequivocal.
As in many other areas, there is a clear mandate
for public places to be smoke free: according to the Big Smoke
Debate—North West, over 85% of North West residents would
prefer smoke free public places.
There are major differences in smoking habits
across Greater Merseyside with rates of over 50% in some of our
more disadvantaged neighbourhoods.
HoM believes that by permitting those public
houses not serving food to allow smoking, this will have a disproportionate
effect in our poorest areas and will encourage greater health
inequalities. We urge a reconsideration of the wording of the
new legislation towards a clear and unambiguous message towards
the pub and hospitality trade.
In the meantime HoM strongly supports Liverpool
City Council's Private Bill (section 239 of the Local Government
Act 1972) to protect workers from second hand tobacco smoke by
prohibiting smoking in enclosed workplaces.
2. WHETHER THE
PROPOSALS ARE
APPROPRIATE, WILL
BE EFFECTIVE
AND WHETHER
THEY REPRESENT
VALUE FOR
MONEY
HoM will develop social marketing campaigns
with our partners supported by our phoneline and website to engage
our local communities to create more informed choices. However,
this needs to be supported by Government campaigns promoting healthier
food choices and a smoke-free environment.
As previously noted, national legislation is
necessary in certain situations. Tobacco is a good example. Voluntary
agreements simply do not work. In many cases, people are very
clear on the healthiest choice. For example most people feel strongly
about food in schools but legislation will be necessary to
require food companies to produce healthier processed foods (with
less hidden fats, sugar and salt) and at the same time advertising
targeting children must be restricted.
If individual and informed choices are not supported
we run the real risk of increasing inequalities as it is always
those from the most disadvantaged areas (including large areas
of Merseyside) who find it hardest to make the changes towards
a healthier lifestyle.
It is difficult to say if the proposals represent
value for money. However, studies have shown that investment in
reducing risk factors (such as promoting a healthier diet to reduce
serum cholesterol) for coronary heart disease is a much cheaper
and more effective method of reducing the disease than cardiological
treatments. [54]
3. WHETHER THE
NECESSARY PUBLIC
HEALTH INFRASTRUCTURE
AND MECHANISMS
EXIST TO
ENSURE THAT
PROPOSALS WILL
BE IMPLEMENTED
AND GOALS
ACHIEVED
HoM believes that it is essential that adequate
funding is provided to support the work described in the White
Paper. Some should be allocated to national social marketing campaigns
linked to local and regional programmes such as Heart of Mersey.
We are pleased that the Government has pledged
to provide more funding to strengthen the evidence base for the
White Paper.
We hope that funding will also be made available
to organisations such as Heart of Mersey who are making a concerted
effort towards preventing the biggest killer—coronary heart
disease—of the population of Greater Merseyside.
* Please note:
Heart of Mersey is a coronary heart disease prevention
programme funded primarily by the 10 primary care trusts and six
local authorities of Greater Merseyside. Its Management Board
includes representatives from:
— Chief Executives and Directors of Public
Health from the Merseyside Primary Care Trusts;
— Chief Executives of the Merseyside local
authorities;
— The Merseyside Councils for Voluntary
Service;
— cardiac patients;
— Merseyside Public Protection Officers;
— University of Liverpool; and
— the host organisations of Sefton Borough
Council and the Sefton Primary Care Trusts.
Heart of Mersey is a non-governmental organisation
currently seeking charitable status.
January 2005
53 http://www.heartofmersey.org.uk/uploads/documents/hm_412r_HoM_foodstrategy_Jan05.pdf. Back
54
See for example, Kelly and Capewell, HDA, 2004: http://www.hda.nhs.uk/Documents/CHD_Briefing_nov_04.pdf. Back
| 
