Memorandum by the Socialist Health Association
(WP 21)
1. The Socialist Health Association promotes
health and well-being, social justice and the eradication of inequalities
through the application of socialist principles to society and
government. It is a voluntary group that is affiliated to
the Labour Party and seeks to influence the Party's policies to
reflect socialist principles.
2. The Association welcomes the opportunity
to give evidence to the Health Select Committee on the Government's
public health White Paper—Choosing Health: making healthy
choices easier on:
2.1.1 Whether the proposals will enable
the Government to achieve its public health goals;
2.1.2 Whether the proposals are appropriate,
will be effective and whether they represent value for money;
2.1.3 Whether the necessary public health
infrastructure and mechanisms exist to ensure that proposals will
be implemented and goals achieved.
3. By and large the Association welcomes
the Government's proposals. However, it notes that the White
Paper focuses predominantly on one domain of public health—people's
individual lifestyles. It does not address the important underlying
determinants of health—such as income, educational attainment,
housing and social networks. It is also weak on the prevention
and health protection domains that add so much to the public's
health through effective immunisation and population screening.
4. The SHA wishes to draw attention in particular
to the following concerns:
4.1 It is not appropriate to treat health
as a consumer good. The more privileged in society have easier
and greater access to consumer goods. If health is to be a
consumer good, then it is likely the health inequalities will
widen, and the overall health of the population will decrease. The
rich and healthy are known to adopt healthy lifestyles more quickly
than more disadvantaged groups. For example, smoking prevalence
is now 10-15% in social classes 1 and 2 and 40% in social class
5. And the gap in life expectancy between rich and poor is
increasing.
4.2 Putting the Department of Health in
charge of achieving the Government's public health goals is not
advisable. Instead, the SHA stresses the need for a cross-government
Cabinet Minister for Public Health with the authority to engage
with all departments of government. The Department of Health
has the responsibility to improve health care. Improving health
is the responsibility of all arms of government and the leadership
must be in place to ensure that they all play their part.
4.3 The role of local authorities must be
greatly strengthened. Indeed we believe they should have the
lead responsibility to tackle health inequalities, so the proposal
to use the national PSA targets and local area agreements more
rigorously is welcome. The SHA also strongly supports the
appointment of Joint Directors of Public Health working to both
PCTs and local authorities. This would "join up"
scarce public health capacity and provide leadership for the Local
Strategic Partnerships that should be in the forefront of the
attack on health inequalities.
4.4 It is welcome that the NHS is to become
an exemplar employer, but this duty should be extended to all
statutory bodies and they should all work to achieve clear national
standards.
4.5 The ban on smoking in all enclosed public
places should be unconditional. The current proposals will
impact adversely on those least able to choose health—employees
and customers in bars and pubs located in disadvantaged areas
of the country. There is no difference in the health risks
from breathing environmental tobacco smoke whether the person
is eating or drinking.
4.6 It is unlikely that voluntary agreements
with the food and drinks industries will succeed. The damaging
consequences of high consumption of coloured fizzy drinks and
processed foods, such as obesity and diabetes, are well known;
as are the adverse consequences of alcohol abuse that include
violence, crime, drink driving and social disorder. The food
and drinks industries have already had sufficient time in which
to improve their products and amend their marketing strategies
but have failed to do so. There is thus no alternative, in
our view, to much stronger regulation in the fields of both alcohol
and processed food. Restricted advertising, clearer labelling
and with alcohol a sustained programme to try to combat the epidemic
of binge drinking, must be on the agenda.
4.7 Children need more protections and support
than are outlined in the white paper; for example, the proposal
to roll out the Healthy Schools initiative to all schools should
be brought forward and made mandatory for all schools as quickly
as possible.
4.8 There is little in the White Paper about
improving mental health and well-being. Mental well-being
is an important factor in health inequalities and chronic mental
illness leads to poor quality of life. Local government and
PCTs have a key role in promoting well-being that is currently
restricted by insufficient resources and capacity.
4.9 Some of the proposed innovations—such
as Spearhead PCTs and health trainers—do not have a firm
evidence base. Data show that there are more poor and disadvantaged
people outside the Spearhead PCT areas than within them and work
based solely on spatial and geographical areas will not address
the issue of inequality systematically or sufficiently. Health
trainers are not evidence based and this initiative risks wasting
resources. It is important to pilot such proposals to ensure
that they can fulfil their aims and do not have unanticipated
outcomes that widen rather than narrow health inequalities.
4.10 Finally, the SHA believes that government
must do much more to raise the level of debate about quite how
unhealthy UK society is, utilising a range of marketing strategies.
5. The Chair of the Socialist Health Association,
Dr Paul Walker, will be pleased to attend the Committee hearing
and provide further detail on these issues to the Committee.
6. This is a corporate response prepared
by the Executive of the Socialist Health Association.
January 2005
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