New public health body to ‘nudge’ people on healthy living
pharmafile | December 1, 2010 | News story | | NHS reforms, Public Health England, alcohol, obesity, public health, smoking
Plans for a new organiation to oversee public health in England have been unveiled, which will ‘nudge’rather than nag people into healthy lifestyles.
Public health is currently the responsibility of the NHS, but critics have always complained that its aim – to prevent illness and promote healthy living – has always come second to treating sickness, and that funds have often been diverted into mainstream NHS services.
Now health secretary Andrew Lansley has unveiled plans to create a dedicated new body, Public Health England, to champion the cause.
The government says it is a ‘radical plan’ to cut causes of premature death and illness and reduce health inequalities, and will guarantee the new organisation’s budgets will not be raided for other services.
Professional groups have welcomed the ring-fenced funding, but concerns have been expressed about the practical details of the plan, particularly as it is tied up with the larger reorganisation of the health care system.
The government says Public Health England will give more power to local people over their health, while also overseeing population-wide issues such as flu pandemics.
Some of the biggest problems facing public health officials include obesity and smoking, and alcohol misuse, which cause much of the preventable health problems in the country. Public Health England will set a series of outcomes against which local progress will be measured.
Health secretary Andrew Lansley said: “Too often in the past, public health budgets have been raided by the NHS to tackle deficits. Not any more. The money will be ringfenced to be used as it should be – for preventing ill health.”
The plans are contained in the White Paper, Healthy Lives, Healthy People. The government says Public Health England could have a budget of around £4 billion, but says it has not yet finalised the extent of its responsibilities.
Directors of Public Health will be able to champion local co-operation so that health issues are considered alongside housing, transport, and education.
‘A less intrusive approach’
The Government says it wants to take a “less intrusive approach” and not restrict choices or impose bans unless absolutely necessary. It says it will follows the Nuffield Council of Bioethics Ladder of Interventions, to provide choice or incentives before imposing a ban.
Directors of Public Health will be employed by the Local Authority and will ‘lead discussion’ about how the ring-fenced money is spent to improve health, and will make sure that public health is always considered when local authorities, GP consortia and the NHS make decisions.
The new arrangements will see money allocated from the NHS budget and ring-fenced for public health; one part will be used by Public Health England for population-wide issues; another will provide a ring-fenced budget to Local Authorities.
A new ‘health premium’ will take into account health inequalities and reward success on specific public health outcomes, with disadvantaged areas given more funding when they show progress.
Details of all the plans will be consulted on in the coming weeks.
The government has asked private corporations, charities, and leading experts from the field to contribute to the running of the new system. The Department of Health says voluntary action by food companies on better labelling, more information about alcohol harms, and a much bigger contribution from industry around campaigns like Change4Life will all make positive contributions.
Reaction to Public Health England
Anna Dixon, director of policy at The King’s Fund said the decision was a positive move, which provided an opportunity to co-ordinate health, social and other services which currently often work in isolation.
Dixon added, however, that ‘strong intervention’ had been shown to be effective and necesary in some cases.
“Ministers are right to focus on how people can be nudged to adopt healthier lifestyles. But, as the ban on smoking in public places has shown, strong state intervention is also needed to change people’s behaviour and meet the challenges posed by smoking, alcohol misuse and obesity.
“It remains to be seen whether the government will strike the right balance on this. The question is not whether regulation or nudging is more effective – a combination of both is required to deliver the behaviour changes needed.”
Dr Richard Jarvis, chairman of the BMA’s Public Health Committee, said the doctors’organisation also supported many of the proposals, including ring-fencing funding.
However he said public health doctors would be worried about some aspects of the proposals, in particular that plans for local terms and conditions of employment may fragment the workforce.
Andrew McConaghie
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