Background
Public health – the promotion of good health and prevention of disease in the community – has been a feature of health care since the middle of the 19th century. Over the past 30 years UK governments have shown a growing commitment to address the underlying causes of ill health such as health inequalities and unhealthy lifestyles.
When Labour came to power in 1997 they were committed to tackling the root causes of ill health. Its first White Paper on public health, Saving Lives: Our Healthier Nation set clear targets to prevent unnecessary deaths, including cutting cancer death rates for under 75s by at least 20 per cent by 2010 (from 69,000 to 55,000) and deaths from heart disease and stroke by at least 40 per cent (from 69,000 to 41,000). It also aimed to halt the year-on-year rise in childhood obesity by 2010 and have a joined-up approach to health across all government departments.
Public health returned to the spotlight in 2002, when a Treasury-commissioned report into health service funding by Sir Derek Wanless warned that if people were not encouraged to lead healthier lives, NHS costs could spiral out of control. Wanless outlined three options, ranging from a full engagement with the public health agenda to minimal uptake. If uptake was only minimal, he warned, the extra costs to the NHS could be £30 billion a year by 2020.
Two years later he produced a report focusing on public health, which sought to turn the NHS from a national sickness service into a ‘national health service which focuses on preventing it’. The report put forward a range of ideas, including a ban on smoking in public places and taxing fatty foods as well as boosting physical activity. But the main onus was on motivating individuals to improve their own health.
After widespread consultation, the government followed this up in 2004 with a White Paper, Choosing Health, focusing on obesity, sexual health, alcohol abuse and smoking. It also introduced a requirement that all government departments assessed the impact of their policies on public health.
In the past three years the Department of Health has undertaken a number of initiatives on public health issues such as alcohol abuse, sexual health and smoking. Most significant was the ban on smoking in enclosed public places in July 2007.
Recently, the most prominent focus for public health has been the ‘obesity epidemic’ which could, if left unchecked, overwhelm health service resources and lead to the first decline in life expectancy in more than a century.
There are still unresolved questions over who is ultimately responsible for public health. Should this be the responsibility of national government or do local initiatives have more impact?
