Q&A: Public health plans

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Ministers have set out their plans for making the nation healthier.

The public health white paper proposes a structural shake-up as well as calling for a change in mindset in a bid to tackle everything from obesity to problem drinking.

What is the challenge?

In a nutshell, people are putting their lives at risk by the unhealthy choices they make.

A quarter of adults and a sixth of children are now obese - up from one in seven adults and one in 10 children in 1993. While research has suggested genetics has a role to play, the most important factors are diet and lack of physical activity.

A recent government report said if current trends continue the country will have more obese people than not obese by 2050.

Risky drinking is also on the rise. More than 1m people are addicted to alcohol, according to latest figures, with another 7m drinking at levels that are deemed dangerous.

Progress has even slowed with one of the success stories of the past half century - smoking. For the last decade the proportion of adults smoking has hovered stubbornly above the 20% figure.

What does the government see as the solution?

The first thing to note is that there will be structural change. Responsibility for public health will be transferred back to local government - it fulfilled this role before 1974.

This move is partly through design and partly through default. Public health directors are currently employed by primary care trusts, but as these face the chop under reforms to the NHS it was always clear they needed to find a new home.

Saying that, most agree local government is a perfect fit because of their responsibility for the wider determinants of health, such as housing, transport and leisure.

Details of how it plans to tackle issues, such as obesity, drinking and smoking, are a little sketchy at this stage. Individual action plans will be published in 2011.

However, the white paper does give some idea of the direction the government is heading, suggesting it wants to "nudge" people into making healthy choices.

What is nudge all about?

The government believes the approach adopted by Labour smacked of the nanny state.

Instead, it believes people respond better to more subtle encouragement.

Ministers say it is all about creating the right environment for people to make healthy choices and then giving them a little push.

One example given was the use of signs in shops which say things such as "most people who shop here buy at least two pieces of fruit".

Ministers said the use of social norms like this was highly effective.

What about health inequalities?

Labour promised to reduce the health inequality gap - measured by infant mortality and life expectancy - by 10% between 1997 to 2000. But ministers failed. In fact, it actually widened during this period.

The gap is now greater than it was during the Great Depression after World War I. This does not mean infant mortality and life expectancy has got worse, just that it has improved faster among richer groups.

This is something the white paper acknowledges needs addressing. It has promised extra money for poor areas - dubbed health premiums - while a health inclusion unit will be established to oversee the push.

What's the thinking with the private sector?

The white paper makes reference to a "responsibility deal" for industry. The groundwork for this has already been done and the details should be unveiled in the new year.

Ministers made it clear that they see a voluntary approach as a way of getting results much more quickly than through regulation.

They gave the example of food labelling. A wide variety of schemes have sprung up as the push for regulation has ground to a halt in the corridors of the European Union.

The government said the deal could include funding for public health campaigns and commitments to reduce the salt and fat content of certain foods.

Does that mean the era of regulation is at an end?

No. The health secretary has made it clear that he does not want to be seen to be lecturing.

But he has also said that where regulation is necessary he will be prepared to get tough.

Ministers have already said they are considering insisting on plain packaging for cigarette packets. What is more, there is no chance of them rowing back on current rules in place, such as the smoking ban.

What has been the reaction to the plans?

Public health directors say they will feel comfortable in local government and are pleased to have a ringfenced budget at a time when councils are facing big cuts in funding overall.

Councils, for their part, see the move as recognition for the close links they have been forging with the NHS partners in recent years.

However, the Local Government Association is uneasy about the idea of having a protected budget when ringfencing has been removed from much of the rest of its funds.

What are the next steps?

The white paper just sets out the direction of travel. Full details of how individual strands of the vision will work will come in 2011.

Aside from the "responsibility deal", expect individual action plans for everything from tobacco control to problematic drinking.

A funding framework will also be published setting out exactly how much money - £4bn has been set as the absolute baseline - the new public health system will get from the entire NHS pot.

Meanwhile, another framework will spell out the goals and ambitions for local and national government so progress can be judged.

However, it will be several years before the new structures come into place.

Public Health England - the arm of the Department of Health that will support councils - will be up and running by 2012.

A year later, councils will formally take control of public health from the NHS.

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