Public health plans 'confused and inadequate'

The government's public health plans are 'confused and inadequate' and fail to follow the advice of last year's influential Marmot review, experts have warned.

Plans to 'nudge' people to be healthier have 'no evidence base' and proposed local health and wellbeing boards will become 'glorified talking shops', experts told MPs last week.

The House of Commons health select committee has launched an inquiry into DoH plans to reform public health in England and heard from witnesses in London last week.

The DoH has proposed creating health and wellbeing boards to oversee local public health work and a new national body, Public Health England.

Professor David Hunter of Durham University said the White Paper Healthy Lives: Healthy People was an 'underwhelming' response to a report by Professor Michael Marmot in 2010. Professor Marmot called for more action to tackle the social determinants of health to cut health inequalities.

Professor Hunter said he was 'disturbed' by plans to focus on 'nudging' people into better health.

'To see this as an issue of individual lifestyle change is to completely miss the target. The evidence base for "nudge" doesn't exist,' he said.

Professor Lindsey Davies, chairwoman and president of the Faculty of Public Health, which represents experts in the field, oversaw the UK's response to the flu pandemic in 2009/10.

She said it was vital that Public Health England retained the ability to speak freely.

'If Public Health England is set up as it is planned at the moment, as just one more directorate of the DoH, it will lose an opportunity to really speak influentially and authoritatively to the public about important public health matters. I think that would be a huge loss.'

Removing practice boundaries would make it 'hugely more complex' to collect essential data on population health,' she added.

Experts also questioned the accountability of public health organisations. The current set-up was 'a bit mixed, messy and chaotic', Professor Hunter argued.

While many people initially backed plans to hand control of public health to local authorities, many have retreated over concerns that recent gains may be lost in the transition, he said.

The lack of clarity over who would assume overall responsibility for local public health was an unresolved issue, Professor Hunter added.

Stephen Robinson

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