Public health pledges cautiously welcomed

Health secretary Andrew Lansley's announcement of a ringfenced public health budget has been welcomed by public health leaders.

But his proposal that outcome-based targets should also be attached to public health measures has been received more cautiously.

Former Faculty of Public Health president Professor Alan Maryon-Davis said the notion of rewarding success in terms of achieving public health outcomes was his ‘biggest worry’ about Mr Lansley’s plans.

‘Does that mean that you then penalise those who are not successful, which would definitely increase health inequalities?’ he said.

Choosing the wrong outcomes could also undermine efforts to improve public health, he said.

Mr Lansley has said that a new public health service will give confidence that health inequalities could be tackled.

But Professor Maryon-Davis said it will be important that this new public health service is not too separate from the NHS and social services.

‘The cross-links with the NHS and the cross-links with local authorities, as well as with the voluntary sector and commerce, must be really solid,’ he said.

Professor Maryon-Davis argues that although ring-fencing is important, on its own it leaves a number of questions unanswered.

‘What is the size of the envelope and what is included in that envelope?’ he said. ‘If you start including things like health visiting and maternity services, what’s left of the real public health?’

Mr Lansley has said that governments could not legislate for people’s food choices and lifestyles.

But Professor Maryon-Davis says he thinks that regulation can play a role in helping to ‘nudge’ people towards making healthier choices. ‘You have to engage and empower people, but you also have to provide the environment so that the healthy choices are the easier choice,’ he said. ‘Well-chosen bits of regulation can help to support people in making those choices.’

Professor Lindsey Davies, former national director of pandemic influenza preparedness for England, took over the presidency of the FPH from Professor Maryon-Davis this month. She agrees that regulation has a part to play in influencing people’s behaviour. 'I do think there’s room for some regulation to help the environment to nudge people in the right direction and to make it easier,’ she said.

‘We are faced today, unfortunately, with the same challenges that we’ve had for some time, over inequalities in health, inequalities in health services and in the kind of behavioural changes we really need to bring about to get people to eat the right things, not eat the wrong things, not smoke.’

Professor Davies said that GP practices have a crucial role to play in helping patients stay healthy. ‘Helping patients not to be ill is just as important and vital a role as treating them when they’re ill,’ she said. ‘It will save work, but it will also make their patients happier and healthier.’

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