Shadow Health Secretary Andrew Lansley has pledged to get tough on public health, binning initiatives for which there is no solid evidence and rewarding success with extra cash.
He also emphasised the Conservatives’ firm intention to adopt an inclusive approach and work with the food industry and retailers to meet public health objectives.
... we need to build a more integrated public health service with a clear distinction between resources intended to meet today’s health needs and services...
Speaking at the Tackling Obesity 2010 conference in London, last week, Mr Lansley implied that a new Tory government would not make the same mistake as successive governments of the past.
That was to equate better health with more hospital beds and new buildings—“as opposed to what we know has the biggest potential impact on health which is improving underlying public health,” he said.
“For that to happen we need to build a more integrated public health service with a clear distinction between resources intended to meet today’s health needs and services and those needed to meet preventive needs and better health in the future. That will be true for a very long time,” he continued.
He then proceeded to paint a picture of what a Tory public health strategy would look like.
Evidence, evidence, evidence
First off, it would be grounded in evidence—and funded accordingly. “Very often when you look at public health research 99% is an analysis of the problem and less than 1% is an evaluation of the responses,” he said.
Initiatives that merely counted recruitment on to a programme as a measure of success rather than long term sustainability were not worth a great deal by themselves, and evaluation had to be built into the NHS R&D programme, he insisted.
“It’s clear to me that there has been insufficient attention still in relation to understanding what we will need to build a successful long term public health strategy – evaluation has to be part of it,” he contended.
But from that point onwards, I have to be absolutely frank, we are going to have to support strategies that work
Short term thinking tended to be reflected in funding arrangements, where initiatives were pump primed to get off the ground, but then not sustained, he said.
But the Tories would not just stump up long term funding, without evidence of merit, he warned, alluding to the green paper they had published last month.
“We stated that we need public health to be supported with what is effectively a payment for success system instead of people saying we have more deprivation and worse health outcomes than anywhere else, so we need more money,” he said.
Starting budgets would initially reflect relative health outcomes, he promised. “But from that point onwards, I have to be absolutely frank, we are going to have to support strategies that work,” he warned.
“Permanent additions to budgets [for the NHS and Local Authorities] will be on the basis of the success you achieve in improving health outcomes in your local areas,” objectively tested against a range of factors including child obesity, physical activity and general obesity, he declared.
Integrated approach
An integrated approach to public health was also essential, he said, “because the determinants of health and obesity are not to be found simply in the health service but across government and the private sector,” he said.
A Tory government would not only create a department of public health, but would create a cabinet post for a secretary of state for public health to lead a cross government strategy, supporting local partnerships, including with the private sector and the food industry, he said.
The Public Health Commission—made up of key players from every sector—which the party set up last year, “is a model we will seek to follow after the election on a national basis and which I hope will be followed on a local basis,” he said.
A Tory government would not only create a department of public health, but would create a cabinet post for a secretary of state for public health to lead a cross government strategy
“Ownership of all those organisations who have an influence on [public health] is absolutely critical,” he explained.
Personal responsibility
Mr Lansley then referred to the 2007 Foresight Report, which made much of the “obesogenic environment” in which we live.
But this conveyed the message to the public “that somehow obesity is something that happens to them rather than as consequence of the decisions they make,” he said.
The key was to create an environment in which it was easier for people to make healthy choices. Obesity was about physical activity and overall diet and not just about “good” and “bad” foods, he suggested.
“I will not go down the path of simply trying to categorise and castigate certain foods as undesirable. It does not correspond to the way the public behaves, and it is vital we do work with the public rather than try and instruct them in how they should choose foods,” a tactic that was counterproductive, he said.
A system of Guideline Daily Amounts (GDAs) was preferable to a traffic light labelling, he suggested.
“We have to work with industry to make sure we have food labelling that enables the public to make good decisions about diet and extends beyond current food labelling in shops to out of home because so many meals are being consumed out of home,” he said.
Working with industry also meant emphasising the importance of reformulating the content of foods, wherever possible to reduce salt/sugar/fat content, providing opportunities for sport through the National Lottery, and working with schools and employers.
A Tory government would support the current Change4Life initiative, however. “My intention is to build on it and make sure that private sector food manufacturers and other retailers feel that it is part of something they own too,” he said.
New relationship between government and the public
The Tories would also develop the Healthy Schools initiative...into places that work with families in the local community to build the self esteem of young people
Regulation was useful, but it couldn’t solve the obesity problem, he said. “We all know we can’t pass the Elimination of Obesity Act 2010... It’s about responsibility and behaviour.”
“That is why I am absolutely clear we have to think about the relationship government has with the public nationally and locally in different ways in the future. It is about what we call nudge philosophy. It’s not about nannying; it’s not about lecturing, and it’s not about regulating,” he said.
The Tories would also develop the Healthy Schools initiative, he said into “places that work with families in the local community to build the self esteem of young people.”
Low self esteem among this age group was behind many public health issues, such as obesity, drug abuse smoking, early sex, and antisocial behaviour, he suggested.
“Many of these issues are treated by the government in separate silos, and responded to in separate ways, but they are all part of the central problem,” he said.
This was about the extent to which young people feel families and communities support their self esteem and self confidence to enable them to make good decisions about their own life, future, and wellbeing, he said.
“For many adults this is about their calorific intake and exercise, but for many children it’s going to be a lot more than that.”
When pressed on whether he could guarantee that spending on public health would be protected given the need to slash public sector spending, Mr Lansley reiterated his party’s stated commitment to increase the spend on the NHS year on year, but at this stage he could not specify the proportion to be spent on public health, he said.