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Regional prevention strategies in England

The new structure

The Regional Offices of Government now include the Regional Directors of Public Health (RDPH) and their teams and are part of central government. The RDPH develop cross-sector working across government departments, regional assemblies and develop regional strategies and work with Strategic Health Authorities. They also work closely with Regional Health Observatories in providing health information.

Under the new arrangements proposed in Putting Patients First (1998) the government will look to merge Strategic Health Authorities (SHA) and the Regional Offices of Government and make them responsible for performance management of the Primary Care Teams and in particular public health.

Strategic Health Authorities

Following reconfiguration in July 2006, there are now 10 Strategic Health Authorities who manage the local NHS on behalf of the Secretary of State.

The health authorities have a strategic role. This means they are responsible for:

• Developing plans for improving health services in their local area
• Making sure local health services are of a high quality and are performing well
• Increasing the capacity of local health services - so they can provide more services
• Making sure national priorities - for example, programmes for improving cancer services - are integrated into local health service plans

Strategic Health Authorities manage the NHS locally and are a key link between the Department of Health and the NHS. They hold all local NHS organisations (apart from NHS Foundation Trusts) to account for performance.

Local action needed

Effective local action is essential to reduce rates of coronary heart disease and tackle health inequalities. A NHF policy goal is to ensure that coronary heart disease prevention is a priority for local as well as national public health strategies. Health improvement programmes should focus on a few key priority areas, including coronary heart disease prevention.

An NHF working group produced a report in 1998: Public participation for public health: Proposals for action. Contact NHF for a copy.

In December 1999 the NHF submitted recommendations to an inquiry into health improvement programmes by the All Party Parliamentary Group on Primary Care and Public Health. Contact NHF for a copy of the recommendations.

NHF policy goals for prevention

• The established risk factors of poor diet, smoking and physical inactivity should remain the primary focus of an effective national coronary heart disease prevention strategy.
• Special efforts should be made to improve the nation's diet and encourage physically active lifestyles through national nutrition and physical activity strategies.
• Every child born into the new millennium should be able to live until at least the age of 65 free of avoidable chronic disease.
• Prevention strategies must take a long-term approach which begins in the foetus, through childhood and builds health over the life course.
• Priority must be given to the most disadvantaged, to address the widening gap in rates of coronary heart disease between higher and lower socio-economic groups and in black and minority ethnic groups.
• Coronary heart disease should be a 'test case' for national strategies to tackle social inequalities in health as it shares many determinants and risk factors with other major causes of death and disability including stroke, diabetes and many forms of cancer.

National Heart Forum activity

The NHF has helped to shape the public health policy agenda since the mid 1980s, and has argued consistently for a strong policy focus on coronary heart disease prevention. As part of this process, the NHF contributed to the public consultation on the latest government public health strategy Choosing Health (2005) providing expert briefings to ministers, civil servants and advancing consensus recommendations on appropriate prevention targets and strategies.

The NHF was represented on the CHD prevention and inequalities taskforces which oversee the implementation of the National Service Framework for CHD and health inequalities delivery plan. The details of the Choosing Health public white paper are available at http://www.dh.gov.uk/ . The NHF's submissions to government and the Health Select Committee are available here

The NHF released a major report in 1999 reviewing the evidence on trends and prevention and setting out a prevention agenda for the 21st century, called 'Looking to the future: Making coronary heart disease an epidemic of the past'.

The NHF also undertook a major review on the early origins of chronic disease and the implications for child health policy -young@heart (2003) which formed the basis of its submissions to the Choosing Health white paper, the Children's National Service Framework and Every Child Matters consultations. Copies of consultation responses are available here.

Copies of the Children's National Service Framework are available at http://www.dh.gov.uk/ and Every Child Matters at http://www.dfes.gov.uk/ 

Children's Commissioner for England

The government has also appointed a Children's Commissioner for England from July 2005. The first commissioner is Professor Al Ansley Green. He will be accountable to parliament and work closely with the Children's Commissioners in Scotland, Wales and Northern Ireland. Visit: http://www.everychildmatters.gov.uk/strategy/childrenscommissioner/

NHF's policy priorities for action for the primary prevention of CHD in 2006 are:

• To undertake an economic and social policy analysis and produce a framework for shaping a health creating economy for the UK
• Identifying and securing effective controls on the marketing of food high in salt, sugars and fats to children at national and European levels
• Reviewing the scientific and practical basis for setting and implementing nutrient based standards for school meals in the UK and securing them as statutory standards
• Contributing to the implementation of the Scientific Advisory Committee on Nutrition (SACN) report on reducing the population's salt intake by advocating and developing a nationwide strategic approach to the primary prevention of elevated blood pressure
• Producing standards for the built environment to support the promotion of physical activity
• Undertaking a review of the upstream determinants on promoting physical activity and identifying the advocacy priorities for the NHF
• Campaigning for a complete ban on smoking in enclosed public places and workplaces
• Advocating and supporting the development and implementation of chronic disease prevention standards (e.g. via the children's National Service Framework) based on a lifecourse approach to prevention
• Supporting delivery of the obesity Public Service Agreement target by revising the Faculty of Public Health / National Heart Forum Lightening the Load obesity toolkit
• To stimulate maximum collaboration and co-ordinate the primary prevention efforts of the voluntary and not-for-profit sectors in preventing CHD and the linked avoidable chronic diseases

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