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The public health agenda in England

Choosing Health white paper

The government's most recent policy document on public health is Choosing Health (2004). The government has pledged one billion pounds of extra investment for public health over the next three years and has prioritised action on nutrition, physical activity, obesity and further action on tobacco. The Choosing Health white paper was accompanied by two further publications, a food and health action plan and a physical activity action plan. The white paper set out 167 commitments for government action over the next three years. These included developing statutory nutritional standards for school food, effective controls on food marketing to children and an obesity campaign.

The Choosing Health white paper supersedes the government's previous white papers - Smoking Kills (1998) and Our Healthier Nation (1999), stepping up the investment in public health and mainstreaming it in the NHS and schools and local authorities.

The Choosing Health white paper prioritises action on childhood obesity. This followed an extensive review by the Health Select Committee on obesity. The NHF presented written and oral evidence available here.

The government has set out five key Public Service Agreements for public health action by government departments. Which include action on CHD and Obesity.

The Wanless Reports

Key stimuli to the production of the Choosing Health white paper were two HM Treasury commissioned reviews on future demands on the NHS by 2020 entitled Securing Our Future Health: A Long Term View (2002) and a follow up review on investing in public health entitled Securing Good Health for the Whole Population. (2004) undertaken by Sir Derek Wanless. These are available at the HM Treasury. The reviews argued for a step change in the quality of public health provision and the level of Government investment, given its very large and untapped potential contribution to improving health and the huge savings of 30 billion pounds per annum by 2020 to the NHS.

The NHF's written submissions to the Treasury team are available here.

The 'Food and Health' and 'Physical Activity' action plans

Food and Health, Choosing a Better Diet and Physical Activity, Choosing Activity, action plans were published at the same time as the Choosing Health delivery plans (March 2005) This is the first time there has ever been a detailed government action plan in England for physical activity and food and health.
The plans are available at the Department of Health  and are referred to in more detail in the NHF website sections on physical activity and nutrition.

The NHF's input to the consultations on Food and Health action plan and Physical Activity action plan is available here.

The National Service Framework for Coronary Heart Disease

The National Service Framework for CHD was published in 2001 and sets a framework of minimum standards for the NHS for the primary and secondary prevention, treatment and rehabilitation of CHD that have to be achieved by the NHS in England and Wales on CHD prevention and treatment and rehabilitation.
The National Service Framework (NSF) for coronary heart disease launched the first ever ten-year programme to set clear standards for the services provided throughout the NHS and its partners for the prevention and treatment of coronary heart disease. The NSF's standards on primary and secondary prevention will be fundamental to its success in helping to eliminate premature deaths and reduce disability from coronary heart disease. The NHF contributed to the development of the National Service Framework through the external reference group whose membership included a number of NHF members.

The NHF has also contributed to the preparation of 'Coronary heart disease: Guidance for implementing the preventive aspects of the National Service Framework' by the Health Development Agency.

The NHF has also produced primary care toolkits on physical activity, nutrition, fuel poverty and obesity to support implementation of the National Service Framework (for CHD). See the publications section on this website for further information.

There are also National Service Frameworks for Diabetes, Older People and Children which cover action on the risk factors for CHD and Stroke.

Annual progress reports are available at http://www.dh.gov.uk/ 

Tackling inequalities in coronary heart disease

The government produced the first ever health inequalities delivery plan for England, entitled Tackling Health Inequalities, A Programme for Action, in 2004 which identified action on the major killers as a priority. This is available at the Department of Health website.

A threefold difference in premature death rates between unskilled and professional men has opened up since the 1970s. The widening social class gap shows that successes in preventing heart disease among higher socio-economic groups are not being matched among lower income groups.

The NHF has recommended that coronary heart disease should be used as a test case for reducing health inequalities. Tackling the determinants and risk factors for coronary heart disease will also impact on other major diseases, such as stroke and cancer. The NHF has produced a report: Social inequalities in CHD: opportunities for action (1998)

Small change, big difference 2006

Many people know what they need to do to improve their health. The UK Food Standards Agency Consumer Attitudes to Food 2003 survey shows that 80% recognise they need to eat more fruit and vegetables, 66% know they need to eat less fat, 66% know they need to eat less sugar, and over 73% are aware they do not have enough exercise.

What is often missing is the will and support to act on this knowledge. For younger people their sense of immortality means this is something to worry about 'later in life', for older age groups some people believe it is 'too late'. So in April 2006 the government launched the 'small change, big difference' initiative to demonstrate how easy it could be to improve both longevity and quality of life.

The initiative is supported by evidence from Professor Khaw's research at Cambridge University looking at over 25,000 people. The study, carried out in Norfolk, is part of the European Prospective Investigation and Nutrition (EPIC), involving half a million people in 10 European countries.

The research was carried out on 45-79 year olds and it is in this group that Professor Khaw reports to demonstrate compelling health benefits.

Types of messages used in the initiative:

  • You can add three years to your life by getting some exercise - like walking up the stairs instead of taking the lift.
  • Eating five pieces of fruit a day could give you the life expectancy of someone three years younger.
  • If you add up the effects of eating fruit and vegetables and being more active, you can slow the ageing clock by up to 11 years. 
  • Some professions are healthier than others - being a shop assistant or bricklayer where you stand up, or are very active, gives  more protection against cancer and cardiovascular disease.

Visit: http://www.dh.gov.uk/smallchange