Health Lexcomm: Public Health White Paper

30/11/2010

Today’s Public Health White Paper provides an insight into Health Secretary Andrew Lansley’s plans to create a healthier Britain. Hailed as a ‘radical new approach’ by Lansley, the White Paper looks outside of central government to deliver many of its aims.

Despite the claim, the White Paper lacks any specifics; Shadow Health Secretary John Healey MP stated that the White Paper was ‘96 pages long but short on detail’. Although lacking specific proposals, the White Paper provides a vision for public health and signifies the priority areas for the Coalition Government. Smoking, physical activity and childhood obesity are all targeted with further consultations and proposals set to follow.

The White Paper highlights the Coalition Government’s dilemma between ‘nannying’ on the one hand and improving people’s health through ‘nudge’ tactics on the other. Whilst Lansley signals his preference towards a less intrusive approach, this debate about the right role for regulation is echoed cross No. 10 and other Government Departments.

In many respects the Public Health White Paper is simply a forerunner to the much publicised Public Health Responsibility Deal – a voluntary agreement with industry to meet public health targets. Where the White Paper indicates the areas requiring reform, the Responsibility Deal will provide specific measures to be met to improve the nation’s health, setting out the commitments that industry has signed up to.

The Responsibility Deal has attracted significant criticism from health campaigners - who see Lansley as allowing the food and drink industry to write their own rules. This position has been championed by the Shadow Public Health Minister Diane Abbott MP, who has been vocal in her calls for a Select Committee inquiry into the influence of business. But in this age of austerity it is perhaps not surprising that Lansley and his team have looked to industry to deliver reform, opting for self-regulation over costly legislation.

It is under this backdrop of delivering more for less that Lansley has turned to local authorities to improve the nation’s health. A ring-fenced budget and over 150 public health directors will be created within local government in order to deliver health improvement strategies. However, with councils facing severe financial pressures, many have questioned the ability of local government to deliver the necessary progress. Lansley has also been keen to emphasise the importance of individuals taking ‘personal responsibility’ for their health and it will be interesting to see how he translates the ‘nudge’ theory in practice.

The White Paper also goes some way in ensuring employers take on social responsibilities. Despite the move towards greater self-regulation under the Coalition Government, Lansley is clearly keen to show he expects industry to take a lead in employees’ health and welfare. The plans to intervene to improve workplace health, such as the proposals to introduce better facilities to allow breastfeeding in the workplace, are in stark contrast to former Conservative policies which would have spurned state intervention in such areas.

Speaking to Andrew Marr on Sunday, Lansley stated he was ‘keen that we don’t over regulate.’ However, with increasing criticism from the public health lobby and Labour Opposition about his lenient approach to industry and the need to deliver tangible successes, a lot rests on the Public Health Responsibility Deal. The reaction to today’s proposals will likely result in increased activity from the health campaigners and the challenge to industry will be to make the partnership work.

Moreover, Lansley’s radical NHS reforms have faced criticism from many quarters, including the new Chair at the Royal College of GPs, and it has recently been announced that the publication of the Health Bill will be delayed until the New Year.  With such high profile policy proposals, Lansley’s public health plans may prove to be one fight too many for the Health Secretary and he will need to deliver political wins in public health or in his controversial plans to reform the NHS in order to keep his seat at the Cabinet table.

Criticised by many on the right as too ‘nannying’ and by those on the left as too lenient on the food and drinks industry, Lansley’s public health proposals will continue to attract controversy. For now, Lansley looks set to continue to work with industry to deliver the changes needed but industry should be in no doubt that should it fail to deliver and pressure mount on Lansley, the temptation to regulate will prove too much to ignore.


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