| Saving Lives: Our Healthier Nation | |||||||
|
1 Better health: a new approach
1.1 England is a rich country - rich in its people, rich in its resources, rich in innovation, rich in its values, rich in its history, rich in its future. Yet in this rich country, not everyone has an equal chance of healthy life. Too many people suffer from poor health. Too many people are ill for much of their lives. Too many people die too young from preventable diseases. 'the opportunity of saving as many as 300,000 lives' 1.2 Saving lives: Our Healthier Nation is an action plan for tackling poor health and improving the health of everyone in England, especially the worst off. 1.3 We believe that if we can achieve the bold objectives we are setting we have the opportunity of saving as many as 300,000 lives over the next 10 years. 1.4 But to do that, we have to tackle the four main killers - the illnesses which, together with accidents, play the greatest part in causing preventable deaths and ill-health: cancer, coronary heart disease and stroke and mental illness. Together they account for more than 75 per cent of all the people who die before the age of 75 years. Combating these killers will not end them: they will still cut into people's lives and the lives of their families. But we can reduce their impact. 'We will achieve what no previous Government has achieved' 1.5 So we are setting new, tougher and challenging targets in each of these priority areas. By 2010:
1.6 These are ambitious targets. But they are achievable
- and we 1.7 We believe we can succeed in this ambition. We believe we can make a difference. We have the principles and programmes in place which will achieve what no previous Government has achieved: 'to attack the
breeding ground of poor health -
'good health, like good education, should be within reach of all' 1.8 These are the building blocks for our new policy for improving the health of our population. They require individuals, communities, local organisations and Government to contribute to meeting the targets in a three-way partnership. Better health is the prize. Better health 1.9 Good health is fundamental to all our lives. We all treasure our own health, and the health of our families and friends. Good health is the bedrock on which we build strong families, strong communities and a strong country. 'If people are
healthier, their demands on the health 1.10 When we enjoy good health, we are able to make the most of the opportunities life has to offer. We can play a full part in our working lives, our family lives and our community lives. Nothing is more precious to most of us than our health. 1.11 Yet we tend to take health for granted - until something goes wrong. Then we look for help - to doctors, to nurses and to hospitals. In Government we are determined to make the modern NHS ready and able to respond to what people need from it. 1.12 But the better everyone's health is, the greater the ability of the NHS to use its resources to best effect. If people are healthier, their demands on the health service will be less than they would have been - leaving resources and facilities available for those who need them more. 1.13 Improving health is about more than just treating people when they become ill. Better health is vital in itself, leading directly to longer, more active and more fulfilled lives. 1.14 Many people are already taking the initiative to safeguard and improve their health. They are increasingly aware of the importance of a better diet, of the value of physical activity, of the benefits of taking proper care of themselves and their families. The enthusiasm of many for improving their health is clearly reflected in the increased levels of informal physical activity such as walking and keeping fit, as well as the use of fitness and sports centres. Support for health is also reflected in the growth of complementary therapies and specialist products, including magazines, radio and television programmes and health websites, for people wanting to improving their health. 1.15 Better health is central to economic performance. A healthier workforce improves productivity and performance. In 1995 in Great Britain around 20 million working days were lost through work-related ill-health. Ill-health is expensive in both economic and human terms. Cutting the cost of sickness at work will help to decrease burdens on business. As we understand more about the causes of disease, such as coronary heart disease, so we can act to reduce preventable illness. And that has the potential to reduce welfare spending as we tackle health inequality and improve the health of the worst off. 'Cutting the cost
of sickness at work will help to 1.16 A modern and successful country needs more people in better health. We are engaged in a wide-ranging programme of modernisation: modernising education, modernising welfare, modernising social services and, in The new NHS White Paper, modernising the National Health Service. A modern approach to improving health and closing the health gap is a key part of this programme. 1.17 Our modern approach is reflected in the goals of this White Paper:
1.18 Our twin goals are consistent with the health strategies being adopted by the other countries of the United Kingdom. They are also consistent with the World Health Organisation (Europe)'s new programme for the 21st Century Health 21 and the European Community's developing strategy for public health. 1.19 We propose the first comprehensive Government plan focused on the main killers of people in our country. We are determined to succeed in our goals - and if we do, then by cutting needless early deaths from cancer, coronary heart disease and stroke, accidents and suicide, there is the real prospect of reducing the number of deaths from these causes by up to 300,000 by the year 2010. 1.20 This is a bold ambition. Improving health for all and tackling health inequality is a challenging objective - a crusade for health on a scale never undertaken by Government before. We will measure the success of our ambition by the numbers of lives saved, and by the improvement in the health of the people of our country. The task is clear: to give everyone in our nation, whatever their background, the chance to lead a long and healthy life. The way to better health 1.21 Improving health means tackling the causes of poor health. We know that the causes of ill-health are many: a complex interaction between personal, social, economic and environmental factors. 1.22 In our new approach to better health, we want to break with the past. We want to move beyond the old arguments and tired debates which have characterised so much consideration of public health issues, including those who say that nothing can be done to improve the health of the poorest, and those who say that individuals are solely to blame for their own ill-health. 1.23 These arguments have focused not on what can be achieved, but on what role there is for those involved - including whether there is a role for Government, or whether these matters are solely issues of personal responsibility. 1.24 We reject the polarity of these positions. We refuse to accept that there is no role for anything other than the personal. Equally we refuse to accept that for some people poor health is inevitable. 'We refuse to accept
that there is no role for anything other 1.25 We reject that hopelessness. As with our policies on education and employment, we reject the inevitability of wasted lives and wasted generations - the belief that nothing can be done. As with education and employment, we believe that people can be instrumental in shaping their own futures, rather than being victims of them. And there is a clear role for local agencies acting together, offering help with the decisions that individuals make. 1.26 People are responsible for their own actions in health as in other areas. But the decisions people take over their health are more likely to result in better health and a healthier life if they have the opportunity to make informed decisions. 'a new balance
- a third way - linking individual 1.27 Our new approach is rooted in precisely that
balance. We believe that individuals can, should and do affect how healthy
they are. But we believe too that there are powerful factors beyond
the control of the individual which can harm health. The Government
has a clear responsibility to address these fundamental problems. Striking
a new balance - a third way - linking individual and wider action is
at the heart of our new approach. 1.28 Smoking provides a striking example of these various factors at work. We have set out our policy on smoking in our White Paper on tobacco, Smoking Kills. Smoking is the most powerful factor which determines whether people live beyond middle age. And smoking more than any other identifiable factor contributes to the gap in healthy life expectancy between the most deprived and the most advantaged. But it is at the same time a factor about which individuals can make a decision. For many people who smoke, the decision to give up is not an easy one. Nicotine is addictive. But there is a clear route to better health. It is a clear route too which those who are more fortunate tend to take more than those who are less fortunate. We want people to stop smoking. But we also want that policy to have a greater impact among the less fortunate, where the harm caused by smoking is greater. To do that we have to address the complex interactions of social, economic and personal factors. Tackling smoking achieves both our objectives - improved health for all, and especially better health for the worse off.
1.29 For people to make such decisions against the background of such powerful determinants, they need to make informed decisions. Such decisions must be based on information about the risks involved in a range of activities, practices and products. People cannot and should not be pressured into responsibility. We do not believe in the old nanny-state approach. But there is a powerful role for Government in making clear the nature and scale of risk, and in some cases, taking protective action in the light of it.
'Governments can
set the preconditions for success in 1.30 We recognise that this is an unusual area for Government action. Governments can set the preconditions for success in improving health. But Governments alone cannot determine success. To do that, the Government needs to work in partnership with others. A three-way partnership 1.31 Partnership is a key element of the Government's approach to a wide range of issues. Partnerships in areas such as business, education, crime prevention and many others are at the core of the way the Government carries out its work. Partnership is at the heart of our new approach to better health in Saving lives: Our Healthier Nation. 'a new three-way partnership,
comprising:individuals, 1.32 To improve health and to tackle health inequality, we need a new three-way partnership, comprising:
1.33 Individuals are central to our new vision for better health. People need to take responsibility for their own health - and many are doing so. There is a new and clear realisation that individuals can improve their health, by what they do and the actions they take. 1.34 Better health information - and the means of applying that information - is the bedrock on which improvements to the health of individuals will be made. But better health opportunities and decisions are not easily available to everyone. For example, membership of a gym may not be an option for someone in a poor neighbourhood or a single mother. 1.35 Communities working in partnership through local organisations are the best means of delivering the better information, better services and better community-wide programmes which will lead to better health. The roles of the NHS and of local authorities are crucial. They must become organisations for health improvement, as well as for health care and service provision. We are underlining this joint responsibility by the new duty of partnership on NHS bodies and local government in the Health Act. All aspects of the way that the NHS works with other local bodies, from the reorganisation of primary care services to the development of healthy neighbourhoods, from the NHS Direct phone-line to the creation of a new Health Development Agency, will be geared not just to treatment of illness but to the prevention and early detection of ill-health. 1.36 Initiatives including the Healthy Citizens programme, health improvement programmes and health action zones will all provide a local focus for the delivery of information and programmes at local level aimed at helping individuals improve their health and the health of their families. The dynamic of health improvement will for the first time be integrated into the local delivery of health care. 'creating the
right conditions for individuals to make 1.37 Government will play its part by creating the right conditions for individuals to make healthy decisions. Across a range of Government policy, we are focusing on the factors that increase the likelihood of poor health - poor housing, poverty, unemployment, crime, poor education and family breakdown. 1.38 The Government is taking action to combat social exclusion, to make work pay, to support children and families, to promote community safety - all moves which will do much to improve people's health, and to improve especially the health of the least fortunate in our country. An integrated approach 1.39 This is our new contract for health. Our new approach, based on our three-way partnership between people, local communities and the Government, adopts a new way of tackling poor health which is both inclusive and integrated, comprehensive and coherent. 1.40 It ensures that all involved in improving health play their part. Individuals have the responsibility to improve their health, and the health of their families. Local agencies, led by health and local authorities, have the responsibility for delivering local services and local programmes which will enable people to claim the right of better health. And the Government has the responsibility of giving everyone throughout our country the opportunity for better education, better housing, and better prospects of securing work. 'the whole will be greater than the sum of the parts' 1.41 Common sense suggests that this integrated approach to tackling poor health is best. It is supported by the scientific and medical evidence. Reducing the impact of cancer and heart disease, for example, can be done only if we tackle smoking effectively. In turn, tackling smoking depends on relieving the conditions - social stress, unemployment, poor education, crime, vandalism - which lead far more people in disadvantaged communities to smoke than in other sections of the community. 1.42 Our approach, based on partnership between individuals, communities and Government, is not one which ranks action by one above the other: by emphasising integration our strategy will ensure that the whole will be greater than the sum of the parts. Targets 1.43 Previous efforts to try to address poor health have been marred both by the limited nature of their approach, resting on simplistic explanations of the causes of ill-health rather than the approach to root causes which we are adopting, and by an over-reliance on too many, poorly focused priorities. 1.44 We will not fall prey to these failings. We reject the checklist approach to improving public health. Instead, we are identifying tough but realistic targets which concentrate on the most important killers of people across our nation:
Listening and learning 1.45 Ten months after coming into office, we set
out the scale of the challenge for improving health and tackling health
inequality in England in our Green Paper, Our Healthier Nation.
Over 5,500 responses were received. The response to consultation was
overwhelmingly supportive with well over 90 per cent in favour of the
proposed approach. 1.46 Individuals and organisations who responded particularly welcomed the emphasis on the fundamental social, economic and environmental causes of ill-health. They also approved of the much wider approach to accountability for improving health which identified the respective roles and responsibilities of individuals, local organisations and Government for improving health. 1.47 We commissioned Sir Donald Acheson to carry out an Independent Inquiry into Inequalities in Health to review the position and to identify the most critical areas to tackle. 1.48 We also commissioned an important study of the previous Government's health policy The Health of the Nation, carried out by specialists from the Universities of Leeds and Glamorgan and the London School of Hygiene and Tropical Medicine. Its findings have helped to shape this strategy. Our Healthier Nation 1.49 We believe that the country is united in an ambition for better health. The ambition to bring up children so that they grow up healthy is one that unites us all. The ambition of a long and healthy life for ourselves unites us all. 1.50 The three-way partnership we see as vital to improving our health is reflected in this White Paper:
1.51 This partnership approach underpins the contracts for health, set out in succeeding chapters, which summarise the action to be taken at each level - individual, local agencies, Government - to tackle each of the most important killers. `action to tackle the four big killers` 1.52 We want to see healthier people in a healthier country. We want to see individuals striving to improve their own health, supported by local organisations working in partnership to deliver the information and services they need, against a backdrop of action by the Government. We want to see people deciding for themselves that they want to embrace better health - but doing so in the light of real and trusted information about the benefits, and about any risks. We will do so by providing the help which was so lacking in the past; and above all we will make it available to the least fortunate. We believe that this holds out the prospect of better health for everyone. We want to see everyone take the chance - and seize better health now, and for the future.
| |||||||
