| Saving Lives: Our Healthier Nation | ||||||||||||||||||||||||
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3 Individuals and health
3.1 How people live their lives - what they eat, how active they are, whether they smoke - is central to improving health. Other factors, including people's education, employment, housing and environment also play a key role. 3.2 Past health strategies have tended to focus excessively on lifestyle issues. Yet paradoxically they have often failed to recognise how people can play a positive part in building healthy lives for themselves and in contributing to the health of other members of society. People were treated as passive recipients of information and services, rather than as active partners. This contributed to the widening of the health gap: we now know that the better off are more likely to act on health information to change behaviour and reduce the risks to their health. 3.3 We know too that people with long-term health problems such as diabetes, epilepsy or arthritis are skilled at recognising the warning signs when their symptoms are getting worse or they need further treatment. In the past, services have not always been flexible enough to enable such people to play an active part in the management of their condition. As a result, people have had to wait to be seen and have become more dependent on health services than was necessary. 3.4 The Government recognises the importance of individuals making their own decisions about their own and their families' health. But we also believe that there are steps we can take to help support the decisions people make. INDIVIDUALS AND HEALTH Physical activity and health 3.5 People know that physical activity is one of the key determinants of good health. A physically active lifestyle, including walking, cycling or participating in sport, reduces the risk of coronary heart disease and stroke and promotes good mental health. The marked growth in the number of people taking part in sporting activities - whether formal or informal, whether with others or alone - is a significant feature of life for many people now, and one which the Government strongly supports.
3.6 To help support the enthusiasm for physical activity and for better health, we will publish a sports strategy later this year which will promote greater scope for participation in sport and physical activity for all. It will build on many existing initiatives:
Diet and health 3.7 Diet is central to our health throughout life. A good diet during pregnancy is important for the healthy development of the growing baby. And women who breastfeed give their children the best start in life. A balanced diet during childhood helps to ensure that children grow well and do not become overweight as they get older. Avoiding sugary foods and drinks helps to prevent tooth decay. Good nutrition through adult life, with plenty of fruit and vegetables, cereals, and not too much fatty and salty food, will help to protect against coronary heart disease and stroke and some cancers. Taken together with physical activity a healthy diet enhances not just the length but also the quality of life.
3.8 People living in deprived neighbourhoods, where comparatively few people own cars and public transport is often poor, and people living in remoter rural areas, have most difficulty in reaching those shops which sell a range of affordable foods to make up a healthy and balanced diet. These "food deserts" can increase a sense of social exclusion and widen health inequality. Shopping at small independent cornershops can be as much as 60 per cent more expensive than a supermarket. As a result, the poorest people often face the highest prices. So one of the Policy Action Teams flowing from the Social Exclusion Unit's work on neighbourhood renewal is developing a strategy to improve shopping access for people living in deprived neighbourhoods. Its approach will foster and underpin the provision of local shops and services to meet everyday needs and, as a part of this, should make a balanced and healthy diet more readily available to these communities.
Smoking and health 3.9 Smoking is the single greatest cause of avoidable illness and preventable death in this country. And although most people now know the health risks of smoking, including from passive smoking, the decline in adult smoking rates since 1972 now appears to have halted, and may indeed have reversed. More worryingly, increasing numbers of children are starting to smoke.
3.10 In later chapters we show how important tackling smoking is to the reductions we are seeking in premature deaths and avoidable ill-health. If we are to achieve our targets more action is needed. In our White Paper Smoking Kills we set out a major action plan for tackling smoking, including ending tobacco advertising and providing new services to help people to give up. People: stress and health 3.11 Stress can harm people's physical health. Evidence has shown that working in jobs which make very high demands, or in which people have little or no control, increases the risk of coronary heart disease and of premature death. Inadequate social support or lack of social networks can also have a harmful effect on health and on the chances of recovering from disease. Fig 3.1 People: stress and health 3.12 People can deal with stress in a number of ways, for example by relaxing, taking up creative pursuits, and being more physically active. Keeping in touch with friends and family and asking for help when necessary also helps. Government and others at national and local level can tackle the wider determinants of stress, for example by improving housing and the environment in general, by tackling poverty and unemployment and by managing stress at work. 'Sure Start works across the boundaries of Government departments' Mothers and young children 3.13 People's health can be strongly influenced by patterns of ill-health which can flow down the generations. For mothers and young children, the importance of improving health to break these patterns is clear. Sure Start, our new cross-Government programme, will provide support to parents and local communities, addressing their needs and making available the support they require to give their children the best possible start in life. It will be targeted on areas of need, providing the glue to bind together existing services, and enhance them to meet the particular needs of young families in the local community. More than £450 million will go into 250 local programmes in England, focused on children under four and their families. 3.14 Sure Start works across the boundaries of Government departments. In communities, it is multi-disciplinary, and multi-agency. Sure Start will build on good practice and local innovation, providing the extra resources needed to co-ordinate one-off projects and fill in any remaining gaps in service provision. It will help children begin school ready to thrive. 'patterns of ill-health flow down the generations' Communicating risk 3.15 Every day people are faced with decisions in their daily lives, including decisions which affect their health. Sometimes they recognise that certain decisions put their health at greater risk than others. But it is not always clear how great or small a risk they are taking. 3.16 We can help people to understand better about risk. Driving a car is a daily necessity for many, playing sport an occasional pleasure, and eating a plate of shellfish from a roadside caravan a personal preference. All, however, can carry risks of death, injury or acute illness. Armed with knowledge and information about risk, and being aware of the conditions under which risks can be greater, people can make informed decisions in managing their everyday life. 3.17 There are other potential risks to health where
individuals expect Government or other responsible bodies to ensure
that measures are in place to protect their health. For example, people
expect to have a safe supply of pure drinking water; they do not expect
a fast food restaurant to serve them partially cooked frozen chicken;
and they do not consider it their responsibility to check that a train
in which they are about to travel will be operated by 'a better understanding of risks' 3.18 There are still other risks to health where the public accepts that there is a need for more than passive release of information to allow them to make a decision. For example, in areas where lifestyle can affect health - HIV and AIDS, cigarette smoking, use of medicines in pregnancy - most people will expect the Government to have an active programme of education to explain the risks and advise the individual on the action to be taken to avoid them. They will also expect special efforts to be made in relation to children, young people, and those who are vulnerable or at particularly high risk. 3.19 The whole question of risks to health, how they are analysed, assessed, communicated and reduced, has come to the fore during the 1990s. Many of the controversies have been in relation to food safety - the BSE crisis, the use of growth- promoting agents or antibiotics in animal farming. We need also to deal with those areas where people perceive possible risks to health but for which there is no scientific evidence of harm (from, for example, genetically modified foods or exposure to electro-magnetic fields). There have been other areas too. The risks of medicines such as the oral contraceptive pill, the perceived risks of vaccines, the risks of contracting meningitis have all captured the attention of the public and the media, often for weeks at a time. They have also highlighted the need for a new relationship between Government and the public in relation to risk. 'a new relationship between Government and the public in relation to risk' 3.20 We are currently reviewing our approach to risk and its communication. A series of seminars have involved key Ministers, the Better Regulation Task Force, senior officials, scientists, professionals, consumer representatives and journalists. The Task Force plans to make a series of recommendations as a result of these consultations. 3.21 In this White Paper we set out our approach to risk in relation to health. The areas of risk which can impact on health are many and varied, including:
3.22 Initiatives deployed to reduce risks to health in these examples and others like them include: information and labelling, health education, counselling and support, skills training, regulation, legislation to manage the performance of health services and good surveillance. 3.23 Perhaps because of the very diversity of factors which can pose a risk to health, perhaps because of their complexity, or perhaps because of the apparently unique circumstances of each, no clear ground rules have been established in the past on the interventions to be used when a hazard poses a risk to human health. 'a balance between risk and personal freedom' 3.24 In some fields of health, being exposed to a risk carries with it no benefits and therefore the aim has to be to eliminate or substantially reduce the risk. In most other situations a potential risk must be weighed against a potential benefit. Vaccines carry great benefits. They prevent diseases which can sometimes be deadly. Against these benefits must be balanced the rare risk of an adverse reaction to the vaccine. Similarly, medicines can relieve pain, restore lost function and, sometimes, save life. They carry risks in the form of side-effects, some minor, some major. 3.25 In short, it is the role of the Government to provide information about risk. But in most cases it is for the individual to decide whether to take the risk. And there is also a balance between risk and personal freedom. Some people enjoy pursuing outdoor sports which others would consider too dangerous to undertake. As long as people are aware of the risk which they are taking, it is their decision whether to put themselves at risk.
Guiding principles and key steps 3.26 The guiding principles and key steps in our approach to risk are:
Healthy citizens 3.27 People can, do and should make their own decisions about their own and their families' health. But the Government can help, acting through local organisations in the community, to make sure that people have the best information available on which to base their decisions - on risk, for example, or on assessing health or health problems. 'Healthy Citizens programme ensuring people have the knowledge and expertise they need' 3.28 We know that people are generally well-informed about some health risks, the effect of smoking on health, for example. But there are other areas where people are not so well-informed, such as the way in which stress can cause physical ill-health. 3.29 In helping individuals to improve their own and their families' health, our new approach to better health will focus on the Healthy Citizens programme. This programme will have three principal strands, all aimed at ensuring people have the knowledge and expertise they need to deal with illnesses and health problems:
NHS Direct 3.30 NHS Direct is a major new initiative aimed at empowering people in relation to health, providing rapid access to professional health advice and information. It is a nurse-led telephone helpline already covering 40 per cent of the population, to be implemented across the country by the end of the year 2000. NHS Direct will be a new gateway to health services, providing the public with prompt and comprehensive access to health information and advice. 3.31 NHS Direct provides access, 24 hours a day and 365 days a year, to comprehensive good quality information and professional advice on health, illness and the NHS with seamless links to specialist information providers on topics such as cancer, mental illness, asthma and so on.
3.32 Besides taking incoming calls, NHS Direct nurses can call with help and advice, for instance reminding people who may need a flu jab to make an appointment, or contacting a mother who has just left hospital with her new baby to make sure that they are all right. Pilots will start by the end of the year in the West Midlands, West Yorkshire and other parts of the country. NHS Direct will also aim to provide integrated access to advice and care out of hours. Pilots will be taking place in Nottingham, West London and the North East during this year. We believe that NHS Direct will benefit people wherever they live. We expect that it will be especially valuable to rural areas where people may have difficulties reaching health care by public transport. People in small communities may also particularly value the confidentiality of NHS Direct. NHS Direct On-line 3.33 From autumn 1999 NHS Direct On-line will start to give people access, at the click of a mouse, to an interactive self-care guide and accredited information about hundreds of diseases and self-care groups. For instance, the service will provide access to a comprehensive range of information on cancers including links to specialist information providers. The interactive self-care guide will direct users through a simple set of questions, and it will be based on the twenty top symptoms on which callers most regularly seek advice from the telephone help-line. The guide will help people decide whether it is safe to look after themselves and offer advice on what they need to do. It will also help them decide when they need professional help. Where people are still unclear what to do they will always have the option of speaking to an NHS Direct nurse. 3.34 Public access points for NHS Direct and NHS Direct On-line will be provided in a range of public places such as surgeries, pharmacies, Accident & Emergency departments, shelters for homeless people, healthy living centres, libraries and post offices. The first 100-200 will be in place by April 2000.
NHS Direct Healthcare Guide 3.35 The experience of the telephone helpline will be used to develop an NHS Direct Healthcare Guide, which will provide further help to people in getting the assistance they need. This will provide advice on common ailments and problems on which NHS Direct nurses most commonly advise. The guide will be presented in a way which supplements the advice a nurse can give over the phone. It will be sent out to callers by NHS Direct nurses when they think it will be helpful and it will also be available on request and through bookshops. The guide will also be appropriate for use as a basis for general training on self-care and health skills. 'NHS Direct Healthcare Guide will provide advice on common ailments and problems' Health skills Health skills for first aid 3.36 A number of NHS bodies including many ambulance services already provide first aid training. There are also many good examples of voluntary initiatives in this area, as we acknowledged in Developing Emergency Services in the Community published in September 1997. For example, the Red Cross, St John Ambulance, the Resuscitation Council and the Royal Society for the Prevention of Accidents as well as the BBC's 999 Roadshow and others provide training in first aid. We will build on those initiatives by investing £1 million a year to expand training for people to learn health skills including first aid, mainly using existing providers. This should pay for 1,000 - 1,500 extra courses and enable around 25,000 more people each year to receive training. This additional training, covering maintenance of airways, breathing and ventilation, will be linked with the NHS Direct Healthcare Guide which is being developed as part of the extension of NHS Direct. The first new courses should be available from January next year. 'expand training for people to learn health skills including first aid, for 25,000 more people each year' Health skills: defibrillators 3.37 In England only two to three people in every 100 survive a cardiac arrest compared with eight to nine in Scotland and 11 in the United States. A number of the deaths in this country are avoidable: there is good evidence that people trained in the use of defibrillators can use them effectively to save lives following cardiac arrest. While we welcome the initiatives already being undertaken by the voluntary aid societies to make such equipment more widely available in the community, there is much more which can be done, both in terms of providing life-saving equipment in places where it is needed, and in training people in its use. 3.38 So we are investing an extra £2 million in a new initiative with the voluntary aid societies to save more lives following cardiac arrest. About half that sum will be available for new equipment to supplement the extra machines already being provided by the societies. That will enable us to buy about 400 additional defibrillators.'In England only two to three people in every 100 survive a cardiac arrest compared to eight to nine in Scotland and 11 in the United States' 3.39 Initially we shall pilot their use in those public places where they are most needed, for example in railway stations, airports and other public areas used by large numbers of people where the incidence of cardiac arrest is likely to be relatively high. We will ensure that the responsibility for maintaining them is clearly allocated, and for ensuring that they are clearly visible and accessible so that members of the public can use them as soon as it is clear that they are needed. 3.40 The other half of the extra £2 million will be used for the provision of a linked programme of training in the use of defibrillators. We will work with the voluntary sector and others to ensure that such training is made available to support the provision of new equipment. Our aim will be to target training primarily on those who work in or near the pilot sites but we will also provide additional training opportunities for members of the public. This will help to de-medicalise and demystify immediate care and enable more people to be both competent and confident in managing emergencies. This will complement our investment in new equipment for NHS bodies, including ambulance services, which will facilitate the implementation of the National Service Framework for Coronary Heart Disease (see paragraph 6.16).
Health foundation skills 3.41 We will also invest in schemes aimed specifically at preventing injury in children. In Oxford we are providing funds to pilot an injury minimisation programme for schools. The aim is to educate 11-year-olds in injury prevention and resuscitation skills. If the evaluation of the scheme shows it to be effective - the results are expected later this year - we will invest in additional schemes elsewhere in the country. We will initially set aside up to £500,000 a year to enable similar schemes to be provided in each health region of the country. This will be targeted on deprived areas where the incidence of childhood accidents is highest (see paragraph 2.10). It should enable around 5,000 children each year to benefit from this training. 3.42 We will establish a Health Skills programme for young people, with two central aims. First, it will provide young people with new opportunities to learn and acquire skills which will help them to maintain their health as they move into adult life, including for example by resisting pressure from their peers to take risks with their health. Secondly, by teaching young people how to provide first aid, including resuscitation techniques, and how to recognise common illnesses, we will equip young people with the awareness, knowledge and skills to recognise and help another person whose life may be threatened by illness. 3.43 The Health Skills programme will build on the proposals put forward by the Qualifications and Curriculum Authority in its recently launched consultation document on the national curriculum. In that document the Authority proposes to strengthen the citizenship and personal, health and social education components of the national curriculum in ways which will encourage young people to adopt healthy lifestyles and become much more informed, active and responsible citizens. When children leave school, they should have the skills to cope with a wide range of emergency situations, including burns, falls, bleeding and stings.
3.44 We envisage the Health Skills programme as a distinctive strand in the joint Department of Health/Department for Education and Employment Healthy Schools programme (see paragraph 4.17). So it will be included in the broader context of the wider curriculum changes. We will develop effective models and partnerships to ensure the early implementation of the programme. The first step will be to test current work where it exists, pilot and evaluate new approaches and explore the feasibility of different models. This will help ensure that the programme which is introduced meets young people's needs in a relevant, timely and effective way.
Health skills for parents 3.45 We will also provide health skills training for parents of young children to help ensure that children have the best possible start in life. The Sure Start programme, targeted at the most disadvantaged children, provides the means for doing so. Sure Start aims to improve children's health as well as their social and emotional development and ability to learn. As one strand of the programme we will ensure that support and advice on health, first aid and action in emergencies is provided for parents and carers. Some of the services to be provided by the first 21 projects include:
Health skills for later life 3.46 We know that the winter poses serious threats to the lives of older people. The English House Condition Survey found that in this country there were 4.3 million 'fuel poor' households (where more than 10 per cent of the household's income has to be spent for adequate heating), with people aged over 60 years making up nearly half of that number. We are already taking action to address fuel poverty and improve energy efficiency; in addition we are working with older people themselves to improve the effectivness of our Keep Warm, Keep Well campaign.
Expert patients 3.47 The final strand of our Healthy Citizens initiative is the Expert Patients programme to help deal with chronic illness. As people live longer an increasing number will suffer from a chronic disease. Amongst people over 75 years, around two thirds suffer from long-standing illness or disability. One national survey found that almost a quarter of people over 75 years suffered from arthritis or rheumatism, while 4 per cent were diabetic. Even at younger ages chronic diseases are common. 3.48 We want these people to have more years of healthy, active life. We shall help people with chronic disease maintain their health, improve their quality of life and slow the progression of conditions which can lead to pain, serious incapacity and premature death. 3.49 People with chronic illnesses are often in the best position to know how to cope. There is increasing evidence from research studies and from patients' associations that people have improved health and reduced incapacity if they take the lead themselves in managing their chronic disease - with good support from the health service. 3.50 But in the past, too little has been done to help people with chronic disease to play a part in managing their own condition. That is why we have asked the Chief Medical Officer to set up a Task Force to design the new Expert Patients programme to address the needs of the very many people in this country with a chronic disease or disability, who amount to one in three of the total population. The Task Force will look at the role which those affected can themselves play as experts in managing their chronic disease. It will set out the relationship between such programmes and the support which people require from the NHS. It will design a pilot programme and provide advice on what needs to be done to make services for people with chronic disease a central part of the NHS. In this way we hope to improve their self-esteem and their quality of life.
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Physical
activity
Smoking
