Published: 06/05/2004, Volume II4, No. 5904 Page 12
For public health movers and shakers, it seems that at long last they are being listened to, and that public health is moving to the top of the agenda. Those who have attended public health gatherings over the last few months will have heard mutterings about the 'heralding of a new dawn' or a 'significant paradigm shift'.
There is no doubt about it: public health professionals are excited.
Derek Wanless' report Securing Good Health for the Whole Population warned that unless the government acted now to implement a 'fully engaged scenario' by 2022-23, the NHS would need an extra£30bn a year to cope with the health time-bomb of increasing obesity, chronic heart disease, diabetes and cancer. In response, health secretary John Reid announced a consultation on what action should be taken, and an eagerly anticipated white paper is expected this summer.
Directors of public health in primary care trusts and strategic health authorities have been called on by the Department of Health to conduct the consultation and have been given guidelines on the areas they should be looking at in their locality.
But how is this translating on the ground? One director of public health in a highly deprived area of the North East says that there is a large degree of 'consultation fatigue' and that because of this their PCT has decided not to hold any specific Choosing Health consultations.
They explain: 'Where multi-agency groups and PCT groups are holding general meetings we are raising the public health consultation, but it is difficult to demand that people take time out from what they are already doing to take part in yet another consultation.'
Although public health may have made its way on to the national platform, a common problem for public health directors is trying to convince other senior management at local level that money should be channelled into health improvement.
A public health director in the west of England says that their biggest problem is trying to persuade the chief executive and finance director to earmark money for local health improvement projects because their top priorities are always on cutting waiting times.
A recent National Institute for Clinical Excellence survey of PCT public health directors highlights the conflicting problem of national targets compared to local priorities. It showed that 76 per cent of PCT public health directors felt that national work programmes, particularly waiting lists, had displaced local priorities either 'completely or to a large extent'.
One director of public health in the South of England who holds a joint post with the local authority says that they hope the public health white paper will recognise the need for local government and primary care trusts to work much more closely on local health improvement.
'Local authorities have a huge amount to contribute to public health, I am a big advocate of local authorities being given discretionary power through new public health legislation to implement local health improvement policy such as banning smoking in public places'.
Rather than local authorities pooling budgets with PCTs he says the emphasis should be on an increase in joint public health posts and common work programmes.
There is a visible momentum within the public health community.
People are excited and many think that the white paper is the biggest opportunity in the last three decades to change the way in which health is perceived in government at national and local level, in the health profession, and among the public as a whole.
However, as always public health specialists are quick to temper their excitement. As one Manchester director says: 'It is one thing to win the hearts and minds battle in public health and it is entirely another to get people to translate this into diverting resources on the ground.'