Why wait another week to read the public health green paper when The Journal can reveal all?
Ministers will set out their public health plans next week with the launch of Our Healthier Nation, the green paper first promised for the autumn. The document, a draft of which has been seen by the Journal, proposes a new 'contract for health with the people of England', promising 'to bring the nation together in a concerted and co-ordinated drive against poor health'.
The new strategy gets rid of the 27 targets set by the previous government in The Health of the Nation, replacing them with just four key targets. It argues that priorities must be limited if the strategy is to be 'disciplined and focused'.
But it also ducks the more difficult task of setting national targets for reductions in health inequalities - a central aim of the government since its election.
Here, we summarise the main points of the document.
Chapter one: Fit for the 21st century
The case for improving the health of the people of England is compelling and no government can ignore the personal, social and economic arguments for making England's health better. But the fact that such an obvious challenge to this country is still not being tackled effectively poses tough questions for us all and calls for new solutions from everyone - because everyone has a part to play.
The case for better health for England is self-evident. It is personal, social and economic common sense.
Of course, mortality cannot be wished away and we will all die of something in the end. What matters is how long we live and how well we are while we live.
If we are to improve England's health, we will need to be tough and unsentimental about the task, recognising that the reasons why we have all put up with these problems in the past may mean that the task of tackling them is a difficult one.
We have three aims for Our Healthier Nation. They are to
increase the length of our lives;
increase the years we spend able to live life to the full;
increase the opportunities for a healthier and longer life for the many as well as the few.
To show we mean business, we will identify four national priority areas and set a national target for each of them.
This green paper sets out the government's proposals and asks for your views on how these proposals can be improved. We will publish a definitive strategy later this year.
Chapter two: The causes of ill-health
The causes of ill-health are complex and many of the factors are still not clear.
Some of the factors which cause illness and early deaths are in our genes and fixed before birth. Science is only beginning to explain fully how this affects our health. Our priority now must be to concentrate on the many early deaths we do know to be preventable.
Our lifestyle has an important impact on our health. Whether we smoke; whether we are physically active; what and how much we eat and drink; our sexual behaviour and whether we take illicit drugs - all these factors can have a dramatic and cumulative influence on how healthy we are and how long we will live.
Because of the terrible toll that smoking takes on the health of England, the government is preparing a comprehensive strategy on reducing smoking to support Our Healthier Nation. This will be published later this year.
We also know that our actions are not the only influence on our health. It is also affected by our circumstances and these affect how we make choices about our own health.
For example: it is harder to stop smoking or take care about what you are eating when you are worrying about making ends meet; if the nearest supermarket is miles away and the bus does not go there when you can, then it can be difficult to buy a variety of food cheaply; if the street outside the flat is busy with traffic or there are drug dealers in the car park, then it is safer to keep the kids in front of the TV than send them outside to play.
The causes of ill-health which we know about are many and complex. Individuals can make a difference to some of them, but for many factors, local and national bodies must play a part.
For all these factors - individual, social, environmental and access to high quality services - how much you are affected depends on how well off you are, whether you are a man or a woman, where you are born and brought up, and on your ethnic background.
Chapter three: A contract with the people of England
In the past, strategies to improve health have been too much about blame. Individuals were said to be to blame for failing to listen to well-intentioned advice from an out-of-touch government. Or the government was to blame for failing to embrace grand plans for social engineering which would make people healthier without any effort on their part.
In a modern country these old positions must become obsolete. Health is not about blame, but about opportunity and responsibility: everyone in England has a part to play - individuals, families, communities, local services, national organisations and government.
To help bring the nation together in a concerted and co-ordinated drive against poor health, we propose to join with the people of England in a national contract for better health. The contract sets out our mutual responsibilities for improving England's health in the areas where we can make most progress towards our overall aims of reducing the number of early deaths, increasing the amount of time we are healthy and tackling inequalities in health.
To deliver its part in the contracts for each of the four national priority areas, the government must ensure that all government departments are working together.
It has taken three key steps to ensure this: for the first time, the government has appointed a minister for public health; there is a dedicated Cabinet committee of ministers from 12 departments to make sure the whole government plays its part in the national contracts for health; the government will apply health impact assessments to relevant policies.
Government offices for the regions deliver the main government programmes such as housing, planning, transport training and investment in industry.
The health strategy aims to bring the government offices for the regions and NHS regional offices much closer together. Joint working is difficult because their geographical boundaries do not match well, but this needs to be overcome because of the important advantages to be gained.
The government will need technical advice on monitoring progress and measuring improvements in health, advice on how best to involve the range of non-government bodies which can play a part, and support in making the most of the contribution of the NHS and local authorities.
In the light of responses to this consultation document, the government will consider whether to set up special task forces to focus on these important aspects of the strategy. The government will also need to consider what structures are needed to ensure that all those involved in the national contracts have a voice in the implementation and development of strategy.
While government can set a framework and ensure that the social, environmental and economic foundations are strong, it is the army of people on the ground who can do most to make Our Healthier Nation a reality.
Health authorities will have important local leadership roles, and will lead local alliances to develop the health improvement programmes which will set out what each locality will do to play its part in the national contracts for health.
We would welcome views on how HIPs might develop, but we envisage that they will:
Give a clear description of how the three aims, four contracts and four targets will be tackled locally;
set out a range of locally determined aims and targets, with particular emphasis on addressing areas of major health inequality in local communities;
specify agreed programmes of action to address national and local priorities;
show that the action proposed is based on evidence of what is known to work;
show what measures of progress will be used;
indicate which organisations have been involved in drawing up the plan, what their contribution will be and how they will be held to account for delivering it;
ensure the plan is easy to understand and accessible to the public;
be a vehicle for shaping local health services.
HAs will not act alone. They must work closely with local authorities and a wide range of other agencies and organisations which can influence the health of the population.
The government will discuss with the Local Government Association whether the local authority contribution to HIPs can be brought into the best- value regime.
But just as national and local bodies must play their part, the success of Our Healthier Nation depends equally on individuals taking responsibility for the way they live their lives.
Individual responsibility is not just about our own health: in the end that is a matter of individual choice. But for all the individual influences on our health, the example and boundaries that parents set are central to the health of their children. It is in secure and caring families that we learn a responsible and healthy way of living.
Chapter four: targets for health
We have identified four priority areas: heart disease and stroke, accidents, cancer and poor mental health. To energise the contracts and encourage everyone to take part, we propose to set four national targets, one in each of these priority areas (see box).
Anyone who suffers from a particular disease or who has lost a friend or relative to a particular illness will be disappointed if that condition is not prioritised. Medical professionals who care passionately about the patients they treat for the illness in which they specialise will naturally hope that they will be targeted for a national contract.
But the number of priority areas will have to be small if the strategy is to be disciplined and focused in its approach. If everything is to be a priority then nothing will be a priority. If we spread our effort too thinly, we will not achieve a breakthrough. So while in consultation we will pay careful attention to arguments for adopting different priority areas, additional priorities which will dilute our efforts will need a very strong case for inclusion. Suggestions for new national priorities will also need to argue their merits against those which have been proposed by showing how they would deliver greater progress on the three key aims of Our Healthier Nation.
The goals set out in this document are for consultation, and we would welcome views on whether they should be more challenging or more realistic. Simply drawing a graph, plotting where it is likely to go in 10 years and then adding an extra percentage point or so is temptingly straightforward but it is flawed.
As Our Healthier Nation takes shape, we will need to develop effective ways of monitoring progress towards the targets. Technical details on this will be published with the white paper. The NHS contribution to the strategy will be monitored through a new framework for assessing and improving its performance set out in the NHS white paper, The New NHS.
To ensure that the targets and monitoring of Our Healthier Nation are scientifically robust, the chief medical officer will, with the assistance of specialist advisers, review the detailed formulation of targets and assist in tackling the technical and statistical issues which will underpin the strategy.