Public health: when the talking has to stop

Consultation closes tomorrow on the public health white paper, scheduled for publication in July. Helen Mooney reveals the findings of the eight task groups charged with making recommendations for the forthcoming legislation

A ban on smoking in the workplace is chief among the demands of those who have contributed to the consultation on the forthcoming public health white paper.

Health secretary John Reid will be presented with the Choosing Health task groups' recommendations tomorrow and the working for health and opportunities in employment task group will say that the government should consider introducing legislation which would require employers to protect their staff from secondhand smoke.

'This is a strong theme across the consultation and one that has received overwhelming support, ' says Action on Smoking and Health director and task group member Deborah Arnott. She says that action on this issue is something that most of the task groups have been considering.

'We have also worked closely with the better health for children and young people task group on how to reduce children's exposure to second-hand smoke, ' she adds.

The government will also be told to consider a ban on junkfood advertising to children. The young people task group will recommend that the government takes a stronger lead in how food messages are targeted to young people. It will also recommend that the government instructs the food industry to take steps to educate the population towards a healthier lifestyle.

'Having a health choice is fine if you are able to understand the impact on you as the individual, but children have an inability to make informed healthy choices, ' explains regional director of public health for Yorkshire and Humber and young people's task group member Paul Johnstone.

Mr Johnstone believes there is a role for government, the business sector and schools in getting the message across, and that change is starting to happen. 'McDonald's is starting to advertise salads and fresh fruit which is something which would never have happened in the past... the role of the government is to encourage and normalise key behaviour, ' he says.

According to National Consumer Council chief executive and consumers and markets task group chair Ed Mayo, the introduction of 'social marketing', bringing together different aspects of the public health message, will be a key proposal. 'The market can be both disabling and enabling to health, ' he argues. One area the group has analysed is the way in which bottled water has been successfully marketed to the public through advertising and in the fashion and celebrity industry.

'There needs to be a huge culture change in the NHS in the way in which health professionals disseminate the public health message, ' he argues.

He says the consumers and markets group will advise the government to implement a national social marketing programme involving the NHS, private organisations, industry, and the voluntary sector.

British Retail Consortium director of food policy and consumers and markets task group member Richard Ali agrees. He wants to see the government offer a strong, coherent message on what constitutes a healthy lifestyle rather than the current inconsistent messages on diet and exercise.

'We need a proper public information campaign, ' says Mr Ali. 'We need government to propagate a consistent message on a national level, and if industry has this then we will work with government to get the message out there.'

The Choosing Health consultation and the task groups were established primarily in response to Derek Wanless's public health report, Securing Good Health for the Whole Population.

The Department of Health decided on the consultation and established the eight task groups despite Mr Wanless's criticism that there had already been '30 years' of talking about public health.

NHS Alliance national public health lead and maximising the NHS contribution in primary care task group chair Chris Drinkwater says that his group will propose that primary care trusts refocus their commissioning on a wide range of public health initiatives rather than 'commissioning special services from hospitals which they are currently largely focused on'.

'Most local people and local communities feel disengaged with the multiplicity of messages on health they are receiving, there is a certain amount of consultation fatigue, ' says Professor Drinkwater.

He says the group will recommend greater local capacity in public health teams, which should employ local staff and grow a presence in the community. Ann Baines, South Birmingham primary care trust director of commissioning, and a member of the group looking at maximising the NHS contribution across the NHS as a whole, agrees: 'It is important to get more employment into the system as a whole, getting people in locally deprived communities into work in the NHS.We need to think of innovative ways of doing this rather than seeing the NHS as the centre of the world.'

This group, under the chairmanship of Durham and Tees Valley SHA chief executive Ken Jarrold, will recommend that the NHS builds up 'fully engaged' partnerships with local authorities and increases the number and prominence of health promotion specialists locally, the group also wants the NHS to consider sustainability in terms of transport policy and food procurement.

Overarching all the other groups has been the focusing on delivery task group, which formulated a framework to consider all future public health policy before implementation. Health Development Agency chief executive Paul Streets says that the framework will be used as a tool to ensure that all public health initiatives have the right levers in place to make them successful.

'What we are doing is bringing together a framework for delivery.

We may not have been successful in the past because we have not had this, ' says Mr Streets.

Better health for children and young people Chair: Paul Ennals, National Children's Bureau chief executive Controlling children's exposure to second-hand smoke and junk-food advertising are likely to feature strongly on the list of recommendations submitted to health secretary John Reid tomorrow.

One member says the government should take a role in addressing public health for children because of their 'inability to make informed healthy choices'.

It will also propose that the government looks again at the sexual health curriculum in schools to ensure that it addresses 'the emotional impact of relationships as well'.

Consumers and markets Chair: Ed Mayo, National Consumer Council chief executive 'A social marketing programme must be established to educate the population, 'according to Mr Mayo.A key proposal is that the government devises a national advertising campaign to convey all parts of the healthy lifestyle message.The Department of Health is currently consulting with advertising agency Abbott Mead Vickers on how this might be achieved.

Mr Mayo says that the DoH should regard the Home Office's effective drink-driving campaigns as the 'precursor' to such a message.

Focusing on delivery Co-Chairs: Mike Farrar, South Yorkshire strategic health authority chief executive, and Tony Elson, Kirklees metropolitan council chief executive The group has developed a framework against which to test all new public health ideas and policy before implementation.Organisations should test their work against the different public health components to ensure that public health interventions work.

Health Development Agency chief executive and group member Paul Streets says that the framework is about asking 'if we want to achieve a particular outcome, [then] what are we going to need to happen?'

Leisure Chair: Baroness Pitkeathley, New Opportunities Fund chair According to group member Maggie Rae, Health Development Agency regional director for the South West, the group has looked closely at the obesity epidemic and will recommend a range of ways to ensure that people become more active.She says that 'both the individual and the government need to take some responsibility' for ensuring people have time to exercise and are encouraged to do so.

Maximising the NHS contribution across the NHS as a whole Chair: Ken Jarrold, Durham and Tees Valley SHA chief executive Key proposals are to develop strong partnerships between local authorities and the local NHS and develop targets and ratings for local government which are similar to those for the NHS.

The group will also recommend that health promotion will be discussed every time an individual comes into contact with the health service.

Maximising the NHS contribution in primary care Chair: Professor Chris Drinkwater, GP and NHS Alliance public health lead.

'We have to invest to save in primary care, ' says Professor Drinkwater.

Task force: the groups The group will propose that primary care must focus far more on prevention rather than cure.According to Professor Drinkwater, 'there needs to be a single pot of money available for commissioning for public health'.

Working for health/opportunities in employment

Chair: Will Hutton, Work Foundation chief executive

The key proposal from this group will be that the government introduces legislation to ban smoking in the workplace.Other proposals include a greater emphasis on bringing people back into the work place as a way of tackling ill health and depression.

Working with and for communities Chair: Dame Yve Buckland, Health Development Agency chair The group will propose 'one-stop shop'models for community health, whereby the local population will be able to access information about all the areas that help to determine good health.

It will recommend further development of local strategic partnerships and the role of local government overview and scrutiny committees as well as suggesting that targets for local government and the local NHS in public health are closely aligned.