Published: 04/03/2004, Volume II4, No. 5895 Page 25
Derek Wanless has given public health policy a welcome boost.
In my view, some urgent problems such as children's obesity, sexual health and alcohol abuse need energetic multi-focused national campaigns which could benefit by moving away from the Department of Health.
Although we will soon have a white paper on public health, it is a long time since the heady days of 1997 when we all enthusiastically welcomed the appointment of the first public health minister. Since then the post has been downgraded in the government hierarchy and Department of Health energies have been focused on the NHS.
The NHS has seen improvements, but public health problems remain crucial. We still have unusually high rates of premature death from respiratory and circulatory diseases; half the difference in survival to 70 years between social classes I and V is due to higher levels of smoking in class V. At the other end of life, the British Medical Association's recent report on adolescent health created headlines by concluding that 'the next generation will be the most infertile and obese in the history of mankind'.
It is a cliché to point out that the underlying causes of these bleak statistics and predictions are embedded in socio-economic and educational factors rather than healthcare provision.
Mr Wanless has vigorously re-emphasised these key determinants in his second report to chancellor Gordon Brown.
How does the government respond to the challenge of improving population health by economic means and changing life styles? Is taking a real grip on public health strategy beyond the scope of the DoH or, indeed, any single government department?
Of course, much practical work has now been devolved to primary care trusts and local government, but there remains a crucial role for national leadership. The Nuffield Trust has proposed a health of the people act to create new structures for public health delivery.
My immediate solution is to appoint a public heath minister in the Cabinet Office, who chairs a Cabinet committee with crossgovernment responsibilities. There are already signs of interest from Cabinet members outside the DoH. Secretary of state for culture, media and sport Tessa Jowell has been making the running on children's diet and exercise; education secretary Charles Clarke gave the Public Health Faculty's annual lecture in November on improving health through education; and the Department for the Environment, Farming and Rural Affairs has highlighted the environmental links to asthma rates. Following Wanless, there may be Treasury support for a more general economic approach.
My own experience as minister for women in the Cabinet Office convinced me that a central, non-departmental unit can be very influential in motivating cross-cutting action on broad-based policy. You can act as a pressure group within the government.
Politicians are often deterred from tackling lifestyle issues because solutions seem very long term and anyone promoting them is liable to be branded an agent of the 'nanny state' - particularly if they are female! But the UK is facing crises in public health which need nationally driven strategies. It is time to confront knee-jerk reactions about the right of people to harm themselves and to work with the media, local agencies and the voluntary sector to provide campaigning policies which are not confined to a medical model.
Baroness Jay is a former health minister, and minister for women in the Cabinet Office