'For a government which has placed so much emphasis on health inequalities to announce after nine months in office that it has been unable to come up with quantifiable targets for their reduction is an admission of failure on a fairly grand scale'
We all knew what was wrong with The Health of the Nation: it said too much about individual responsibility and rather too little about the economic and social causes of ill health; it set so many priorities that it may as well have set none at all; having set targets, it then transpired that the data needed to monitor progress was sometimes not available; and rather too often it turned out that the government lacked the will to act in a way which promoted the desired ends. In effect, the National Audit Office said as much when it issued its progress report on the last government's strategy two years ago.
So there is a lot of good news in the present government's green paper, Our Healthier Nation, which ministers will launch over the next week or so (see News, page 3; News Focus, page 12). And so there should be, given the credit the government has already taken for giving the issue such prominence.
First the good news. As public health minister Tessa Jowell promised last July when she launched the process which led to the new consultation document, there has been a drastic pruning of priorities. There will be just four national targets, and they will concentrate on outcomes rather than process measures. If that enables health authorities and their allies in this fight to get on with a deliverable programme of health improvements in the way most suited to their populations' needs, and to supplement the small number of national targets with local ones fitted to local circumstances, then all well and good.
Furthermore, in its proposed 'contract with the people', the government strikes the right note in recognising both individual responsibility and the social and economic factors which affect our health. Real effort will now be needed to translate the rhetoric of the green paper into central government action (for example, on the long-awaited anti-tobacco programme, as well as on housing, public transport and pollution) and local health improvement programmes which make a real difference to people's lives.
There is, however, at least one serious disappointment. For a government which has placed so much emphasis on health inequalities to announce blithely after nine months in office that it has been unable to come up with quantifiable targets for their reduction is an admission of failure on a fairly grand scale. Of course, the whole language of the green paper is shot through with talk of action on inequality, and there is some prospect of targets at some stage in the future. But without quantifiable steps towards a reduction in inequalities in health against which progress can be measured and for which organisations and individuals can be held accountable, there is a danger that momentum will be lost. This is one omission which ministers must rectify in time for the white paper.
There must also be serious doubt about the stringency of the targets which are proposed. At the time of the National Audit Office study, deaths from coronary heart disease and stroke, from breast and lung cancer, from accidents among young people and from suicide were already on a long-term downward trend. Our Healthier Nation says it is not acceptable simply to extrapolate long-term movements and then add a percentage point or two, yet there is little evidence that the Department of Health is doing anything else. The targets require expert scrutiny and should be amended if necessary to ensure they are stretching for those charged with achieving them.
Finally, like The Health of the Nation before it, Our Healthier Nation has nothing at all to say about the resources needed to tackle preventable ill health at its roots. As events in Scotland illustrate (See News Focus, page 14), simply expecting resources to flow from treatment to prevention is no solution.
Public health requires at least pump-priming money, and, if the government is serious about tackling inequalities based on gender, race and class, rather more than that. But then perhaps ministers are keeping that up their sleeve until the launch. We look forward to chancellor Gordon Brown's unexpected arrival at the launch to announce he's found a bit more cash.