The public health white paper sets out ambitious targets for reducing deaths by 2010. Mark Crail canvassed responses to it and found widespread scepticism that it would reduce health inequalities

In setting a target of 300,000 lives to be saved over the next decade, the government is at least proving itself mathematically consistent.

Like the£21bn it claimed for the NHS in last year's public spending review, the target set in the Saving Lives white paper is a cumulative one - a life saved this year counts as two lives saved next.

Even so, despite concerns at the paucity of the£96m set aside as a public health development fund over the next three years, no one has so far come forward to claim that the target should have been more challenging.

For the four priority areas, it will mean that by 2010 there will have been a reduction on 1997 figures of 14,000 deaths from cancer, 28,000 from circulatory disease, 2,000 from accidents, and 900 from suicide (see figures).

But beyond the rhetoric, the work involved in setting up mechanisms to deliver and measure progress can now get under way - and no one, in Whitehall at least, will be busier than chief medical officer Professor Liam Donaldson.

It will be his job to oversee the work of the Cancer Action Team announced earlier this year by the prime minister.

There will be a 'high-level taskforce' accountable to the chief medical officer for each of the other three key target areas, each of which will also have 'someone of national prominence to act as its champion'.

The chief medical officer will also be expected to set up a strategy to deal with communicable diseases, focusing both on old diseases in their new antibiotic-resistant guises and new diseases such as HIV/AIDS.

A 'forthcoming' HIV/AIDS strategy will cover testing, treatment and prevention, and there will be a 'high-level taskforce' on genetics and disease prevention which will work to the Human Genetics Commission announced in May.

The government's strategy on breast and cervical cancer screening will be published later this year, and pilot projects on screening for colorectal cancer will report in 2002.

The white paper promises a strategy to tackle alcohol abuse, which will be published after consultation early next year, a sports strategy and a road safety strategy. There will also be a national forum of non-governmental public health groups to offer expertise and advice on healthy living centres.

Building on NHS Direct, it says NHS Direct On-line will go live in the autumn, with access points in surgeries, A&Es, homeless shelters, healthy living centres, libraries and post offices. Up to 200 should be in place by April 2000.

There will also be£1m to expand first-aid training courses, enabling around 25,000 people a year to get training from January,£1m for defibrillators to be sited in public places and another£1m to train people in their use.

Health impact assessments - but not health inequality impact assessments - will become a routine part of policymaking across government.

Properly structured careers in public health will be opened up to those with a non-medical background, with a 'rapid' public health skills audit followed by a public health workforce national development plan.

In particular, the role of health visitors is to be 'modernised' and that of school nurses 'developed'.

Eventually, there will be a new post of specialist in public health of 'equivalent status' to medically qualified consultants in public health medicine and able to become public health directors.

A clearer picture of public health needs will come from a review of national sources of public health information and the setting up of a public health observatory in each region based on the one established in Liverpool in 1990. Information about chronic diseases will be tracked on local disease registers.

Current work mapping all available research will lead to a research and development strategy for public health, and there will be a fast-track development programme to encourage young public health academics.

As predicted, the Health Education Authority will be replaced - subject to legislation - by a Health Development Agency.

Research commissioned from the centre for reviews and dissemination at York University into water fluoridation will, if it confirms that there are benefits and no significant risks, lead to further legal changes.

Local authorities will take responsibility from health authorities to consult the public, and, where there is strong local support, water companies will be obliged to fluoridate.

Progress towards the 2010 targets will be monitored continuously, with a review published every three years.

There are interim targets for 2005.

The white paper is little changed from the draft submitted by health secretary Frank Dobson to Downing Street (news and news focus, 3 June), and contains few major changes from the green paper published last May.

There were, the white paper reports, more than 5,500 responses to the consultation which followed the green paper, 'with well over 90 per cent in favour of the proposed approach'.

Saving Lives: our healthier nation .

www.ohn.gov.uk

Responses to Saving Lives

Yve Buckland Chair, Health Education Authority; chair designate, Health Development Agency 'This announcement heralds a very significant reform of the HEA, which will need to be tackled boldly and in consultation with everyone we work with.

The HDA will have an important national role - which will have to be more tuned to what is happening locally. Our new responsibilities mean we will be working at the cutting edge of developments, but our efforts will only be relevant if they are capable of practical application by those working on the front line to improve health.'

Stephen Thornton Chief executive, NHS Confederation 'We hope that accessing the£98m to be made available from the modernisation fund will not be via yet more time consuming bidding processes, but will be played out to the NHS as soon as possible according to an agreed formula. In its submission to the green paper last May, the NHS Confederation called for health inequality to be a primary objective of health policy. It is therefore profoundly disappointing that government has not itself set a national target in this area.

Asking HAs to set local targets seems an inadequate response. Unless there is a radical joint review of the funding formula for local authorities and health authorities in favour of areas of poverty, the situation will continue to favour more affluent areas.'

Rita Stringfellow Chair, Local Government Association social affairs and health committee 'Modern public health began in local government and the new duty [to promote social, economic and environmental well-being] supported by this white paper will help us build on that proud record. It is vital that it is included in the Local Government Bill coming before Parliament in the next session.'

Donald Reid Joint chief executive, UK Public Health Association 'There do not appear to be national targets for reducing health inequalities - we desperately need these. The government is being far too optimistic when it says it can tackle these issues through this white paper. The development fund will make little difference. Will trust chief executives now be told to prioritise public health over waiting lists?'

Professor James McEwen President, Faculty of Public Health Medicine 'We thoroughly endorse the proposed measures to strengthen professional support of public health. We believe the HDA will be of great benefit to ensure high-quality public health services. The public health observatories will enable a variety of health skills to come together to provide the evidence for sound public health practice.'

Rodney Bickerstaffe General secretary, Unison 'Unison members across the caring services will have a key role in delivering success. Unison believes the white paper should have included a national target for reducing health inequalities. This agenda can only be achieved with properly resourced public services. A particular concern is that the school meals service is still facing cutbacks.'

Geoff Martin, campaigns director, London Health Emergency 'There's no point in the government setting targets for a healthier nation if they continue to duck the two major issues which really make a difference:

tackling the root causes of ill-health and major investment in primary and preventative healthcare.'

Cliff Prior Chief executive, National Schizophrenia Fellowship 'One in 10 people with severe mental illness will meet an unnatural death. We want to make sure the government's target is more than met, despite the fact that suicide rates are still on the rise for young men. What is needed is quality care provided early. That means a lifting of the financial restrictions that exist on the best drug treatments, comprehensive risk assessments at first contact and at discharge, as well as better staff training.'

Sally Greengross Director-general, Age Concern 'If the government wants to improve the health of the whole nation it should focus on the needs of all older people, including those over 75 years of age. Excluding them is detrimental to both the older population and the NHS.'

Eoin Redahan Stroke Association 'We welcome this long-term strategy, but the government shows reluctance to take measures to more quickly reduce death and disability from stroke. By ensuring everyone has access to organised stroke care, an estimated 3,500 lives could be saved every year and a similar number of unnecessary institutional placements avoided.'

Judy Wilson Director, Long-term Medical Conditions Alliance 'We are very glad to see both recognition of the special needs of people with long term illness and their expertise. It is a welcome balance to the emphasis on saving lives. The 'expert patients' taskforce seems to be a good step forward and LMCA will be glad to contribute to it.'

What the papers say. . .

Dobson's patches are not the answer 'Beneath the headline-grabbing targets, the small print of Mr Dobson's white paper offers small beer rather than real beef. This is because he and his colleagues insist that standards of health depend crucially on social and economic conditions. So the main effort to improve the nation's health must come from better housing and education, and more jobs. It's a familiar theme and a complete cop-out, for it omits any consideration of what, in the end, is really going to determine health standards - the National Health Service.'

Daily Mail

Not Frank Enough 'Yesterday the health secretary published ambitious targets for improving the nation's health by 2010. His intentions are laudable. More questionable, however, is whether government exhortations will improve British health - and happiness. Every politician would agree with Mr Dobson's desire to see 'healthier people in a healthier country'.

The question is how this can best be achieved. Yesterday Mr Dobson added too little to that debate.'

The Times

Sound and fury as Dobson forgets one of his health tips 'Spittle flying from his lips, the secretary of state for health - but for how much longer? - came to the Commons to announce a white paper on health. As government initiatives go, it was one of the flimsier. Mr Dobson tried to compensate for this by abusing his opponents. On yesterday's form, Mr Dobson might benefit from better stress management.'

Quentin Letts, The Daily Telegraph

The peoples' road to hell is paved with government advice 'After the constant complaints levelled at the Tories' former health secretary, Virginia Bottomley, there is an insistence that the aim is not 'preaching' or 'nannying'. Rather it is a 'partnership' between state and people. But, in spite of the disclaimers, there is still an air of nannying about the white paper. Of course, nannying is cheaper than nurses.'

The Independent

Daily Star says. . .

Health secretary Frank Dobson says he's going to make Britain healthier. He claims he can save 300,000 lives over the next 10 years. Oh yeah? This sounds suspiciously like mere window dressing. What we want from governments are better hospitals and shorter waiting lists. Not gimmicks.'

Daily Star

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