Though the green paper on prevention incorporates some effective tactics as star player, it does not add up to a winning team, says Anna Dixon


Many of England’s World Cup performances in recent years remind us that, whilst we have star players, it takes more than fancy tactics or good intentions to create a winning team. Players need a decent pitch, a coherent strategy and the ability to work together to win.

So it is with the Prevention Green Paper, published this week. It contains some very welcome measures and deploys some effective tactics to support population health and healthy ageing.

But is the condition of the pitch right? And will they come together to deliver the best result?

One star player in the green paper is the ambition to go smoke-free by 2030. Smoking rates remain persistently high among lower socioeconomic groups and those with mental health conditions, and the commitment to ramp up access to smoking cessation for these groups will make a significant contribution to closing the gap in healthy life expectancy.

We also have commitments to food reformulation and clearer food labelling, discussion on whether the highly effective tax on sugar-sweetened beverages should include sugary milk-based drinks, and movement on banning promotion of food and drinks high in fat, sugar and salt. And there’s a push to encourage people to be physically active at all stages of life. 

These measures are important signals that government recognises the value of legislative and fiscal levers to make healthy choices the easy choices for all. Like a good coach, the government is deploying its star players and some proven tactics to hit its goals.

Doesn’t go far enough to create a level playing field

What these star players are missing is a pitch on which to perform. The green paper describes the impact that housing condition, employment, financial security and neighbourhoods can have on healthy ageing.

But, despite some progress, it doesn’t go far enough. 

Take one example, urban design. A public health push on the built environment would address many of the risk factors and health conditions that the green paper highlights.

Improving traffic flows and the layout of our towns and cities – and ensuring access to green spaces, leisure facilities and affordable public transport – could simultaneously:

  • Reduce noise and light pollution in the community, which would improve sleep quality and impact on weight;
  • Act to improve air quality, which would reduce asthma, COPD and other respiratory conditions;
  • Facilitate community connections and reduce the fear of crime and personal safety, which would enable physical activity and improve mental health.

Then there are the homes and communities we live in, one of the most important determinants of whether we can live safely and independently whatever our health. As the green paper notes, NHS England’s Healthy New Towns programme has explored new housing developments.

We now need to see hard measures put in place to improve existing developments so that everyone has fair access to a health-promoting environment, from walkable streets and places to sit to accessible and inclusive public transport options. 

Making both new and existing homes suitable for everyone to live in is an essential part of enabling people to age healthily

Crucially, we need to build every new home to be accessible and adaptable, so that people living with a disability or who have lost mobility with age aren’t shut out of the housing market. As well as upgrading poor quality housing that exacerbates health conditions, we must build every new home to be accessible for people of all ages and abilities.

That requires stronger housing regulations and greater support and guidance for local authorities as they deliver the homes needed by their communities.

Making both new and existing homes suitable for everyone to live in is an essential part of enabling people to age healthily.

Work and health are critical elements for a successful public health strategy

Another example is employment. The green paper is right to acknowledge that good work can provide financial security, social connections and a sense of purpose, all of which underpin good mental and physical health.

Sadly, too many employers are still reluctant to provide the flexible working conditions that can enable people with health conditions – and those with caring responsibilities – to remain in employment. And there is often resistance or misunderstanding when it comes to the small, simple adjustments to the workplace or employment practices that can make all the difference for someone balancing health and work.

The green paper sets out a commitment to consult on measures to reduce ill-health-related job loss, focused on musculoskeletal conditions. This is to be welcomed, but we need to look at employment through a wider lens and tackle job insecurity and in-work poverty if we are to create the financial conditions that give everyone a fair chance at good health.

Overall, it’s fair to say the government has assembled some great players and adopted some of the most effective public health tactics it has available. What we need now is a bold strategy to bring everything together – a white paper that looks across government to create the physical and social conditions to underpin longer, healthier and happier lives.