Rounding-up 2013's public health debates and looking forward to the coming year

2013 has proved to be a significant year for English primary care. With the transition of public health from PCT to local authority, April saw the introduction of a whole new system of structures for healthcare commissioning and provision. Whilst it’s still too soon to say whether this move has delivered the desired effect of making local health services more relevant for the communities they’re provided for, the indications from the second half of the year suggest that there’s an increased sense of stability in the sector by comparison to this time last year. For many however, this will hardly come as a surprise given how many NHS departments, let alone individual positions, had uncertain futures twelve months ago.

Plain packaging

One of the biggest public health stories from 2013 was the debate around the plain packaging of tobacco products. The issue became increasingly mired in controversy after it emerged that Lynton Crosby – a campaign consultant at the heart of Downing Street – was also actively representing the interests of the tobacco industry. Although out of the limelight for the time being, this issue along with other public health measures such minimum unit pricing are unlikely to be out of focus for long. Their importance in combating what Dr Zafar Iqbal and others have described as the ‘social and market forces which help to perpetuate health inequalities’ will undoubtedly mean their re-emergence in 2014. Our coverage and perspective on the story can be revisited here.

CVD prevention

The summer also saw Public Health England placing an increased emphasis on promoting cardiovascular disease prevention. However as PHE and the Health Secretary served up the evidence on the predicted benefits of England’s flagship CVD prevention programme – the NHS Health Check – others were voicing their doubts as to the projected net gain. As it has emerged, many of the charges levelled against the programme by critics have been based on misrepresentations of the English model of CVD prevention. Again, our in-depth critique which draws out the specifics of the argument can be read here.

Going forward: the macro view

Fortunately, for those on the ground and working hard in communities to provide the health checks and increase awareness on the effects of poor lifestyle behaviours, the news looks positive. Recognising that ‘doing nothing’ in regard to national health inequalities ‘is not an option’, NHS England’s chief financial officer this week announced an increase in funding for NHS commissioners from £96bn to £100bn over the next two years. As well as the increased budget, a new funding formula for local health commissioners ‘that more accurately reflects population changes and includes a specific deprivation measure’ is said to be being introduced. With the NHS Health Check at the very centre of CVD prevention policy, these announcements should provide the means to continue increasing the efficiency and effectiveness of a programme that is already estimated to ‘prevent 1,600 heart attacks and strokes, at least 650 premature deaths, and over 4,000 new cases of diabetes each year’.

Developments at Health Diagnostics

With this comprising the macro-outlook, a big question going forward for us at Health Diagnostics is: how can we best support the drive to alleviate health inequalities and the growing social and economic burden of cardiovascular disease in our own capacity? We’ll certainly be working hard to continue providing a first-class service to all our NHS partners, however in addition a handful of the new developments will include:

• Working closely with reputable academic institutions to help establish empirical outcome data on the efficacy of the NHS Health Check. The potential benefit of using Health Options® software in delivering the health checks will be investigated in particular.

• A new software release is planned for January 2014. This latest version will include some exciting new developments including the integration of the Diabetes UK questionnaire.

• To coincide with this software release, Health Diagnostics are launching the new range of client report fact sheets. With a keen emphasis on design and clarity, the new reports are intended to facilitate the communication of essential health information. With tens of thousands set to be distributed, the team at Health Diagnostics have been working hard to make the reports as coherent, concise, and informative as possible.

• We’ll again be attending the Commissioning Show in June, with details set to be announced closer to the time. To view the findings of the events run in conjunction with the 2013 show, click here.

Until 2014 then, wishing you a happy and healthy Christmas and new year!

NHS Health Checks Compete with tobacco and alcohol policy for headlines

Plain cigarette packaging as has been introduced in Australia. Photo: AFP

July has turned out to be a topsy turvy month for public health. Whilst Public Health England has revealed its plans to drastically scale up the delivery of NHS Health Checks, other policy announcements have delivered significant blows to those campaigning for public health reforms.

Despite a drive to deliver 15 million NHS Health Checks over the next five years, July also saw the shelving of plans to introduce minimum unit pricing on alcohol and a rejection of proposals that would have meant cigarettes needing to be displayed in plain packets.

For many, this contradiction is likely to prove problematic. Whilst the government’s commitment to assess and advise the population on cardiovascular risk is ambitious, the political messages are mixed. Decisions that are likely to have a detrimental effect on people’s health mean that the government’s overall approach cannot really be deemed ‘holistic’.

As David Cameron has stated ‘health inequalities in 21st century Britain are as wide as they were in Victorian times. We can't go on like this.’ Despite sounding decisive, there is arguably a mismatch between the rhetoric and the policies actually being implemented (or not in the case of tobacco and alcohol).

In regard to plain packaging, the government argued last week that there was lack of evidence that such measures would work. This is no longer the case. On the 22^nd July a study entitled ‘Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study’ was published by the BMJ. A very brief summary of the study’s conclusion is as follows:

‘‘The early indication is that plain packaging is associated with lower smoking appeal, more support for the policy and more urgency to quit among adult smokers.’’

The above was strongly suspected by many involved in public health. The Faculty of Public Health even felt it appropriate to withdraw from responsibility deals and issue a strongly worded statement when the government decided in favour of allowing cigarette manufacturers to continue branding their goods.

What does seem clear at this stage is that the introduction of plain packaging would constitute an extremely grim medicine for those with vested interest to swallow. The importance of a market identity to cigarette companies is perhaps most potently demonstrated than by the fact that, in 2003, the industry allegedly spent a combined total of $15.12 billion on promotion and advertising. To remove the ability to brand the products is therefore, arguably, to take away one the tobacco industry’s most effective and refined tools.

Given that the evidence has now been published, the government can re-establish the debate armed with the knowledge they were previously lacking. Hopefully in doing so they’ll be able to standardise a consistent approach to promoting healthy living.

That said, if the contradictions ensue, one could argue that the drive to deliver 15 million health checks runs the risk of having its rationale undermined by the detrimental impacts of other big decisions that promote damaging lifestyle behaviours. Despite being a crucial element in the country’s public health programme, the NHS Health Checks need to be part of an overall set of directives that work towards preventing widespread poor health from overwhelming the NHS over the coming decades.

Yes, the issue is ultimately one of education, however the potency that lies within regulating the pricing, advertising and branding of unhealthy, ‘demerit’ goods cannot be underestimated.