A Vision for Prevention
Matt Hancock, UK Secretary of State for Health and Social Care since July 2018, launched his prevention vision on 5 November.
His other priorities are to advance health technology and provide better support for the health and social care workforce. He sees prevention as having two aspects. Partly it is about keeping well physically and mentally, to prevent ill health, but also about the environment around people, their lifestyle choices and how existing health conditions are managed. The aims are for the average person to have 5 more years of healthy independent living by 2035, and to reduce the gap between the richest and poorest. At present there is a large discrepancy in spending with £97 billion (public money) spent on treating disease and £8 billion on prevention across the UK!
The proposed actions in the vision are:
- “Prioritising investment in primary and community healthcare
- Making sure every child has the best start in life (our emphasis)
- Supporting local councils to take the lead in improving health locally through innovation, communication and community outreach
- Coordinating transport, housing, education, the workplace and the environment – in the grand enterprise to improve our nation’s health
- Involving employers, businesses, charities, the voluntary sector and local groups in creating safe, connected and healthy neighbourhoods and workplaces”
The Department of Health and Social Care’s (DHSC) paper is called ‘Prevention is better than cure: Our vision to help you live well for longer‘.
It states there is strong evidence that prevention works and recognises that a healthy population is both vital for a strong economy and for reducing pressure on services like the NHS (almost 10% of the national income is spent on healthcare). Average life expectancy is now 81 years, helped by:
- advances in healthcare
- changing attitudes so there is less stigma with some conditions
- improvements in the environment, at home, work and in neighbourhoods
- antibiotics and mass vaccination
- public health programmes.
However, there are major challenges in the huge discrepancies between areas – ‘A boy born today in the most deprived area of England can expect to live about 19 fewer years in good health and die nine years earlier than a boy born into the least deprived area.’ (p.7)
Duncan Selbie, Chief Executive of Public Health England, welcomed the change of focus to more emphasis on prevention and pointed out the need for collaborative working – NHS, national government, local government, voluntary and community sector, and industry. It will be important to monitor industry involvement to ensure that it does not create conflicts of interest, undermining health. Infants, young children, pregnant and breastfeeding mothers are particularly vulnerable, which is why the World Health Organisation developed guidance to protect them from conflicts of interest (WHO 2016 Guidance on the Inappropriate Promotion of Foods for Infants and Young Children) and other inappropriate commercial influence (International Code of Marketing of Breastmilk Substitutes, 1981, and subsequent WHA resolutions).
Improvements will depend both on encouraging individuals to choose healthy lifestyles and manage their own health, and expecting local authorities to take the lead in improving the health of their communities. The challenges of smoking, mental ill health, obesity, high blood pressure and alcolol-related harm are mentioned, along with the benefit of having a more personalised approach to health.
The section on ‘Giving our children the best start in life’ (p.20) mentions healthier pregnancies, improved language acquisition, reducing parental conflict, improving dental health, protecting mental health and schools involvement, but infant feeding is not mentioned at all!
However, in the Parliamentary debate on the vision (Prevention of Ill Health: Government Vision) on 5 November, Alison Thewliss MP made the case for supporting breastfeeding by investing in the Baby Friendly Initiative to bring all maternity and community services up to the minimum standard. Matthew Hancock’s reply sounds positive: ‘The earlier that we can start with this sort of strategy of preventing ill health the better, and there is a lot of merit in a lot of what the hon. Lady said.’
‘Prevention, Protection and Promotion’ at Public Health England
Earlier in the year (March 2018), Professor Viv Bennett, the Chief Public Health Nurse, and Professor Jane Cummings, the Chief Nursing Officer, came together to launch a campaign on the ‘3Ps – Prevention, Protection and Promotion’, which is about actions to improve public health and reduce health inequalities. Breastfeeding is mentioned in the Maternity Transformation Campaign and Better Births and there appears to be increased govenment commitment to the key role breastfeeding plays in improving public health.
Directors of Public Health have a key role
The DHSC paper expects Directors of Public Health to ‘play an important leadership role’ (p.15). As an example, the Annual Report of Croydon’s Director of Public Health, published in mid-November, We are Croydon: Early Experiences Last a Lifetime, focusses this year on the first 1000 days of a child’s life.
It includes three breastfeeding recommendations:
- Reset targets for increasing breastfeeding rates at 6 to 8 weeks and 6 months across the Borough and within particular localities
- Achieve level 3 of the UNICEF Baby Friendly award
- Turn Croydon into a breastfeeding friendly Borough, so women feel comfortable breastfeeding when they are out and about
How can progress on prevention occur unless it starts at the beginning – with infants? Will other Directors come up with similar recommendations?
Make London a ‘Baby-Friendly’ city
The Mayor of London, Sadiq Khan, aims to “make London a ‘Baby-Friendly’ city” in the London Food Strategy. This strategy aims to increase the health of all Londoners from infancy onwards, including supporting and normalising breastfeeding across London Transport and across government buildings and workplaces, and encouraging all London boroughs to become Unicef UK Baby Friendly-accredited in maternity and community services.
The UK government is due to publish a Green Paper on Prevention in 2019 to set out more detailed plans and, together with the NHS Long Term Plan, which is due to be published soon, is relevant to a future with better health for all.
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