Education And Debate

Sexual health–a Health of the Nation failure

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7096.1743 (Published 14 June 1997) Cite this as: BMJ 1997;314:1743
  1. Michael W Adler, professora
  1. a Department of Sexually Transmitted Diseases, University College London Medical School, London WC1E 6AU
  • Accepted 13 May 1997

Introduction

The Health of the Nation initiative was launched five years ago in July 1992 with the publication of a white paper.1 The five key areas–coronary heart disease and stroke, cancers, mental illness, accidents, and HIV/AIDS and sexual health–were given priority and specific objectives, and targets were set. For HIV/AIDS and sexual health the objective was to reduce the incidence of HIV infection and of other sexually transmitted diseases, with specific targets related to gonorrhoea and conceptions among teenagers. These specific targets were to reduce the incidence of gonorrhoea among men and women aged 15-64 years by at least 20% by 1995 (from 61 new cases per 100 000 population in 1990 to no more than 49) and to reduce the rate of conceptions among girls aged under 16 by at least 50% by the year 2000 (from 9.5 per 1000 girls aged 13-15 in 1989 to no more than 4.8). A closer examination of the incidence of sexually transmitted diseases, HIV infection, and conception rates suggests that there is still a long way to go.

The targets

Gonorrhoea

Although the target for gonorrhoea has been achieved ahead of time (fig 1), the incidence was declining so rapidly before the target had been defined, and continued to do so afterwards, that it was almost certain to continue declining without any new initiatives. The decline was therefore probably a poor indicator of effective health promotion and improved service delivery by departments of genitourinary medicine.

Fig 1

New cases of infection with Neisseria gonorrhoeae seen in genitourinary clinics in England, 1988-95

Caution is needed when claiming success for the Health of the Nation programme. New cases of gonorrhoea among homosexual men have not shown a rapid decline (fig 2).2 Cases of gonorrhoea seen in genitourinary medicine clinics in the Thames regions, reported as acquired through …

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