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Recent BMJ editorials have questioned the value of health targets
(1,2). In Sandwell, we have just completed a review of our achievements
against the first 10 year Healthy Sandwell Charter (3), based on the
European Targets for Health for All. (4)
Sandwell has seen substantial improvements in key mortality indicators.
Coronary heart disease in the under 65s has fallen by about 1/3, all
circulatory disease by about ¼ ,lung cancer in men by over 1/3 and all
cancers by 10%. All of these were against our local target reduction of
15%, baseline 1990. Coronary disease, infant mortality and lung cancer in
men have declined faster than the national rate and for the first time,
shows levels lower than comparable manufacturing districts.
Mortality rates have declined for accidents in the over 65s and road
accident deaths; however road accident casualties have increased.
Perinatal mortality remains stubbornly above national and lung cancer in
women shows a small rise. In 1993, infant mortality fell sharply, which
we have attributed to the 'Back to Sleep' Campaign to prevent cot death.
Coronary disease mortality fell dramatically in 1995 and 1996, consequent,
we believe, on the implementation of a successful early management of
heart attacks policy. A reduction of 12000 in the number of smokers,
between 1990 and 1995 and reductions of smoking in pregnancy have, we
believe, been significant in reducing coronary heart disease deaths, lung
cancer and respiratory disease deaths and possibly, in the 1995 fall in
perinatal mortality.
Other local partnership efforts to improve the pre-conditions for health
improvement have included a halving of derelict land, large reductions in
housing lacking basic amenities and reductions in unemployment, although
the levels remain higher than national and the levels of long term
unemployment are intractably high.
Average earnings in Sandwell remain way below national levels with 1/3 of
households on less than £5,500 per year. In the light of this key
indicator of inequality in health, it is remarkable that any health
measures have shown improvement.
Health improvement targets are essential if health strategies are to take
health improvement and health services in the right direction. It is
unusual, in this day and age, for the people who started out on the
journey, to be there at the end of it, but unless the maps are drawn,
those following will not know if they have arrived where they should.
Because health target setting is difficult, is not an excuse for not doing
it.
John Middleton,
Director of Public Health,
Sandwell Health Authority,
Kingston House,
West Bromwich,
B70 9LD
References
1. McKee M, Fulop N. On target for health. BMJ 2000; 320: 327-8.
2. Davis RM. Healthy people 2010:objectives for the United States.
BMJ 2000; 320: 818-9.
3. Middleton JD, ed. All change for health. The 11th annual public
health report for the borough of Sandwell. West Bromwich: Sandwell public
health publications, 1999.
4. World health organisation. European targets for health for all by
the year 2000. Copenhagen: WHOEURO, 1985.
Health Targets
Recent BMJ editorials have questioned the value of health targets
(1,2). In Sandwell, we have just completed a review of our achievements
against the first 10 year Healthy Sandwell Charter (3), based on the
European Targets for Health for All. (4)
Sandwell has seen substantial improvements in key mortality indicators.
Coronary heart disease in the under 65s has fallen by about 1/3, all
circulatory disease by about ¼ ,lung cancer in men by over 1/3 and all
cancers by 10%. All of these were against our local target reduction of
15%, baseline 1990. Coronary disease, infant mortality and lung cancer in
men have declined faster than the national rate and for the first time,
shows levels lower than comparable manufacturing districts.
Mortality rates have declined for accidents in the over 65s and road
accident deaths; however road accident casualties have increased.
Perinatal mortality remains stubbornly above national and lung cancer in
women shows a small rise. In 1993, infant mortality fell sharply, which
we have attributed to the 'Back to Sleep' Campaign to prevent cot death.
Coronary disease mortality fell dramatically in 1995 and 1996, consequent,
we believe, on the implementation of a successful early management of
heart attacks policy. A reduction of 12000 in the number of smokers,
between 1990 and 1995 and reductions of smoking in pregnancy have, we
believe, been significant in reducing coronary heart disease deaths, lung
cancer and respiratory disease deaths and possibly, in the 1995 fall in
perinatal mortality.
Other local partnership efforts to improve the pre-conditions for health
improvement have included a halving of derelict land, large reductions in
housing lacking basic amenities and reductions in unemployment, although
the levels remain higher than national and the levels of long term
unemployment are intractably high.
Average earnings in Sandwell remain way below national levels with 1/3 of
households on less than £5,500 per year. In the light of this key
indicator of inequality in health, it is remarkable that any health
measures have shown improvement.
Health improvement targets are essential if health strategies are to take
health improvement and health services in the right direction. It is
unusual, in this day and age, for the people who started out on the
journey, to be there at the end of it, but unless the maps are drawn,
those following will not know if they have arrived where they should.
Because health target setting is difficult, is not an excuse for not doing
it.
John Middleton,
Director of Public Health,
Sandwell Health Authority,
Kingston House,
West Bromwich,
B70 9LD
References
1. McKee M, Fulop N. On target for health. BMJ 2000; 320: 327-8.
2. Davis RM. Healthy people 2010:objectives for the United States.
BMJ 2000; 320: 818-9.
3. Middleton JD, ed. All change for health. The 11th annual public
health report for the borough of Sandwell. West Bromwich: Sandwell public
health publications, 1999.
4. World health organisation. European targets for health for all by
the year 2000. Copenhagen: WHOEURO, 1985.
Competing interests: No competing interests