Health charities call on UK prime minister to put prevention at top of agenda

BMJ 2014; 349 doi: (Published 06 November 2014) Cite this as: BMJ 2014;349:g6642

Re: Health charities call on UK prime minister to put prevention at top of agenda

There is a growing consensus that the UK must prioritise the prevention of ill health.(1-5) We agree with the Richmond Group, a coalition of 10 charities, that a new national plan is urgently needed to match the scale of the public health challenges.(5) There are common risk factors such as smoking, diet, alcohol consumption and inactivity that need to be included in the plan, but so too does the ubiquitous problem of inequalities. In addition, two areas that are often overlooked, and where there is scope for dramatic improvements, are accident prevention and mental health.(6,7)

However, these topics should not be promoted in isolation; a comprehensive multi-sectoral approach is needed and action is required, for example, in workplaces, schools and general practices.(8-10) A wide range of key people need to be galvanized into action including teachers, local government staff, nurses and doctors. This is a crucial role for public health professionals; they must help key people gain a greater appreciation of how their work, individually in different settings, can contribute to improving health.

Primary care is an important healthcare-delivery environment where there are many opportunities for maintaining and promoting the health of individuals and their families.(10) Besides knowledge about individuals, many practitioners have an intimate knowledge of their local community including information about local factors that may influence health. However, considerable support will be needed, including that from public health professionals, if health improvement responsibilities are to be met. Moreover, the vital issue of staff shortages will need to be addressed.(11-12)

We agree that the workplace is a setting where action is needed, and that all NHS organisations and local authorities must play their part in looking after and promoting the health of their staff. Guidance for effective approaches in the workplace is now available both in terms of theory and exemplars of good practice.(13-14) It is essential that a planned approach is undertaken and that sufficient thought is given to monitoring and evaluation. In addition, any approach must not just be an information giving exercise; healthy environments need to be created. For example, in relation to healthy eating relatively low cost steps such as changing portion sizes, offering greater choices and highlighting healthier options can help to re-model obesogenic environments.

Robust and well-resourced public health departments are vital to effective coordinated action across settings.(15) We, like the Richmond Group, urge all political parties to commit to making prevention of ill health and health promotion a higher priority. If this was to happen, we believe that together we could succeed in dramatically improving the quality of people’s lives.

1) Wanless D. Securing our future health: taking a long-term view. Final report. London: HM Treasury, 2002.
2) Marmot M, chair. Fair society, healthy lives (the Marmot review). UCL Institute of Equity, 2010.
3) NHS England, Public Health England, Monitor, Care Quality Commission, Health Education England. Five year forward view. October 2014.
4) BMA. Four steps to a healthier nation.
5) Richmond Group of Charities. What is preventing progress? Time to move from talk to action on reducing preventable illness. 6 Nov 2014.
6) Public Health England. Reducing unintentional injuries in and around the home among children under five years. London: PHE, 2014
7) Davies, S.C. Annual Report of the Chief Medical Officer 2013, Public Mental Health Priorities: Investing in the Evidence. London: Department of Health 2014.
8) Tones K and Tilford S. Health Promotion: effectiveness, efficiency and equity. Cheltenham: Nelson Thornes, 2001.
9) World Health Organization, Ottawa Charter for Health Promotion. Copenhagen: World Health Organization, 1986.
10) Watson, M., Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.
11) Goddard M, Gravelle H, Hole A, Marini G. Where did all the GPs go? Increasing supply and geographical equity in England and Scotland. Journal of Health Services Research & Policy. 2010. 15(1): 28–35.
12) Limb M. Increase GP trainees by 450 a year to avoid crisis, says taskforce. BMJ2014;349:g4799.
13) Faculty of Public Health and the Faculty of Occupational Medicine. Creating a healthy workplace: A guide for occupational safety and health professionals and employers. London: Faculty of Public Health, 2006
14) Scriven A and Hodgins M. Health Promotion Settings. Principles and Practice. London: Sage, 2012.
15) Department of Health. The Report of the Chief Medical Officer’s Project to Strengthen the Public Health Function. London: Department of Health, 2001.

Competing interests: No competing interests

10 November 2014
Michael C. Watson
Associate Professor in Public Health
Dr Mark Forshaw (President, Institute of Health Promotion and Education. Subject Leader in Psychology, Natural Sciences and Psychology, Liverpool John Moores University.)
University of Nottingham, Faculty of Medicine and Health Sciences, D86, Queen's Medical Centre, Nottingham. NG7 2HA
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