Intended for healthcare professionals


Saving lives or sustaining the public's health?

BMJ 1999; 319 doi: (Published 17 July 1999) Cite this as: BMJ 1999;319:139

The English white paper is stronger on disease than it is on health

  1. Naomi Fulop, senior lecturer in health services delivery and organisation (,
  2. David J Hunter, professor of health policy and management (
  1. London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. Nuffield Institute for Health, University of Leeds, Leeds LS2 9PL

    England's long awaited public health white paper, Saving Lives: Our Healthier Nation,1 has finally appeared over a year after publication of the green paper.2 The British prime minister has written the foreword and 12 ministers have signed the preface—symbols of the relative importance of the health strategy and the importance attached to cross government working. But the title, Saving Lives, the headline target to prevent 300 000 deaths, and the proposal to introduce defibrillators in public places seem to emphasise narrow, disease based health care over wider public health concerns.

    The four priority areas remain the same as in the green paper: coronary heart disease and stroke; cancer; mental health; and accidents. More challenging targets have been set in some areas, such as suicide and undetermined injury, and there is a greater emphasis on health in later life. Some major new public health initiatives are proposed to improve the quality of the public health function. The Health Education Authority will be replaced with a Health Development Agency that will act as a public health equivalent of the National Institute for Clinical Excellence, the …

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