Intended for healthcare professionals


Report calls for bold action to prevent early deaths

BMJ 2016; 353 doi: (Published 07 June 2016) Cite this as: BMJ 2016;353:i3172

Re: Report calls for bold action to prevent early deaths

There is a mounting consensus that bold public health action is needed now to improve health and wellbeing, and relieve some of the burden on our overloaded NHS.(1-5) The Richmond Group, a coalition of 12 charities, are quite right to draw attention to the current scale of our public health threats and some of the effective individual focused and environmental interventions that could address them.(5)

In their latest report(5) that is based on the PROMISE study,(6) the Group endorses holistic and collaborative actions. However, they only suggest activity in four key areas – poor diet, harmful alcohol consumption, smoking and physical inactivity. We suggest that there are two other important areas where there is scope for dramatic improvements: accident prevention and mental health.(7-9)

Individual focused approaches that are recommended in their report include behaviour change advice delivered by doctors and nurses in primary care, and smoking cessation services, particularly to assist individuals from hard to reach groups.(5) Importantly to support such actions the authors also recommend environmental approaches. Two examples of these are: redesigning urban areas to prioritise walking and cycling; and, the reformulation of packaged food, including portion size control.(5)

Combining individual and environmental approaches is in line with the Ottawa Charter – a seminal document of the new public health movement that was produced by experts studying effectiveness.(10) The Charter was also influential in highlighting the need for activity in different settings. Coordinated action across hospitals, primary care, schools, workplaces and other settings is required.

We hope that the Commons Health Committee, that is still reviewing public health in England, will be bold in their final report. As a minimum, a new long term public health strategy is needed that not only focuses on priorities including healthy eating, sensible drinking and mental health but also seeks to address inequalities. In addition, robust and well-resourced public health departments are vital to effective coordinated action across settings.(4)

We, like the Richmond Group, think that prevention of ill health and health promotion should be a far higher priority. Greater spending in this area would have health and economic benefits, and result in fewer treatment costs and lower welfare payments.

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) Watson M C and Lloyd J. Need for increased investment in public health BMJ 2016;352:i761. doi:10.1136/bmj.i761 pmid:26860902.

5) Richmond Group of Charities. Living longer, living well: how we can achieve the World Health Organization’s ’25 by 25 goals in the UK. Jun 2016.

6) Scarborough P, Cowburn G, Cobiac L, Foster C, Matthews A, Milton K, Thomas E, Wilkins E, Rayner M. Translating the World Health Organization 25x25 goals into a United Kingdom context: The PROMISE study. London: Richmond Group, 2016.

7) Public Health England. Reducing unintentional injuries in and around the home among children under five years. London: PHE, 2014

8) Lloyd J, with Baillie M, Evans I, James A, Bennetts J, Watson M C, Safety Education: Priorities for children and young people – A Manifesto for Action. Welwyn: Institute of Health Promotion and Education, May 2015.

9) Davies, S.C. Annual Report of the Chief Medical Officer 2013, Public Mental Health Priorities: Investing in the Evidence. London: Department of Health 2014.

10) Watson, M., Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.

Competing interests: No competing interests

08 June 2016
Michael Craig Watson
Associate Professor of Public Health.
Dr John Lloyd (Vice President Institute of Health Promotion and Education, Institute of Health Promotion and Education,
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA