Intended for healthcare professionals

Rapid response to:

Editorials Election 2017

Time to put health at the heart of all policy making

BMJ 2017; 357 doi: (Published 02 June 2017) Cite this as: BMJ 2017;357:j2676

Rapid Response:

Re: Time to put health at the heart of all policy making

The Institute of Health Promotion and Education fully endorses John Middleton’s call “to put health at the heart of all policy making”.(1) We firmly believe that this would be good for the health of individuals, the economy and for the future of the NHS.(2)

It is important to note that Middleton’s BMJ editorial is in line with a seminal document produced by the World Health Organisation: the Ottawa Charter for Health Promotion.(3-5) The Charter recommended building healthy public policies and creating supportive environments so that it would be easier for members of the public to choose the healthier options.

Middleton is right to draw attention to the unsatisfactory state of children’s health as does the current CMO, Dame Sally Davies and the Royal College of Paediatrics and Child Health (RCPCH).(6,7) The RCPCH report highlights the significance of personal, social and health education (PSHE) in schools which can lead to improved health outcomes and social mobility.(7) Making PSHE compulsory for all schools has to be an essential element of any national strategy which aims to improve child health and reduce inequalities.

We feel strongly that the next government must tackle the stark inequalities in child health. Children living in deprivation in England are more than twice as likely to be overweight or obese compared to their counterparts living in more affluent households.(8) In addition, children living in the most disadvantaged areas of the country have a 50% higher risk of being burned, scalded or poisoned than those living in the most advantaged areas.(9) This cannot be allowed to continue especially as there are effective interventions available.(10-13)

We are pleased that Middleton has mentioned Brexit as the negotiations could have a considerable impact on health. Future agreements and subsequent government policies must be used to maintain and promote health improvement. However, the government must not try and “go it alone”. They must draw on the UK public health community: academics, practitioners and professional organisations. Together they are a substantial body of committed and expert professionals, covering a wide range of public health knowledge that includes effective interventions to protect and improve health.(14-16)

1) Middleton J. Time to put health at the heart of all policy making. BMJ 2017;357:j2676.

2) NHS England, Public Health England, Monitor, Care Quality Commission, Health Education England. Five year forward view. 2014.

3) World Health Organization. Ottawa Charter for Health Promotion. Copenhagen: World Health Organization, 1986.

4) Poland B, Green L and Rootman I (eds). Settings for Health Promotion. London: Sage Publications, 2000.

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

6) Davies S. Annual report of the Chief Medical Officer 2012. Our Children Deserve Better: Prevention Pays. London: HM government. 2013.

7) Royal College of Paediatrics and Child Health. State of child health. 2017.

8) Public Health England. Patterns and trends in childhood obesity. PHE 2016.

9) Orton E, Kendrick D, West J, Tata LJ. Independent Risk Factors for Injury in Pre-School Children: Three Population-Based Nested Case-Control Studies Using Routine Primary Care Data. PLoS ONE 2012; 7(4): e35193. doi:10.1371/journal.pone.0035193.

10) BMA. Food for thought: promoting healthy diets among children and young people. London: BMA 2015.

11) Watson MC and Lloyd J. Taxing sugar should be just one element of a multifaceted campaign. BMJ 2015;351:h4388.

12) Watson M C and Errington G. Preventing unintentional injuries in children: successful approaches. Paediatrics and Child Health 2016; 26(5), 194-199.

13) WHO. Report of the Commission on Ending Childhood Obesity: implementation plan. Report by the Secretariat for the 140th Session of the WHO Executive Board. Geneva: WHO, 2017.

14) Watson MC and Lloyd J. Re: BMJ briefing: meet the new masters of public health. British Medical Journal Rapid Response 8th July 2013.

15) Watson M and Tilford S. Directors of public health are pivotal in tackling health inequalities. BMJ 2016;354:i5013.

16) Middleton J Public health in England in 2016—the health of the public and the public health system: a review. British Medical Bulletin 2017; 121:31–46.

Competing interests: No competing interests

03 June 2017
Michael Craig Watson
Associate Professor in 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