The government has launched a range of proposals on ways to tackle the causes of preventable ill health in England. The green paper includes a smoke-free 2030 ambition, a mental health prevention package and pushing forward on their Childhood Obesity Strategy.
The aim is to have a decade of proactive, predictive, and personalised prevention, which means tailored lifestyle advice, personalised care and greater protection against future threats.
A new prevention model will also include new technologies such as genomics and artificial intelligence to allow children born with an inherited a rare disease to have the best start in life.
No more passive recipients of care
Using data held by the NHS and generated by smart devices worn by individuals, it hopes to usher in a new wave of intelligent public health where everyone has access to their health information and many more health interventions are personalised.
It said: "In the 2020s, people will not be passive recipients of care. They will be co-creators of their own health. The challenge is to equip them with the skills, knowledge and confidence they need to help themselves.
"Over the decades, traditional public health interventions have led to significant improvements in the nation’s health. The commitments outlined in this green paper signal a new approach for the health and care system.
"It will mean the government, both local and national, working with the health and care system, to put prevention at the centre of all our decision-making. But for it to succeed, and for us to transform the NHS and improve the nation’s health over the next decade, individuals and communities must play their part too."
Smoking and areas of high deprivation
Although we have the lowest smoking rates in Europe with fewer than one in six adults smoking, the paper highlighted that smokers are disproportionately located in areas of high deprivation.
Action on Smoking and Health (ASH) welcomed the proposals but said that ending smoking by delivering a smoke-free generation by 2030 - defined as prevalence below 5% across society - is achievable but will be 'extremely challenging' to achieve.
Deborah Arnott, Chief Executive of ASH, said: “The government is to be congratulated on setting an ambitious target to end smoking by 2030. However, to achieve this will require innovative new policies and funding, to quote the Health Secretary, Matt Hancock, ‘business as usual’ will not suffice. The public understand this, which is why three quarters of the adult population in England support Government interventions to limit smoking, with a growing proportion of them thinking Government should do more.”
Efforts to tackle obesity have been less successful
The green paper admitted that obesity is a major health challenge that the government has been less successful in tackling. In fact, the trend is going in the wrong direction – with only a third of adults a healthy weight. Since 1993, rates of adult obesity have almost doubled (to 29%), and morbid obesity has quadrupled (to 4%). One in three children aged 10 to 11 are now overweight or obese and obese children are five times more likely to become obese adults.
Chapter 3 of the childhood obesity plan will form part of this green paper and sets out the government's plans for: infant feeding, clear labelling, food reformulation improving the nutritional content of foods, and support for individuals to achieve and maintain a healthier weight.
It said: "We will challenge businesses to improve the nutritional content of commercially available baby food and drinks. PHE will publish guidelines for industry in early 2020. Industry’s progress will be monitored and reported to the government. If insufficient progress is made, the government will consider other levers. PHE will also explore including baby food within the popular Change4Life Food Scanner app to help parents and carers make healthier choices for their infants.
"Central to our approach to improving diets is working with food and drink companies to make their products healthier. We often call this reformulation. Over time, these small changes can add up to big improvements in the nation’s health."
The Obesity Health Alliance said it was pleased see the proposals address important areas such as the content and marketing of infant food and clear labelling to support families to understand the nutritional content of food they eat. It also welcomed the recommitment to consider extending the sugar levy to high sugar milk drinks.
However, the charity said we won’t make real progress in preventing obesity related ill health without structural changes that address the way less healthy food is marketed, promoted and sold.
It added: "That’s why we need the Government to swiftly and fully implement plans announced over a year ago to introduce calorie labelling on menus, restrict unhealthy promotions and introduce a 9pm watershed on junk food adverts on TV and online.”
Mental health plans fall short
Centre for Mental Health chief executive Sarah Hughes said that the Government’s prevention green paper offers some tentative steps towards better health for all by 2030 but falls far short of what is needed to create a healthy future.
She said: “The green paper rightly talks about the risk and protective factors for mental health and the need to address them to promote wellbeing and reduce inequalities. It is short, however, on solutions to address them. Investing in evidence based parenting programmes, local public health services and youth work, for example, will be essential if we are to address the determinants of our mental health.
“We welcome the ambitions to end smoking by 2030 and to improve children’s health and prevent type 2 diabetes. None of these will be possible unless we acknowledge the psychological stresses and strains that undermine people’s physical health. And we need concerted action to support physical health for people with mental health conditions. Our Equally Well campaign is supporting action to bring back the ‘stolen years’ and we need the whole of the NHS to get behind this effort."
According to Hughes, it is particularly light on solutions to address health inequalities. Poverty, housing insecurity, isolation and discrimination all drive poor mental and physical health and a whole government approach is needed to tackling every aspect of health inequality.
The paper states that it will lay the foundations for good health by pushing for a stronger focus on prevention across all areas of government policy. At local level, it expects different organisations to be working together on prevention. This means moving from dealing with the consequences of poor health to promoting the conditions for good health and designing services around user need, not just the way we’ve done things in the past.
It added: "When our health is good, we take it for granted. When it’s bad, we expect the NHS to do their best to fix it. We need to view health as an asset to invest in throughout our lives, and not just a problem to fix when it goes wrong. Everybody in this country should have a solid foundation on which to build their health."
Join our sister journal GM in London this October at The Ageing Patient: Midlife and Beyond for updates on:
• primary and secondary prevention strategies for patients aged over 50 years
• promoting and maintaining independence in frail older populations.