Public Health Policy - Essay Example

? Public Health Policy/Strategy Analysis in UK INTRODUCTION Policy analysis plays a fundamental role in planning future policy implementation by providing a comprehensive insight into past and current policy failures and achievements (Walt, 2008). Over the last few decades, the governments in the UK have been actively improving policies and interventions to confront the root causes of poor health and socio-economic inequalities (Thompson, 2006). However the concept of public health is poorly defined, inadequately understood and facing accomplishment crisis throughout the world. The recent history and present state of public health policy dwells on the wide gap and lack of collaboration between public health interventions at national levels and acute health care at the local level. It is now widely acknowledged that efficient and effective implementation of a policy requires it to be working as one whole system rather than in discrete parts. There are also several concerns about the neglected responsibility for implementation of national strategy at local level (Hunter, 2003). This paper attempts to investigate effectiveness and sustainability of the current public health policies and their implementation. It also aims to critically analyse the key deficiencies and major barriers in the public health policy implemented by the previous two governments. Finally, the conclusion considers the future of Public health policy and makes suggestions for its effective and sustainable implementation. THE PREVIOUS PUBLIC HEALTH POLICIES The United Kingdom was a formal signatory of WHO’s Health for All, a global strategy for improving population health in 1978. This strategy asked governments to identify and achieve targets for population health by the year 2000 (Radical Statistics Health Group, 1991). However, the English government took more than a decade to come up with the first ever strategic health approach published as The Health of the Nation in 1992. It marked a major change in national health policy and provided broader context for the planning of services offered by the National Health Service (NHS). The Health of the Nation mainly focused on key health areas such as coronary heart diseases, cancer, mental illness, sexual health, and accidents. Each of these areas defined specific set of objectives and targets to tackle with public health issues in the UK. Though regarded as a major milestone in the right direction and widely welcomed, it failed to produce significant results in its entire five year lifespan due to lack of cross-organizational commitments and ownership. The performance was measured at short term outputs and was ineffective to develop strategic health impacts. The managers and practitioners lacking the required skills and competences were unable to prioritize the strategic action of health. Moreover, the national targets were not in compliance with local circumstances and technical variances failed to deliver on the health strategy (Uni. of Leeds & Glamorgan& London Sch of Hyg & Trop Med, 1998). According to the former secretary of the state, William Waldegrave, “a strategy imposed by government which takes no heed of the views of those who will have to implement it, including the people themselves, is valueless” (Sec. of State for Health, 1991). With arrival of the new Labour Government in 1997, public health sector underwent several reforms. A public health minister was aptly appointed, who took quick initiatives to analyze flaws in The Health of the Nation and develop a new strategy. Following the evidence based policy making, the government published the new strategy titled Saving Lives: Our Healthier Nation along with an action report on Reducing Health Inequalities in 1999. Other simultaneous health initiatives included establishment of a new body under the name of Health Development Agency, health action zones, healthy living centres and various other programmes for reducing social inequalities. Though Wales, Scotland and Northern Ireland have equivalent health plans, the devolution of The Health of the Nation and Saving Lives: Our Healthier Nation to these countries is not applicable (Hunter, 2003). The four priority areas of this comprehensive health strategy were cancer, coronary heart disease and stroke, accidents and mental health. Targets in these areas were set to alleviate ill-health and prevent up to 300,000 premature deaths. About ?21 billion were invested in the NHS to ensure healthy population. Smoking was prioritized as the biggest avoidable root cause of ill-health. The strategy also emphasized on development of a three way partnership including people, communities and government for improving public health (Department of Health, 1999). Targeting health-related behaviour change interventions and adopting integrated approach in the health strategy showed significant improvements in health and life expectancy. Later, the Wanless report published in 2002 emphasized on the economic benefits of public health (Hunter, 2003). However, despite these encouraging advancements in some areas, Government faced emerging challenges in influencing public attitudes and behaviour in later years (Durante, 2007). For instance, obesity in the UK rose from 16.4 % to 23.8 % in women and from 13.2 % to 23.6 % in men from 1993 to 2004 (ONS/NHS, 2005). Due to increase in prices, fewer people now smoke than those 3 decades ago (Jochelson, 2005). However, the gaps between social classes are rising which influence public attitudes, and as the ability of individuals to make healthy choices depends on socio-economic conditions, such interventions will require appropriate legislation. Labour government’s cessation programs also remained ineffective in underdeveloped areas due to lesser reach (Durante, 2007). THE CURRENT AND FUTURE PUBLIC HEALTH POLICIES The external influences, political context, evidence, and collaborative effort of policy and research communities are all instrumental for implementation of an effective health policy in the UK (Macintyre, 2012). Despite of the fundamental shifts in public health policy under the labour regime, socio-economic health inequalities in the UK were growing progressively by 2010. Obesity in the UK was far higher than any of the other nations in Europe. Over 80,000 people were dying due to smoking-related diseases every year. The government needed to adopt a long term vision and a new approach for empowering citizens to make healthy choices themselves. The white paper titled Healthy Lives, Healthy People: Our Strategy for Public Health in England was published in 2010 to address serious health threats. Government encouraged local authorities through decentralization of the health strategy and a new body Public Health England was established to serve the purpose of evidence based policy making (Department of Health, 2010). The white paper emphasized on the need for a trans-disciplinary approach that would target public behaviour through collaboration of the local communities. The strategy is mainly based on research of social determinants of health and their impact in different cultures. Moving some elements of the public health to local authorities and the placement of Public Health England under Department of Health would further divide the workforce. It was also argued that local authorities would be unable to employ adequate technical support essential for defined function of public health. However, the NHS was claimed to be liberated from political influence and control. (McKee et al., 2011). These responses to the long-term vision for public health future in England encouraged the consultation process and the government addressed those issues in Healthy lives, Healthy People: Update and Way Forward published in 2011. Concerns about fragmentation of services and public health profession were considered, and a reformed public health system for England was devised (Royal College of Nursing, 2012). April 2013 is set for the actual functioning of Public Health England and Local authorities under this document. The document clarified the role of local authorities and Public Health England, stated clear principles for emergency preparedness, resilience and response, promised wider work force strategy, and described allocation methodology of Public health funding (Department of Health, 2011). Professor Sir Michael Marmot, who also chaired the WHO Commission on the Social Determinants of Health in 2008, reviewed strategies for reducing health inequalities in England. The final report published in 2010 as Fair Society, Healthy Lives proposed six policy objectives; “1. Give every child the best start in life. 2. Enable all children, young people and adults to maximise their capabilities and have control over their lives. 3. Create fair employment and good work for all. 4. Ensure healthy standard of living for all. 5. Create and develop healthy and sustainable places and communities. 6. Strengthen the role and impact of ill-health prevention.” The findings of the report revealed that fairness and social justice are the prime causes of health inequalities. It emphasized on the participatory role of government, the NHS, the private sectors and community groups in policy for effective local delivery of public health services. The report recommended empowerment of the individuals and communities for effective delivery of health services at local level to reduce inequalities (Subramanyam et al., 2010). The government published Public Health Outcomes Framework for England, 2013-2016, in January 2012. The key focus of the framework is achievement of desired outcomes for public health and their measurement. The two major outcomes identified are increased life expectancies, and reducing differences in life expectancy among individuals as well as communities. The four domains covering public health are specified as improvement of wider determinants of health, health improvement, health protection, and preventing premature deaths (Department of Health, 2012 a). The House of Commons Select Committee also published its report on public health in 2011, which examined the proposed changes in the delivery of Public Health. The committee made several recommendations for improvements in Government role in public health interventions, Public Health England, and role of Local authorities. For instance, the report criticized behavioural intervention to resolve major issues such as obesity and alcohol abuse by nudging and asked for setting out clear strategy for monitoring progress (Mansell, 2011). The government published response to the select committees report on 07 Feb. 2012, which reaffirmed its commitment and determination to tackle disadvantages in proposed public health intervention strategies. The response also agreed on giving leadership role to local authorities and independent status to Public Health England (Department of Health, 2012 b). Public Health England is undoubtedly a positive intervention to tackle inequalities. It is the proposed new public health service body which will be set up as part of the Department of Health. It will assume its full responsibilities by April 2013 and will work to deliver on health protection, national emergency responses and bring together the fragmented functioning of government, NHS and the community. It will be funded from overall NHS budget and spending in health areas is estimated at over ?4 billion. It aims at targeting behavioural change, empowering individuals to make healthy choices and reduce health inequalities formed as a result of socio-economic differences (Department of Health, 2010). It will make efficient use of the public health budget to tackle ill-health, which have been often used to fix deficits previously. It is designed to work under evidence based policies and can help in exploring the areas of further research. Public Health England will be very effective in emergency responses to situations such as flu-pandemics. Its directors will be appointed by local authorities and improvements in better control will lead to better health. The decentralized approach of Public Health England is probably a major step forward in addressing public health concerns in different communities according to their varying social and economic needs (Department of Health, 2011). The white paper Equity and Excellence: Liberating the NHS published in July 2010 proposed the establishment of statutory health and wellbeing boards within local authorities or strategic partnerships (Department of Health, 2010 b). These boards aim at strategically promoting local wellbeing through integration across adult social care, public health and the wider NHS agenda. The joint strategic needs assessment would allow effective policy implementation according to the local circumstances. Though 90% of the Local authorities throughout England have become early adopters, these boards will assume statutory duties in April 2013 (Staite and Miller, 2011). However, some institutions have raised serious concerns over the involvement of selective representatives in decision making. The British Medical Association’s General Practitioners Committee protested against the exclusion and non-engagement of some GPs in new commissioning consortiums on basis of their contractual status. As the excluded GPs such as salaried and sessional are involved in higher proportion of clinical work, the association reiterated that they should be able to vote and contest elections of consortia boards (Jacques, 2011). Furthermore, the handing over of powers to GPs in commission services has been criticized as it would affect the patient power adversely (Campbell and Helm, 2011). The Faculty of Public Health also criticized the basis on which incentives for action to reduce health inequalities called Health Premium will be awarded. Deprived areas will receive a greater premium according to their achievements. However, some vulnerable areas and groups may not even have the sufficient initial funding to make any progress at all. In addition, health inequalities are more likely to widen if the total health premium budget is not in compliance with health inequality adjustments (Faculty of Public Health, 2011). As public health budgets have often been utilized to fund acute and clinical services in the past, Public Health England will allocate conditional ring-fenced grants to the local authorities starting from April 2013 onwards. However, the government is planning to provide shadow allocations to councils in order to prepare them for assuming public health responsibilities from the NHS in 2013. According to the Department of Health, ?5.2bn would be allocated for public health from April 2012 to April 2013. Along with health premium, ring fenced allocations would help local authorities to tackle the wide determinants of public health in their respective areas (Williams, 2012). CONCLUSION Critical analysis of previous and existing public health policies under different governments reveal that public health policy in United Kingdom has underwent several innovative, integrated and dynamic reforms since 1992. The identification of challenges, limitations and successes offered by all health strategies are vital to ensure continuous learning and change in the policy process. As Hunter (2003) noted, “the problem in public health does not lie in the lack of sound policy but in its follow through and implementation, where progress has been less impressive”. The policy of empowering citizens to make healthy choices to reduce health inequalities will probably help to bring widespread societal change in the near future. However, the economic challenges associated with moving to new structures such as Public Health England cannot be neglected. The flexibility in organization of this body and its ability to respond to crisis in any area is still questionable and needs further research. The talk about social determinants of health is full of debate and controversy, and has massive social consequences. The ethical aspects and understanding of social determinants has different schools of thought, and it is too hard to address concerns on a single platform. REFERENCES Campbell, D. and Helm, T., 2011. Health chiefs issue stark warning over damaging effect of NHS reforms. The Guardian. [online] Available at: [Accessed on 22 March 2012] Department of Health, 1999. Saving lives: Our healthier nation: Executive summary. London: Stationery Office. 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