UK: Government Publishes White Paper on Public Health

On 16 November 2004, the UK Government published its long-awaited White Paper on Public Health (called Choosing Health: Making Healthy Choices Easier). It outlines a raft of measures aimed at improving public health in the UK.

The White Paper establishes three core principles of the new public health approach:

The White Paper states that the public wants to be able to make its own decisions about choices that impact on people's health. The public expects the Government to support this by helping to create the right environment. However, the Government considers there to be two important qualifications to the "free choice" perspective:

(a) there needs to be special responsibility in relation to children who are too young to make informed decisions themselves; and

(b) special arrangements need to be in place where one person's choice may cause harm or nuisance to another (the White Paper uses the example of second-hand smoke).

The Government acknowledges that not everyone requires the same support. For example, those in more deprived areas may need support that is more tailored to the realities of their individual lives, with support that is "personalised sensitively".

The Government considers that people need help to get healthier, and that "real progress depends on effective partnerships across communities", including local government, the National Health Service ("NHS"), advertisers, retailers, the media and so on. The Government considers its role to be to lead, co-ordinate and promote such partnerships.

The White Paper establishes the Government's six priorities in relation to health.

1. Reducing the number of people who smoke, because:

(a) it can lead to various fatal diseases

(b) people feel that they need support to address the problem

(c) people are concerned about the effects of second-hand smoke

(d) parents are concerned about their children taking up smoking.

2. Reducing obesity and improving diet and nutrition, because:

(a) there has been a rapid increase in obesity in both adults and children over the past decade

(b) effective action now could help tackle related diseases (such as heart disease, cancer, stroke, high blood pressure etc).

3. Increasing exercise, because it reduces the risk of major chronic diseases and premature death, and that a third of people are not active enough to benefit their health.

4. Encouraging and supporting sensible drinking, because:

(a) alcohol misuse is linked to deaths from stroke, cancer, liver disease, injury and suicide

(b) it places a burden on the NHS

(c) it can be linked to absenteeism, domestic violence and violent crime.

5. Improving sexual health, because:

(a) risk-taking sexual behaviour is increasing

(b) diagnoses of sexually transmitted diseases from HIV to chlamydia have increased in recent years

(c) delays in diagnoses and treatment could lead to more people being infected.

6. Improving mental health, because:

(a) mental well-being is crucial to good physical health and making healthy choices

(b) stress is the most commonly reported cause of sickness absence

(c) mental health problems can lead to suicide. 

The Government plans to ban smoking in all enclosed public places and workplaces by the end of 2008. In addition, all restaurants and bars that prepare and serve food will be smoke-free, but this will not extend to other pubs and bars, which will be free to choose whether to ban smoking or not. The restrictions on advertising of tobacco will be tightened further, and the Government proposes to consult on how to use picture warnings on tobacco products most effectively. The Government also wishes to place more emphasis on helping smokers to quit, from phone to text message support schemes.

Neither side of the smoking debate appears to be happy with the Government's proposals. Professor Alex Markham, chief executive of Cancer Research UK, described the proposals as a "huge missed opportunity … The government has failed in its fundamental duty to protect our citizens' health and safety by opting out of a total ban on smoking in public places"¹. The chairman of the British Medical Association, James Johnson, told the media that he was concerned that pubs would find loopholes in the law, for example, by ceasing their sale of food. 

Conversely, Tim Lord, Chief Executive of the Tobacco Manufacturers' Association, in a statement on 16 November 2004, said that the TMA considered the ban to go "beyond what the public has said it wants". Simon Clark, a director of Forest (Freedom Organisation for the Right to Enjoy Smoking Tobacco) said most people would be happy with more no-smoking areas, but a ban was a "systematic attempt to demonise smokers".

The Government has stated its aim that, by mid- 2005, processed foods will be clearly labelled to indicate fat, sugar and salt content for "shoppers in a hurry". The Food Standards Agency has been looking into this area in detail over the past couple of years, and it is also being investigated by the EU. It seems likely that some form of "signposting" scheme will be brought in later this year, but the exact nature of how this will be done is yet to be finalised.

Ofcom, meanwhile, is studying how foods are advertised to children, with a view to voluntary restrictions on "junk food" adverts. The Government has stated that it plans to bring in legislation in 2007 if the voluntary restrictions fall short of what the Government believes is required. 

Emphasis is also being placed on schools to provide healthier meals and more fresh fruit and vegetables. Money will also be invested in school sport and the promotion of exercise generally.

Food signposting or "traffic light" system: the National Consumer Council endorsed a traffic light scheme, which it has been advocating for several years. The BMA has also said that it is "pleased by the commitment to improve food labelling. The proposed traffic light system is a good starting point on which to build"². The industry is likely to be less keen, especially in a simplified "traffic light" where green means "eat plenty" and red means "eat sparingly", as certain foods may fall close to the line, and significant sales may be lost if a product falls just short of so-called "healthy levels" or is healthy in some ways (low in salt) but not in others (high in sugar). 

Food advertising: health organisations appear to welcome the ban, with the BMA describing it as a "bold initiative". It remains to be seen how such legislation would work in practice if, indeed, it is even deemed necessary. The White Paper may be seen largely as setting a marker down to the industry.

Ofcom has strengthened the rules of broadcast advertising of alcohol, in particular those adverts aimed at underage drinkers. The new rules came into effect on 1 January 2005, but there is a grace period that runs to September 2005 to allow those adverts already prepared to be shown this summer. Ofcom has delegated the difficult task of preparing guidance notes to the rules to the Advertising Standards Authority, which hopes to have some finalised notes in place by spring 2005.

Alcohol manufacturers have been urged to include warnings to encourage sensible drinking on products and in advertising, but no such warnings are obligatory. The industry appears to be on a warning to put its house in order, before the Government does it for them.

Many people are displeased that alcohol has, in their opinion, been given a relatively low profile in the White Paper. The Royal College of Physicians in a statement on the White Paper, accused the Government of missing an opportunity to tackle alcohol misuse, and it feels that the Ofcom regulations "do not go nearly far enough in limitations on broadcast advertising of alcohol". The BMA has called for a complete ban on alcohol advertising and clear labelling of alcoholic drinks to show the number of units they contain.

Sexual health: the Government plans a new national campaign targeted at those most at risk of catching a sexually transmitted disease, or having an unplanned pregnancy. By 2008, the Government hopes that everyone referred to a Genito Urinary Medicine Clinic will have an appointment with 48 hours, and that chlamydia screening will be rolled out across England by 2007.

Mental health: The Government wishes to tackle inequalities experienced by people from black and minority ethnic communities in their access to mental health care services. A further proposal is to put measures in place, under the Sure Start programme, to ensure young people are set on the "right path in life to protect against later mental health problems".

Sexual health: many seem to welcome the Government's plans in this area, but some, including the National AIDS Trust, think that it falls short of aiding those with specific needs. 

Mental health: again, some have welcomed the plans, including the Mental Health Foundation, which described the White Paper as a "new beginning", whilst others, including Majorie Wallace Chief Executive of the charity SANE, are "disappointed that the Government should choose targets which … do not recognise the urgent needs of the thousands of people with mental illness now".

The White Paper is very general in a number of areas, making broad statements about how things should be dealt with, but deferring actually dealing with them until later. Moreover, much of the White Paper summarises existing proposals, such as the food labelling "signposting" or "traffic light" systems, and focuses them into one document. Where the Government does make concrete proposals, such as smoking and on sexual and mental health, supporters of such plans often appear to consider them to fall short of expectations and needs, whilst opponents argue that they take away choice from consumers (for example, by imposing broad bans on smoking in enclosed public spaces).

The cautious approach of the Government may be welcomed by some, as it could be seen to demonstrate the Government's willingness to balance the need for controls in some areas but without over-regulation. 

Footnotes

^{1. 16 November 2004, Cancer Research UK press release.}

2. BMA press release "Why are we waiting for action on public health.?" 4 February 2005.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.