The publication yesterday of the Public Health White Paper saw the Government unveil its vision to tackle lifestyle-driven health problems and address health inequalities across England.
Public health is a familiar and long term problem, and one that previous governments have tried to address in different ways. Much was made by the Conservatives in opposition of their interest in ‘nudge theory’ – encouraging people to change their environment and make different, healthier choices.
The input of behavioural economics and social psychology is evident in the proposals published yesterday, with support for incentives and peer pressure and persuasion in encouraging people to take responsibility for their health.
It’s not all about nudging however. The White Paper refers to a ‘ladder of intervention’ to change our behaviour – ranging from doing nothing to eliminating choice through regulatory action. The Government acknowledges that there is no one size fits all approach to addressing public health challenges.
The radical measure in the proposals is the expected devolution of ring-fenced funding and power to local authorities, to improve public health and address inequalities on a local basis. This funding will be supplemented by a ‘health premium’ allocated to reflect relative population health outcomes and promote and reward action to reduce health inequalities.
In opposition, Andrew Lansley stated that the overall vision for public health reform would be “unashamedly decentralised”. While there is a strong theme of localism running through the proposals, the state has not let go and in a country with such high levels of adult and child obesity and lifestyle related health problems that’s hardly a surprise.
The health service has to focus on outcomes, and the Secretary of State will want to show improvements in public health by the next election despite financial constraint. The Department of Health hopes that its White Paper will drive innovation in health across the country, with an emphasis on local delivery. The challenge will be achieving real improvements against a backdrop of entrenched public health problems.