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    Physical inactivity

    41% of the adult population in England are insufficiently active (HSE 2012: 35% men, 46% women)

    Obesity trends

    Diabetes

    Walking and cycling:

    • can provide the same health benefits as sports or other exercise
    • can increase cardiorespiratory fitness
    • to work is as effective as a training programme and can fulfil the recommendations for physical activity.
    • and it’s good for the local economy

    Car commuters in Adelaide, Australia gained more weight over a 4 year study than non-car commuters.  The effect was particularly pronounced when comparing those who had sufficient leisure time

    • Switching from car to active travel or public transport: Body Mass Index fell by 0.32kg/m2 (95% Confidence Interval 0.05-0.60)
    • Switching from car to active travel: Body Mass Index fell by 0.45kg/m2 (95% Confidence Interval 0.11-0.78)
    • Switching from active travel or public transport to car: Body Mass Index rose by 0.34kg/m2 (95% Confidence Interval 0.05-0.64)

    The benefits of walking and cycling include:

    • Activity
    • Age-independent
    • Affordable
    • Access
    • Air quality
    • Flexible
    • Mental health
    • Less sick leave
    • Longevity

    Health impacts of Air Pollution include:

    • Asthma
    • Other respiratory disease
    • Heart attacks
    • Stroke
    • Lung cancer
    • Obesity
    • Neuro-developmental disorders
    • Neuro-degenerative diseases

    There are 40,000 deaths per year in UK from air pollution and costs in the  UK exceeds £20 billion a year. More vulnerable populations disproportionately in poorer communities, the old, the young and those with existing circulatory or respiratory disease.  Poorer communities are disproportionately exposed to air pollution.

    Transport should be about shifting people or freight, not cars or lorries.

    • Motor vehicles are the only increasing source of air pollutant emissions in the UK
    • Transport benefits accrue more to car users
    • Harms from motor vehicles accrue more to poorer, more deprived communities

    The policy response should be to reduce car use and spatial planning that does not assume or encourage car use

    • ↑ Active travel – ↑ physical activity
    • ↓ Emissions of pollutants
    • Serious injuries
    • Transport inequalities

    Save our cyclists

    The media – and doctors – notice injured cyclists. They don’t recognise the dangers of not cycling.

     

    Fatalities by mode - younger

    Fatalities by travel mode

    Fatalities per billion km by mode and sex,aged 17-69

    The actual risk for cycling (Figures for England 2010-2):

    Risk of death for males (20.8 per billion kilometres)

    • 1 per 48,000,000 kilometres cycled
    • Individual risk: one fatality every 32,000 years (assuming typical cyclist rides about 1,500km pa)

    Risk of death for females (16.9 per billionn kilometres)

    • 1 per 59,000,000 kilometres cycled
    • Individual risk: one fatality every 39,000 years

    The Transport Planning Heirarchy

    active travel

    A default national speed limit of 20 mph on residential streets would make a lot of difference to fatalities:

    • Reduces risk of collision
    • Reduces injury/fatality consequences if collision occurs
    • Reduces fear of traffic
    • Makes streets more pleasant places for social use, including children’s play
    • Encourages walking & cycling

    Fatality risk related to speed

    So far

    Local Authorities covering 13.5 million people in UK have implemented it locally

    National legislation is:

    • Much cheaper
    • Changes the accepted norm more quickly – affecting drivers’ behaviour
    • Smoother driving, reduces pollution
    • Improves police enforcement
    • Adds less than a minute to most journeys
    Crossing the road

    Increase crossing times on signalised crossings

    Walking speed

    Walking speed by age

    Walking speed by age: Most older pedestrians are unable to cross the road in time

    HSE 2005 timed walk data showed road crossings are set too quickly for more than 3 in 4 older people and  children, parents, those in wheelchairs or with other impairments, with luggage, etc.

    Expenditure on transport and active travel

    We should invest in active travel.

    Public Health England:

    “Health-promoting transport systems are pro-business and support economic prosperity …enable optimal travel to work with less congestion, collisions, pollution, and.. support a healthier workforce.”

    • Set a legal minimum % of national & local transport budgets to be spent on active travel (eg 5%? 10%?)
    • Better quality pedestrian environment
    • More, better cycling infrastructure (especially junctions)

    Invest in Public Transport instead of subsidising car travel

    • Building roads
    • Costs to society from car use (externalities)
    • Benefits (social & economic) of public transport
    • Easier & cheaper to travel by public transport
    • Average cost vs marginal cost for car use
    • Reverse the Beeching cuts to reinstate local rail services
    • Bus regulation to enable joined-up thinking and journeys that work
    • Faster replacement to Euro VI standards
    • Retrofitting existing buses & coaches

    Funded by

    • Not building /widening major new roads
    • Road charging (polluter pays) &/or taxation on fuel, reflecting costs to society (NOT scrapping fuel duty rises for cars!)

    Faculty of Public Health. Local action to mitigate the health impacts of cars.

    5 Priorities for national government:

    1. Default 20mph speed limit nationally for residential streets
    2. Better crossing facilities – more crossings, more time
    3. Invest in active travel
    4. Invest in public transport
    5. Enforcement of existing laws & rules

    This was presented at our conference Public Health Priorities for Labour

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    The process of produced a plan on transport and the environment

    Problems with roads

    Air Quality

    Ambitions for the city – cycling

    Vision for the environment

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    We Must All Take Greater Responsibility For Our Own Health

    Society today is less active than ever before. Meanwhile, demands on our health service have reached unprecedented levels. This is not a coincidence.

    Our living and working environments have been stripped of movement, with drastic consequences. Technology has taken us from hunter-gatherers to smartphone takeaway swipers, offering easy calories with none of the requisite exertion to maintain a healthy weight.

    As with any complex issue, turning the tide on our country’s inactivity epidemic requires a range of innovative solutions and collaborative efforts.

    Today, I’ll address nearly 600 thought leaders from the fields of health, politics and physical activity at the ukactive National Summit in London. The conference will outline ukactive’s Blueprint for an Active Britain and the role that exercise can play in safeguarding the future of the NHS.

    The need for concerted action is pressing. Physical inactivity causes twice as many deaths as obesity and costs the UK economy an estimated £20billion each year. Living a sedentary lifestyle significantly increases risk of up to 20 conditions including heart disease, type-2 diabetes, cancers and mental health problems.

    For the NHS, tasked with finding billions in efficiency savings by 2020, around 70% of its budget is currently consumed by the treatment of long-term conditions such as the above.

    Put simply, if we want the NHS to survive and indeed thrive, we need a radical shift towards prevention over cure. Our focus must switch from waiting to treat illness to proactively promoting wellness.

    Since 1948, the NHS has been a central pillar of our society. It has been there to support us throughout our lives – from birth, to parenthood, in our most vulnerable moments and right through to our final days.

    Now it’s time for the public to support the NHS. We must empower people to take responsibility for their health by making the right lifestyle choices.

    With its unrivalled network of facilities and ever-growing expertise in behaviour change, the physical activity sector could be perfectly placed to take the strain off our overstretched health service.

    We have seen countless examples of how integrated health and wellbeing services can transform communities when aligned to the facilities and services of the physical activity sector.

    That’s why I’m calling for the government’s Industrial Strategy to lead a £1billion regeneration scheme to transform the UK’s ageing fleet of leisure centres into new community wellness hubs.

    These wellness hubs combine swimming pools, gyms and sports halls, with GP drop-in centres, libraries and police services, to create a one-stop-shop for public services.

    Yes, it’s a big ask at a time of tight budgets. But this level of investment is a drop in the ocean compared to the cost to the NHS of a full-blown inactivity epidemic.

    It is a fraction of the cost of the £55billion HS2 project or the £17billion Third Runway, and yet it could save thousands of lives.

    The Government’s Industrial Strategy must recognise that our public health infrastructure is just as important as our train or plane networks.

    With government borrowing costs at an all-time low, now is the perfect opportunity to invest in our future. Transforming our infrastructure to inspire movement can catalyse the cultural shift needed to inspire a more active Britain.

    Putting physical activity – described by the Academy of Medical Royal Colleges as a miracle cure – at the heart of community infrastructure is the only long-term solution to save the NHS from bankruptcy.

    It is time to take the bold and radical decisions to integrate physical activity into our daily lives. For the sake of our health and that of the NHS, we must all take responsibility.

    This article first appeared in the Huffington Post

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    North West Leicestershire is about to publish its Local Plan. An inch thick, this pedestrian document tells us that this Council will co-ordinate a wide range of other organisations to ensure infrastructure is provided at the right time and in the right place to absorb the impact of new housing developments and provide for the health needs of people moving into the area.

    The best predictor of future behaviour is past behaviour.

    At a recent Policy Development Group, a cross-party committee of elected Members pursued the fate of £1.3M of developer contributions for health that remained unspent, some of it at risk of being paid back.

    Lacking a root cause analysis local GPs, NHS England and Council planners were involved in a blame game. The tangle of red tape, risked developers laughing at the public sector as they re-pocket money returned with interest.

    Teasing this mess apart has allowed some funds to escape the log-jam and NHS England we are now spending some s106 money on Long Lane Surgery in Coalville and on a surgery in Measham. But I am not taken in by this snippet of good news. Nor do I trust in future solutions such as moving to a Community Infrastructure Levy. My GP informants still describe a legal system that makes easing this money out of the bureaucracy so difficult that most clinicians give up.

    Remaining focused on funding GP premises, when so much else is pushing healthcare into the abyss, is almost certainly not enough. A Local Plan with vision would look beyond the immediate needs of service providers, such as GPs to the wider determinants of public health.

    Loneliness is a killer. Thanks to the developer-centric demands of the National Planning Policy Framework, the Council’s plans for cultural facilities in Policy IF2 grudgingly allow their expansion if the community can prove an increase in demand.

    After the closure of the iconic Snibston Discovery Museum perhaps I should not complain that the Plan appears to major instead on preventing existing community buildings from being demolished.

    My colleagues in public health should be pleased to see that the Plan does have a detailed section on transport infrastructure. The Royal College of Physicians reports that there are 40000 deaths a year due to poor air quality mostly from exacerbations of asthma and COPD. We know that we have road junctions that repeatedly breach air quality guidelines including the Copt Oak and Broom Leys junctions.

    According to the RAC North West Leicestershire along with neighbours South Derbyshire are in the top 10 Districts where working people are obliged to use their private car to go to work.

    It is axiomatic that wealthier communities are healthier communities. Ensuring people in North West Leicestershire can access properly paid employment has to be a key public health strategy.

    In supporting this Plan going forward for consultation, I am therefore particularly pleased to support Policy IF5 in which North West Leicestershire, in direct contrast to the County Council, commits itself to supporting the provision of public transport on the Leicester to Burton line.

    Providing East-West connectivity and putting the former mining town Coalville of back on the railway map, as HS2 looks increasingly unaffordable, it would be good to get national support for this important public health intervention.

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    (arising from member policy day held on 18/6/16 in Birmingham)

    AUTHORS: Val Little and Jacky Chambers

    Improving the health of our people and the health of the poorest fastest is a cornerstone of the socialist programme. Improving health requires policy intervention across a range of traditionally silo policy areas – it is a cross-cutting theme.

    Example: Tackling the hazard to health posed by air pollution

    Outdoor air pollution is a major hazard to health (causes an estimated 40,000 deaths a year, increased lung and heart disease, risks to the baby in the womb and lifelong damage to the lung function of exposed1i).

    AIR POLLUTION INEQUALITIES

    In England, exposure to air pollution is mainly an urban problem and strongly associated with areas of deprivation. Estimatesii iii suggest that around 11% of neighbourhoods (circa 5.7 million people are exposed to NO2 levels of pollution higher than that recommended by the EU Ambient Air Quality Directive.

    20 per cent of deprived neighbourhoods had higher air pollution levels than the least deprived neighbourhoods – 1.5 µg/m3 higher PM10 and 4.4 µg/m3 NO2 after adjusting for other factors.

    The worst air pollution is experienced in ethnic minority (> 20% non white neighbourhoods).

    Biggest differences in exposure to air pollution between communities are seen in London.

    HEALTH INEQUALTIES

    These pollution inequalities contribute to worse health in those communities – for example, children living in highly polluted areas are 4 times more likely to have reduced lung function when adults.

    POLICY MEASURES

    Road transportation is now the largest single pollutant source (one third of UK emissions of oxides of nitrogen, mostly from diesel; verging on one fifth of UK emissions of particulate matter, again mostly from diesel; one third of UK total of carcinogenic benzene emissions- petrol combustion)iv.

    Reducing the harm caused by air pollution from road transportation requires action across a range of policy areas by:

    1. Safety regulation – making vehicles cleaner and less polluting
    2. Reducing the volume of road traffic and exposure of local communities to pollution from road traffic

    1 Safety regulation – making vehicles cleaner and less polluting

    • support tighter EU standards to reduce vehicle emissions (contributing to accelerated achievement of Gothenburg protocolv standards)
    • ensure independent verification of vehicle testing – no more VWs
    • develop an industrial strategy which promotes switch to electric vehicles , incentivises research, development and production based on renewable energy sources , puts UK in lead and creates new jobs.
    • introduce road tax regimes which further encourage companies and people to buy and run less polluting vehicles.
    • give metropolitan councils more powers to create and enforce low emission zonesvi

    2 Reduce volume of road traffic

    1 Amend land use planning framework and regulations to

    • promote mixed development aimed at reduced car journeys to shops and work;
    • define proximity limits for major roads to new residential developments schools and nurseries and give guidance to Highways Authorities and Planning Inspectors to reject new developments in air pollution hot spots
    • require walking and cycling infrastructure as part of planning approval process

    2. Create a modal shift (at least 5%) towards greener forms of transport

    • develop an air quality control plan which is underpinned by public spending /spending review on programmes and local transport plans which change ratio of investment in cycling and walking infrastructure from eg 11% : from 4% to 25% of total transport budget by 2020/21
    • subsidise public transport so that it is cheaper than costs of driving by car (eg between 1997-2015 motoring costs decreased by 10% while rail fares increased by 23% and bus fares increased by 25%)vii
    • reinvigorate use of rail for freight as part of a publicly owned rail system.
    • reverse impact of LA cuts in bus services (eg since 2010 80% of local authorities have reduced school buses)

    Measures to reduce environmental air pollution inequality and the health impact of this pollution should focus on cutting vehicle emissions in deprived urban neighbourhoods.

    References

    i Royal College of Physicians Every breath we take: The Lifelong impact of Air Pollution Report of a Working Party February 2016 https://www.rcplondon.ac.uk/projects/outputs/every-breath-we-take-lifelong-impact-air-pollution

    ii Fecht, D. et al. ‘Associations between air pollution and socioeconomic characteristics, ethnicity and age profile of neighbourhoods in England and the Netherland’,Environmental Pollution (2014), http://dx.doi.org/10.1016/j.envpol.2014.12.014

    iii  Davis A. Submission to the Independent Inquiry into Inequalities in Health. Input paper: Transport and pollution. 1998

    iv National Air Emissions Inventory http://naei.defra.gov.uk/overview/ap-overview

    vi Campaign for Better Transport letter to Rory Stewart MP 18th August 2015. http://www.bettertransport.org.uk/sites/default/files/pdfs/Air-pollution-Rory-Stewart-letter.pdf

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    The “inverse care law” is the principle that the availability of good medical or social care tends to vary inversely with the need of the population served. Proposed by a GP, Julian Tudor Hart in 1971, it is a pun on the “inverse-square law” a concept from physics.

    This is hardly a new idea. It was published by another doctor, St Luke, 2000 years ago. In a conversation with Zacheus the taxman, Jesus concludes a story with the pithy comment,

    ‘I tell you that to everyone who has, more will be given, but from the one who has not, even what he has will be taken away.’

    The Inverse Care Law is alive and well here in North West Leicestershire. According to statistics released by Rail Minister Claire Perry on June 8th, the East Midlands received the lowest railway investment per head in 2014-15.

    With rail investment of £34 per head of population the East Midlands received less than a tenth of the funding given to London (£353) and a third of that invested in Yorkshire and Humber (£98) and the North West ( £93). Even the East of England did better (£71) leaving the East Midlands languishing at the bottom of the table even lower than South West (£35).

    This is not due to a lack of need. In 2013 the RAC Foundation reported in ‘The Car and the Commute’ that, outside London, 60-70% of workers need a car to get to work. With severe pockets of income deprivation, scarce bus and rail services and slow journeys even where public transport is available, both North West Leicestershire and South Derbyshire are in the top ten English and Welsh local authorities for car dependency with 80% of working adults having to travel to work by car/van.

    With air pollution causing 40,000 deaths a year and fossil fuels driving global climate change, surely something must be done?

    Continuing to lobby

    After receiving a report from consultants AECOM, Leicestershire’s cross-party Environment & Transport Scrutiny Committee recommended to Cabinet that Leicestershire County Council “should continue to lobby nationally and regionally for the upgrade of the Leicester to Burton Line”.

    Should we be surprised then that, despite this advice, the Conservative Cabinet decided on the 17th June that “the County Council will undertake no further investigatory work on the proposal at this time.”

    Leicestershire’s determination to quash the heightened “interest amongst the general public, local elected representatives and many other stakeholders about the proposal of reopening the Leicester to Burton Line to passenger traffic” is in direct contrast to our neighbours Lincolnshire County Council.

    Expressing disappointment at the low level of rail investment in the East Midlands, Lincolnshire have spotted an opportunity.

    The East Midlands rail franchise will be re-let by the Department of Transport soon. Lincolnshire will be using that opportunity to lobby for better rail services for their County. According to Andrew Roden (Rail Magazine) their shopping list includes “a bridge over the East Coast Main Line near Newark to allow more services to run on the Lincoln to Nottingham line.”

    It appears that North West Leicestershire doesn’t just lack investment in rail infrastructure. It also lacks a ruling elite with the political will to go out and fight for it.

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    With a lifestyle involving sitting or lying down ten hours or longer each day, people over the age of 65 tend to experience the lowest activity level of any age group. Their sedentary life tends to cost them dearly. Inactivity stiffens the joints over time, making movement harder and harder; seniors who work little opportunity for physical activity into their lives end up finding it more challenging each passing year to enjoy simple pleasures such as stepping out for everyday activities.

    An inactive lifestyle can ruin the health even further. Research finds strong connections between activity level and both physical and mental health. Strokes, heart disease, diabetes, depression and dementia tend to be common among seniors who live slow lives.

    Staying active doesn’t necessarily need to involve strenuous movement. As healthy as swimming, running or taking up a sport can be, nearly any kind of movement helps — 30 minutes each day doing anything from tending garden to taking a brisk walk or mowing the lawn. As long as it is strenuous enough to raise the heart rate, it helps improve an arthritic condition.

    Raising activity level can come with immediate health benefits, quickly lowering risk of heart disease and stroke. The elderly, though, do not choose their sedentary lives for reasons of a lack of interest in activity, though — one in five experience serious arthritis that makes movement painful. Staying active as you grow older requires careful planning for ways to continue moving without pain. Staying inactive can only make arthritis worse each passing year.

    The more you move, the easier it gets 

    The less active one is, the less lubrication the joints receive, and the more difficult it progressively becomes over time to move at all.

    When you experience joint pain, then, you need to not let it discourage you from staying active. Rather, you need to find ways to tackle the pain as you attempt to keep moving. Taking the weight of your body off your joints as you move can be an effective idea when it comes to getting joint lubrication going without pain. Fun, water-based group aerobics in a swimming pool, for instance, is an excellent way to go.

    Find massage services 

    Research finds that skilled massage therapy can be immensely helpful in improving mobility in arthritic joints through the improved circulation that such therapy promotes. Massage can also help with ability to move through healing inflammation, relieving overall stiffness and lowering stress. Since regular massage therapy can be expensive, finding scientifically designed massage chairs capable of kneading and tapping motions can be a serviceable alternative.

    Joint irrigation 

    Joint lubrication and cartilage health become so precarious in serious cases of arthritis, joints begin to experience the abrasive effects of accumulated cartilage debris. Having debris in the joints can cause extremely painful movement.

    Joints affected by accumulations of cartilage debris tend to be visibly swollen. As a debilitating as the condition can be, orthopedic surgeons today offer a simple solution — joint irrigation. A simple 10-minute procedure is all it takes to irrigate the knee joints deep inside, and clean out troublesome debris. Treatment tends to be affordable; the effects can last several months.

    Shots of hydroaluronic acid 

    In many cases, arthritic joints become painful with poor lubrication, but stop short of problems as serious as debris accumulation. Traditionally, doctors have recommended joint replacement therapy for patients with poor lubrication — movement tends to simply be too painful.

    With recent advances in arthritis medicine, though, doctors are able to offer patients a simple a office-based procedure in which a lubricant named hydroaluronic acid is injected in the joint. The effects of the artificial lubricant last six months, and can help patients put off knee replacement surgery for as long as a decade.

    Find pleasurable ways to move 

    It’s important to remember that constant movement is what keeps the joints healthy. The more successful you are at moving, the more lubricated your joints become, and the less painful movement is. Doctors recommend finding enjoyable ways to move that can take your mind off the painful chore of moving.

    A healthy sex life as an excellent way to go. Video games that use movement sensors such as Microsoft’s Kinect or Nintendo’s Wii are also fun ways to motivate yourself into moving. Having a pet to play with, playing with children, and moving lightly to music are fun possibilities, too.

    As the joints give out in old age, they still tend to be usable; all it takes is a creativity and a pro-active approach.

    Brianna May works as a physiotherapist and likes to offer her insights online. Her thoughts can be found on a number of retirement, health and elderly lifestyle blogs.

    Image credits

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    Shadow Secretary of State for Transport, Lilian Greenwood MP (pictured right) and Daniel Zeichner MP (right centre), Shadow Minister for Cycling joined CTC, the national cycling charity and Becky Renolds (left) of Bricycles, the Brighton cycle campaign group, for a ride in support of Space for Cycling along the Brighton sea front on Wednesday.

    The national Space for Cycling campaign aims to create conditions for people of all ages, backgrounds and abilities can cycle safely. It is targeted at councillors, seeking their support for improving cycling at a local level.

    ​Lilian Greenwood MP, Shadow Secretary of State for Transport said:

    “I’m delighted to join Bricycles and CTC in Brighton. I am determined that Labour will be a strong voice for cyclists in Parliament, especially as we are approach a critical point in the Government’s policy development. We will be holding Ministers to their promise to produce a meaningful Cycling and Walking Investment Strategy that sets out clear, long term funding – as well as pressing the case for restoring national safety targets.

    Sam Jones, CTC Campaigns and Communications Coordinator said:

    “It’s great to see the new Labour Transport team coming out in support of cycling at their conference in Brighton.

    “There’s cross party support in Westminster, and now more than ever we need to see all parties working together to get Britain cycling. This means the Cycling and Walking Investment Strategy must have funding of at least £10 per head, and the national design standards to ensure the money is well spent on space for cycling.”

    Cycling politicians

    Becky Reynolds, campaigns officer for Bricycles, the Brighton and Hove cycling campaign group said:

    “We are very grateful to Lilian and her team for taking time out to ride with us today. Cycling has enormous health and environmental benefits. These need to be extended to more people. We value Labour’s support for a more reliable system of funding for cycling so that using a bike becomes easier and safer for everyone.”

    For more information visit – Best MTB Gear

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    In Britain, cycling is highly unequal. Women, older people, and disabled people are all under-represented. Transport for London (TfL) reports that 74% of cycle trips there are made by men, while across England men are twice as likely to cycle to work as are women. It’s been the case for so long that people assume it’s normal. Cyclist equals young man on bike, in Lycra. But it’s not normal – and it doesn’t have to be like that.

    Over the past few years, I’ve seen ‘inclusive cycling’ start to move from being marginal to, if not the mainstream, at least greater prominence. In 2010, I remember an officer telling me in a ‘stakeholder interview’ that it was unrealistic for cycle campaigners to demand access for trikes and handcycles; just getting a small amount of bicycle infrastructure was going to be hard enough. That year, 2010, was the year of the Equality Act, which places a duty on public authorities to promote equality of opportunity and not discriminate on grounds of sex, age, and disability. The Equality Act has been used to challenge failures to provide tactile paving, so it does apply to the street environment. Not that you’d know it from the cycling environment in most parts of Britain, which still has physical and cultural barriers: from bollards blocking access to everyone but skinny two-wheelers, to the continued assumption that we are building for ablebodied young men happy to mix it with HGVs.

    This article covers some research I’ve done into cycling and diversity. It challenges the assumption that more cycling will automatically ‘trickle down’ and become more equal. It puts forward a different way of thinking about cycling and equality, where ‘inclusive cycling’ isn’t just boxed into a ‘minority’ corner but becomes central to cycling for everyone.

    More cycling, more equality?

    In countries like Germany, the Netherlands, and Denmark, the picture’s very different. In the Netherlands, women consistently cycle for a higher proportion of their trips than do men. In all three countries, it’s quite normal for older people to cycle. Rather than – as in the UK – cycling declining rapidly at older ages, in high-cycling countries, cycling levels drop down in young adulthood but often then increase at older ages. Dutch adults do more physical activity as they get older because retired people have more time to ride.

    A lot of academic and policy work hasn’t caught up with this. I still read papers where it’s assumed that women won’t cycle as much as men. I read claims that we need bus services because older and disabled people can’t cycle. Yes, we do need buses, but for some older and disabled people, cycling could be more accessible than walking and getting a bus. I’ve interviewed people who struggle to walk to the bus stop, but can easily ride a trike.

    Places where cycling is higher, where it’s easier and more normal, are places where you’ll see lots of cycling by women, older and disabled people, and children. We can even see this in the UK. Cambridge is not cycling heaven – it has its share of bollards and hostile main roads – although it’s better than many places. But, because of a range of factors, from the medieval street plan to the long-standing bans on Cambridge University students bringing cars with them, cycling has remained popular, with around one-in-three commuting residents doing so by bike.

    And the patterns seen in high-cycling countries are also found in Cambridge, with roughly equal gender balance and more than one-in-four commuting over-65-year-olds still doing so by cycle. Compare that to London, where 5.2% of commuters aged 30-34 ride to work but under 2% of those aged over 60 do.

    The Cambridge effect, and the correlation between cycling levels and cycling equity (both within the UK, and comparing the UK to other countries) has led some commentators to assume that to get greater equity, all we need to do is to get more cycling. A report by Department for Transport/Sport England states that: ‘The ratio of men to women also varies depending on the overall level of cycling: i.e. it would appear that getting more men to cycle to work encourages gender equality on this measure.’ In other words, target the low-hanging fruit and the rest of the tree will follow. But is that really the case? A piece of work that I’ve carried out with Anna Goodman and James Woodcock has tested this thesis – and found reason for scepticism.

    England and Wales: no increase in diversity

    Our starting point was that cross-sectional association between more cycling and more equal cycling. We wanted to test if that held true over time. In places across the country where cycling has increased, has it become more equal? We needed to use local level data, and so we used the 2001 and 2011 Population Census (for England and Wales), which includes some authorities where very large changes have taken place. The census includes a question on main mode of travel to work, which isn’t perfect but good enough for our purposes.

    In both years, the census shows the usual cross-sectional trend for gender: places with more cycling have a more equal representation of women. However, when you look at change over time, and correlate change in cycling against change in gender equity, the relationship disappears. Places that managed to increase cycle commuting failed to shift the gender balance. Although cycling’s gone up in all Inner London boroughs, there’s no overall change in gender balance. Looking at age, the picture’s even less optimistic. In 2001, looking cross-sectionally, there was a weak association between cycling and age equity. Places with more cycling had a better representation among over-55s. In 2011, that relationship no longer held. Looking longitudinally, we can see that those places that managed to increase cycling actually got worse in terms of age equity. Cycling became even more concentrated among the young.

    These results are on the one hand rather disappointing. We had expected – and hoped – to see some improvement in equity. On the other hand, thinking about what happened between 2001 and 2011, it’s perhaps not that surprising. As a nation, we failed to invest in cycling. Spending on cycling was a tiny fraction of what was needed, and often wasted on paint. And we continued to see cycling as something only the young, the male, the fit and the able-bodied would do. Check out the cover of Cycle Infrastructure Design, published in 2008.

    Brav

    So far, Britain’s growth in cycling – where it exists – is mostly driven by culture, not infrastructure. In London, cycling is fashionable again, with millennials turning away from car ownership. Better to be on a train connected to social media, or getting much needed exercise on your bike or on foot, than holding onto a driving wheel in a jam, going nowhere and doing nothing.

    But culture’s reaching its limits, and increasingly even London’s confident, fit, and active millennials have had enough of being marginalised on the roads, reading about yet another cyclist crushed under a truck (with no one charged). They’ve had enough of paint masquerading as infrastructure, of rat runs masquerading as ‘quiet residential streets’. And they’re fed up that their friends, parents and children are unable or unwilling to ride with them.

    What we’re seeing in those statistics is the limits of where we’ll get to without substantial change in infrastructure, policy and enforcement. Evidence shows that women are disproportionately put off by cycling conditions that force them to mix with motors. So as long as our cycling infrastructure remains poor to non-existent, we can expect the gender balance to stay stuck.

    Re-thinking cycling & equality

    So far, so depressing. But it’s also an opportunity. The data says to me that we can’t keep building for ‘Mister Local Transport Note 2/08’, riding with grim determination alongside HGVs on that narrow advisory lane. That’s pretty off-putting to most other people, and even Mr LTN 2/08 is complaining. He’d rather we built for everyone too.

    We need to turn discussions about cycling and equality on their head. Even in the Netherlands, women’s cycle trips tend to be shorter than men’s. As distance increases, women, on average, stop cycling before men do. And yet in this country we persist in thinking it makes sense to build the fast and direct route for the fearless young men and the wiggly detour for everyone else.

    The statistics on distance show that you need to build fast, direct routes for women: fast, direct routes that feel safe. Happily, those kind of routes also suit the fearless young men too. Get to your destination quickly and unthreatened: a win-win for everyone.

    Providing good cycling environments is particularly important for low-income people without car access, and for people in rural areas with limited other transport options. The recent iConnect study showed that people without cars benefitted more from highquality separated infrastructure for walking and cycling. Of course they did! They have fewer other options. Cycling is a democratic, inclusive transport mode, which can transform people’s life chances. But only if we ensure that the cycling network is democratic and inclusive.

    We know what people want, and we know the status quo is exclusive. My Near Miss Project research showed that slower cyclists are experiencing three times as many near misses for a given journey distance as quicker cyclists. This feeds through into inequalities experienced by gender, as women – on average – cycle somewhat more slowly than men.

    It isn’t acceptable. Too often, Britain’s hostile roads force people cycling to tool up, speed up, man up or – more often – just give up. We need inclusive space for cycling, where everyone from Mr LTN 2/08 to the wobbliest pootler can get to where they’re going safely, comfortably and at their own speed.

    This article was first published in the August-September 2015 issue of Cycle, the magazine of CTC and is reproduced with permission.

    Tagged | Comments Off on Pedalling towards equality?

    The Equality Trust has published our latest report. Taken for a Ride looks at the inequality within our transport system and finds that the richest 10% of households receive almost double the transport subsidy of the poorest 10%. The report can be found here, and also finds:

    • In total the richest ten per cent receives £978 million in transport subsidy; over three times more than the £297 million received by the poorest ten per cent.
    • When broken down by household the richest ten per cent still gain nearly double the subsidy of the poorest, £294 per year per household compared to just £162.
    • For the rail system alone a household in the richest ten per cent receives over three and a half times as much subsidy as one in the poorest ten per cent.
    • A household in London benefits from almost four times as much from rail subsidy as a household in Wales
    • Inequality of travel subsidy is not a recent development, for most of the last 20 years the richest ten per cent has received over four times the level of subsidy of the poorest ten per cent

    Duncan Exley, Director of the Equality Trust, said:

    “Our transport system is vital to us all. It’s how we get to work, send our kids to school, how we shop and generally move around. It literally binds the nation together. But despite this it is still failing many of our poorest.

    “This isn’t helped by our system of subsidies. We are spending a huge amount of money helping the already relatively well off. But far less money is going towards helping those at the bottom, people who desperately need support to access decent jobs. The result is these subsidies are effectively increasing inequality.

    “Government policy making pays far too little attention to the multitude of social and economic benefits of inequality reduction. We need a drastic overhaul of how policy is made if we are to arrest our damaging levels of inequality and see these benefits realised.”

    The report recommends that:

    • All government departments should consider whether or not any new policy proposal increases inequality, as part of their cost-benefit evaluation process.
    • The Department for Transport, and all other government departments, should review the net effect of their existing policies as a whole on inequality.
    • The Government should commission the Office for Budget Responsibility to estimate the net impact of its annual budget on UK inequality
    Tagged , | Comments Off on Inequality within our transport system

    Labour’s New Approach to Public Health in the 21st Century

    Introduction

    When the NHS was created in 1948, life expectancy in England was 66 years for men and 70 years for women. Today it is 79 years for men and 83 years for women and set to keep on getting longer as this century progresses.

    This is welcome but poses new challenges for our NHS and more importantly, for us all as individuals, parents and families. If our bodies are to be on the road for longer, all children will need the healthiest possible start in life and the earliest possible intervention when needs arise. And, as we grow older, we will all need to take better care of ourselves, if we are to get the most out of life in our later years. It is still not widely understood that lifestyle has an impact not only on the chances of developing diseases like cancer and heart disease, but also affects the chances of  developing diseases like dementia too.

    The truth is that individuals and communities will need to be helped to take more responsibility for their health. Because, if we don’t make changes, the NHS simply won’t be sustainable in a century of rising demand for healthcare. So that’s why the nature of the public health challenge has changed. If the 20th century challenge was all about adding years to life, then the 21st must also be about adding life to years.

    But here’s the rub: the very nature of 21st century living works against it. Changes to diet and lifestyle mean it is all too easy to lead a less healthy life than in times gone by, and we all risk taking on more sugar, fat and salt than is good for us and failing to move about enough to burn it off. Our complex and fast-moving modern world is exposing children to ever-more sophisticated commercial pressures. We are all absorbing higher levels of stress and insecurity which can erode mental health and wellbeing and lead to poor diet and addiction. For too many people this is the new reality of modern living in the 21st century. Helping people deal with it will require a new approach to public health. If it was ever true that healthier nations can be built through Government action alone, then it’s certainly not true now. Instead, we need to build a different culture where we empower individuals to take on more responsibility for their own health and help communities look after each other.

    This is one of the main conclusions of Labour’s root-and-branch review of public health policy.

    In Government, Labour took a number of bold steps to improve the nation’s health. For example, teenage pregnancy rates fell by over a quarter and the proportion of non-smokers in the population increased significantly. The ban on smoking in enclosed public places is an example of how big social change to improve health can be achieved with broad public support.

    But, to avoid accusations of a ‘nanny state’ approach we need to set out clearly what we see as the proper limits to government action. If policy makers fail to address the ‘nanny-state’ claim, it could in the end undermine public support for making progress on public health. A negative tone, perceived as telling people what to do, can turn people off. On the other hand, there is a danger in over-reacting to the ‘nanny-state’ charge and failing to take the necessary action to protect people’s health.

    The current Government, fearful of it, and unable to stand up to vested interests, has relied too heavily on a voluntary approach with industry. It has not worked. The 2010-2015 Parliament has seen a real loss of momentum on public health policy, with the Government failing to deliver promised measures, such as on tobacco packaging. It has been left it to Labour, from the Opposition benches, to lead the public health debate with the move to ban smoking in cars with children and proxy purchasing of cigarettes.

    The time has come to find a better response to concerns about the ‘nanny state’ and a new point of balance in the public health debate. We must be clearer about where the state has a particular duty to intervene and where it should instead focus on empowering people to make informed choices.

    To help this, Labour proposes two new guiding principles for public health policy:

    • For children, we will take decisive action to give each child a healthier start in life.
    • For adults, we will place a new emphasis on empowerment to make healthier choices.

    In this complex modern world, there is much more that we can, and should, be doing to protect children from the pressures and risks they face. Adults must be free to make their own choices but there is more we can do to help people navigate the system and take more responsibility for their own health.

    Labour’s new approach to public health can be illustrated in food policy. We propose to regulate for a maximum level of fat, salt and sugar in food marketed substantially to children while to support the population as a whole, Labour will pursue improvements to food labelling to help people better understand what they are eating, including working at EU level to introduce mandatory traffic light labelling of packaged food.

    While it is first and foremost the responsibility of parents to secure the health of their children, the justification for firmer Government action in respect of children comes from the fact that other people frequently make choices on their behalf: what they eat or drink; the environment in which they are placed; the structure of their day. Because of that, government has a clear responsibility to minimise the harm that poor choices can do to a child’s health. There is far more we can, and should, be doing to protect children from the harm caused by smoke, sugar, alcohol and inactivity – and give every child a better start in life – and we will not be deflected from doing it.

    But, beyond that, we will develop a different approach to promoting the health of the rest of the population. We will empower people with better information and support to make their own choices, rather than the finger-wagging ‘don’t do this, don’t do that’ approach that can make people switch off.

    Emblematic of this new thinking about an empowering approach to heath is our plan to place the promotion of physical activity at the centre of public health policy. Building a more active nation will be our pre-eminent public health objective. Physical activity offers the simplest, and cheapest, route to good health. It is a positive call to action and, for many, the easiest lifestyle change to make. But it also has the virtue of being a catalytic change, prompting positive changes in diet and on levels of smoking and drinking. Rather than set a Government target, we will instead develop a new national ambition on physical activity. We will encourage companies, councils, charities and others to sign up too and join a new national campaign to build a more active nation.

    Asking individuals and communities to do more to promote health is a recognition that, going forward, action on public health is essential not only to improve health and wellbeing but to ensure the NHS remains sustainable for the long term.

    We need to help people look after each other. The plan we set out here for all young people, by the time they have left school, to have had access to emergency first aid training along with a new plan to locate defibrillators in major public places is just one example of how we will build that community resilience.

    Though Labour’s new approach to public health reflects changing times, our historic mission remains the same: to break the link between health and wealth and tackle health inequalities, so that no-one’s health is disadvantaged by where they live or what they earn. To be successful, our new approach will need to be supported by the ‘health in all policies’ approach, as advocated by Professor Sir Michael Marmot.

    Labour believes that the NHS needs to break out of its 20th Century medical model and embrace a new whole-person, social model of support that starts with prevention. By asking Health & Well-being Boards to lead local commissioning for the increasing number of people with complex and multiple needs, and by bringing together services to work around the individual, we will finally be able to link health policy at a local level with all of the other local policies that have a bearing on health – most notably, housing, planning, education, employment, skills and leisure – and, in so doing, build more resilient individuals and communities. Bringing together services, in this way, will also help create the right conditions and incentives for services to intervene earlier to stop problems before they arise or become worse. 21st Century living, and the scale of the challenges ahead of us, demand new thinking, new ambitions and new leadership on public health. Labour has traditionally led the way on public health policy and is ready to do so again.

    The scale of the challenge

    When the NHS was established, many of the biggest health problems in the UK were curable illnesses like infectious diseases and accidental injuries. Over half a century later the picture is very different. Overall, health is improving and our life expectancy has increased. We have controlled or conquered many of the infectious diseases such as polio which blighted previous generations. Many thousands more people are now living into their 80s and 90s, and beyond, as life expectancy has improved.

    Obesity, tobacco and alcohol are contributing to the development of long term conditions such as diabetes that require lifelong treatment. Opportunities to be regularly physically active are declining in our daily lives, some of us are regularly eating and drinking more than is healthy, and the growing stresses and insecurity of modern life are adding additional pressures to our mental health. This new reality requires new thinking on public health. We have added more years to life, now we also have to add more life to those years. The ageing society should be a cause for celebration not a cause of fear.

    Changing this means embracing new ways of tackling entrenched challenges. Right now, the 21st century is asking questions of our 20th century health and care system that it is increasingly unable to answer. To plan our future health services and ensure the best use of our resources, we must understand the true picture of the public’s health.

    Diet

    Our lives have changed significantly over the years. The quality and range of food available has improved, but so too has the formulation of much of the food and drink that children consume. Nearly two-thirds of adults and a third of children in England are classed as being overweight or obese. More people, children as well, are getting Type Two diabetes and other obesity-related conditions. It is predicted this will affect the life expectancy of millions and will also hit the NHS.

    Obesity related illness such as heart attacks, strokes and diabetes are already costing our NHS over £5 billion a year and this is expected to rise to more than £8 billion by 2025. The cost to wider society is of course much higher and is estimated to reach £37 billion by 2025.

    The nation’s diet today is very different to our diet when the NHS was created. Modern food manufacturing and marketing techniques make it harder for parents to make healthy choices for their children. The rise of food processing has meant that, unwittingly, we are eating more fat, salt and sugar than we realise. For example, parents used to be able to monitor the amount of sugar their children were adding to cereal from a bowl on the breakfast table; now, large amounts are often added at the point of manufacture, before it reaches our bowls. A Which? report in early 2012 found that sugar levels in 32 out of the 50 breakfast cereals they examined were extremely high and they were particularly concerned about the sugar levels in cereals that were marketed to children. It is notable that in some cases there is a marked variation in the amount of sugar in the same cereals as marketed in different countries. In the UK, it is recommended that no more that 10% of our food energy should come from sugar. The World Health Organization suggests that we should in fact be aiming to go much further and get the level of sugar in our diet down to 5%. But currently, in children aged 4 to 10 years, it is 15% and in those aged 11 to 18 years it is 15%. Teenagers’ intakes are the highest of all groups – they consume 50% more sugar on average than is currently recommended.

    The UK is the biggest market for salty snacks in Europe and the demand is mostly amongst the young. The National Diet and Nutrition Survey found that our salt intake was higher than the recommended levels for all groups of children and adults. Our average intake of saturated fat exceeds the 11% recommendation in all age groups.

    Yet change towards a healthier diet and all of us living more active lives is painfully slow. The voluntary approach with industry – through the Government’s Responsibility Deal – has failed to deliver the goods.

    Physical inactivity

    Just a few generations ago, physical activity was an integral part of daily life. Modern life makes it much harder to be physically active and many of our children and young people are not getting sufficient activity to learn good lifelong habits and stay strong, fit, healthy and happy. Advances in technology, community safety concerns and limited access to green spaces are just a few of the reasons why.

    Getting people walking and cycling from a young age is crucial to building lifelong well-being and resilience, improving the environment and cutting transport congestion. Yet only around half of children are walking or cycling to school. In England only 2% of primary school children cycle to school compared with almost 50% in the Netherlands.

    It is becoming clear that sedentary behaviour (sitting or lying down for long periods while doing things such as working at a computer or watching TV) can cause health problems. Insufficient levels of physical activity are estimated to cost over £7.5 billion nationally, £1.06 billion in the NHS, £5.5 billion in lost productivity and £1 billion in premature mortality in the working age population in England.

    Labour had a strong record in promoting physical activity – and particularly promoting sport for children and young people. In 2003/4, just 44% of children undertook at least two hours of PE in school, but by the end of our time in government this had been raised to 84 per cent. This Government has scrapped School Sports Partnerships, axed Labour’s school sport targets and a recent Youth Sport Trust survey found an alarming drop in the amount of PE offered to children in England. The Tory-led Government abandoned the legacy on physical activity that Labour left, failed to show leadership on active travel, and missed the opportunity to build on the once-in-a-lifetime Olympic moment after the 2012 games in London. At the same time as the country was engaging more with sport, the Government was dropping the free swimming programme, axing Cycling England and stopping the school travel survey.

    Smoking and tobacco

    Smoking is the largest cause of preventable illness and death. There are about 10 million adults who smoke in Britain, around 20% of the population. Every year smoking causes around 100,000 deaths and it is also a major driver of health inequalities – smoking rates are markedly higher among low income groups. Yet there are still more than 200,000 children under the age of 16 who take up smoking every year, according to Cancer Research UK. That means around 600 children are lighting up for the first time every day.

    Under the previous Labour Government, the proportion of adult smokers fell from 28% to 20% between 1998 and 2010, due to a series of national initiatives, including the ban on smoking in enclosed public places and the raising of the legal age for buying tobacco from 16 to 18. Other significant steps forward included expanding NHS Stop Smoking Services, supporting hundreds of thousands of smokers to quit. Yet the Tory-led Government has failed to build on this work. In the face of prevarication from the Government, it was left to Labour, from the Opposition benches, to push forward the legislation to enable the introduction of standardised packaging of cigarettes and a ban on smoking in cars with children.

    But that was over two years ago and the regulations on standardised packaging have not yet appeared, despite parliament voting overwhelmingly in favour of it and numerous evidence reviews showing that standardised packaging prevents young people and children from taking up smoking. The failure of ministers to act is not because of a lack of time or a lack of evidence. It is because of a lack of political resolve to stand up to big tobacco firms and their lobbyists. The fact is that the Government has come under intense lobbying from the big tobacco companies and vested interests, attempting to persuade ministers to sit on their hands.

    Mental health

    One in four of us will have a mental health condition at some point in our lives and one in twelve of us will experience depression. The insecurity of modern life – precarious employment, people working and living away from their families and the pressures of social networking and the 24-hour society – can erode our sense of mental wellbeing.

    For the first time, stress is the most common cause of long-term sickness absence for both manual and non-manual workers. The number of prescriptions for anti-depressant drugs has increased by around 93% over the last decade from over 27 million in 2003 to over 53 million in 2013. Undiagnosed or untreated mental illness can have a devastating impact on  individuals and their families. It has real consequences for our society and our economy. The annual cost in England is estimated at £105 billion. Yet, the Government is failing to fulfil their promise of delivering parity of esteem between physical and mental health. Pressures on mental health services are increasing to intolerable levels, with vulnerable people forced to travel hundreds of miles for a bed and in some cases they are not receiving the treatment they need at all.

    Sexual health

    The rates of some sexually transmitted infections are steadily increasing. Since 2010 we have seen upward trends in syphilis, gonorrhoea and genital herpes. In 2012 there were nearly half a million new cases of sexually transmitted diseases, with chlamydia infection making up nearly half of those cases. Rates of infectious syphilis are at their highest since the 1950s and in England in 2011, one person was diagnosed with HIV every 90 minutes. Last year a Public Health England report found the number of people living with HIV in the UK has exceeded 100,000 for the first time. Despite these increases, sexual health services have been fragmented as a result of the reforms to the NHS, statutory Sex and Relationships Education has not been included in the National Curriculum, and youth services – a crucial part of reaching young people most at risk outside school and college – have been drastically cut.

    The progress that was made under the previous Labour Government in reducing teenage pregnancies is at risk of being undermined. It has been estimated that if the current squeeze on services continues and strategic work continues to be dismantled, the additional cost to the NHS plus wider public sector costs could total between £8.3 billion and £10 billion.

    Alcohol

    The UK rate of alcohol dependency amongst men and women is higher than all Western European countries other than Norway. Excessive drinking is associated with a wide range of chronic diseases including liver disease, cardiovascular disease and cancer, as well as with crime and disorder.

    In 2012, there were 8,367 alcohol related deaths in the UK. Deaths from liver disease have reached record levels – a 20% rise in a decade. In people under 30, liver disease death rates have increased by 112% over the last ten years. Other evidence highlights the damaging effects of alcohol including the number of A&E attendances and the levels of domestic violence and disorder on our streets. The rise is excessive drinking has been fuelled by the increasing availability of low-cost, high-strength alcohol. Cheap, high-strength alcohol is now a permanent feature on the supermarket shelves including an endless wave of special offers and promotions, and such marketing has been shown to be particularly attractive to harmful and dependent drinkers, binge drinkers and young drinkers.

    Our society’s relationship with alcohol also impacts on our children. It is estimated that 2.6 million children in the UK are living with parents who are drinking hazardously. In 2012/13 6,500 under 18s were hospitalised because of alcohol, including 283 under 11s. Indeed almost half of school students say that they have drunk alcohol at least once.

    Tackling health inequalities

    Improving public health will be an essential part of ensuring the NHS remains sustainable for the next generation. And it is the best way to avoid a  frightening vision of a future where the Chief Medical Officer’s warning that today’s children may live for fewer years than previous generations is realised. Indeed, there is already emerging evidence that life expectancy amongst the elderly is falling in some parts of the country. Despite a 27 per cent reduction in the infant mortality rate under the previous Government, the UK is still behind its European neighbours in preventing deaths among children, with the causes affecting the more disadvantaged communities in our society.

    The substantial gap between the health of the worst-off and the most prosperous in our society continues to be persist. The stark truth is that people living in the poorest neighbourhoods will on average die 7 years earlier than people living in the richest neighbourhoods. Where you live in modern Britain, what you earn and how long you stay in education, may still impact on your health.

    Left unchecked, these public health challenges will not only ruin the lives of individuals, they will also impose substantial costs on the health service and our wider economy. Our NHS will face a large funding gap by 2020 unless action is taken. Demand will rise faster if we as a society do not do all we can to prevent avoidable illnesses. The long-term capacity of the NHS to treat everyone who needs it will be at risk without a strong focus on wellness and prevention as well as cure.

    Progress on tobacco and teenage pregnancy between 1997 and 2010

    The proportion of adult non-smokers in the population rose from 72% to 80%  between 1998 and 2010. This was due to a series of national initiatives implemented by the Labour Government, of which the most striking was the restriction on environmental tobacco smoke in public places. Other significant steps forward were tough legislation on vending machines and tobacco advertising at point of sale. The creation of several Regional Tobacco Control Offices and the extensive network of NHS Stop Smoking Services were further examples of Labour’s commitment to saving a hundred thousand lives currently being lost to tobacco every year.

    The rate of teenage pregnancy fell by 27% during the Labour Government and the downward trend achieved by better sexual health services for young people and dedicated funding for long-acting contraceptives has continued. The introduction of HPV immunisation for teenagers under Labour is a good example of a successfully developed and implemented public health programme.

    The Government’s approach is not working

    The sheer scale of the public health challenge we are facing demands strong leadership and bold ambition. The Government has failed to show either and has lost its way on public health.

    When the Coalition Government came to power in 2010, the health of the nation had showed significant improvement. Infant mortality was at an all-time low, cancer mortality had fallen and teenage pregnancy had dropped by nearly a quarter. But the Government has failed to build on this legacy. Their decision to abolish the Cabinet Sub-Committee on Public Health after only two years is indicative of the failure of ministers to make public health a priority across all government departments. Much of the progress in public health made under the previous Labour Government has stalled, if not started to reverse.

    The defining approach to public health from this Government is a heavy reliance on voluntary action with industry. The decision to rely largely on the ‘Responsibility Deal’, a programme encouraging business to take action voluntarily to improve public health, has raised the concern that the Government has become too close to commercial interests to take the bold action on public health that is required. The scale of the challenge we are facing is too great to rely solely on a non-binding and piecemeal deal with a select group of companies. Some of the major supermarket chains, big drinks producers and high street food outlets have signed up, but other organisations have walked away from the scheme, including Cancer Research UK and the Faculty of Public Health. Many initiatives such as cutting salt and removing harmful trans-fats were already under way before the voluntary scheme was launched, while newer ones such as the drive to increase vegetable and fruit consumption were too “vague” to be meaningful. The monitoring and evaluation framework is not sufficiently robust or independent. The Government has set no timetable for reviewing progress and has failed to outline the action it will take if results are not achieved. In the latest annual report, nearly a third of the retailers and suppliers signed up to the Deal’s various pledges failed to hit the targets they set themselves.

    Industry is disappointed too.

    While some of the companies signed up to the programme have made significant effort and progress, and the steps they have taken are recognised and very welcome, by itself this is not enough. And those companies who try to do the right thing are undermined by competitors who refuse to join.  This leaves those who want to make changes at a competitive disadvantage. Some companies have taken commercial risks to bring forward change, whilst others have simply refused to sign up and have continued undisturbed. It is not surprising that many of those that had signed up, drop out. For change to work in a market context, all players need to be following the same rules. Key players in the sector are calling for transparency and clarity along with a level playing field.

    Alongside the absence of strong leadership on public health policy, the Tory led Government has disrupted the public health system as part of the reorganisation they have imposed on the NHS. Labour welcomes the shift of much of public health delivery to local authorities. It is right that the power to make decisions about a community’s health and wellbeing sits with the community itself and that is where it will stay under the next Labour Government. However, this transfer has created problems in practice. Some places have failed to appoint a Director of Public Health on a substantive basis and the Government has failed to ensure that Public Health budgets in some areas have been spent effectively.

    Improving health and well-being needs to be at the heart of everything a 21st century local authority delivers, rather than just an add-on. This approach links closely to our proposals for the full integration of physical and mental health and social care. A service that cares for the whole person needs to include preventative public health measures. This Government has failed to provide the answers on public health that we need. Too often they are unwilling to stand up to vested interests or are ideologically opposed to intervening in markets. We need a new approach.

    Labour’s new approach

    Labour’s new, two-part approach to public health is borne out the desire to avoid a ‘nanny-state’ approach on the one hand, whilst recognising the failure of the Government’s heavy reliance on a purely voluntary approach with industry on the other. The point of balance lies between the two:

    • Decisive government action to protect children;
    • Empowering people to lead healthier lives whilst respecting their right to make their own choices.

    Helping parents and protecting children

    If we want to make Britain a more equal society, where children have a better chance in life, we must look more closely at the health of our young people. Children’s early experiences are central to shaping their long-term health and well-being, and reducing inequalities in health over the life course. But the reality is that we are not doing anything like enough as a society to give all children the healthiest possible start in life.

    We are clear that, when it comes to the protection of children, more decisive action by government is needed. The justification for firmer government action arises from the fact that children do not make their own choices but have choices made for them. The Government has an obligation to protect children from poor choices that may be harmful to their long-term health. An example of Labour’s more decisive approach in respect of protecting children was the decision to seek, and secure, Parliamentary approval for protecting children from tobacco smoke in cars. It is developed further in new policies in this document on physical activity, food, smoking and alcohol. But the Government should also do more to support parents trying to make the right decisions for their children. Modern marketing and advertising techniques, along with commercial pressures, can make this difficult.

    Government has a crucial role to play in standing up to vested interests and empowering parents to make informed choices. Indeed, this is action the overwhelming majority of parents want: recent polling has shown three-quarters of parents think the Government should more strictly regulate the way junk food is advertised to children.

    A more positive enabling approach

    The last Labour Government had a good record of achievement in many important areas of public health, but there were areas where, when we left government, we knew further action was needed. We know we can’t tackle some of our most entrenched public health challenges from within the health system alone. We also know that legislation is not the answer to everything. Good health is not created by the Department of Health, nor solely by the actions of the NHS. It is the product of many separate policies and activities, not just in government departments but also in communities, schools, workplaces and homes across the country.

    Whilst we are clear that the Government has a responsibility to protect and safeguard children and has an important role to play in tackling health inequalities, we are not in the business of telling people how to live their lives.  The evidence shows it simply doesn’t work. Public health is about a partnership between businesses, governments, the voluntary sector and the citizen. It is not something done to people by experts.

    Instead, we want government to be on people’s side, supporting them in making healthy choices and improving their health and that of their family. We propose new national ambitions – positive, shared aspirations that will help us all play our part to become a healthier, happier nation. International comparisons show that smoking can be reduced further, obesity and associated illnesses reduced and physical activity improved. We are setting out ambitions for our country that people can share, companies and organisations can partner in, and that are achievable.

    A focus on physical activity as the positive catalyst for change

    We will focus on positive catalysts for change and physical activity is the golden thread running throughout our entire public health policy  programme. Promoting physical activity is a single, simple, positive goal for the whole country to get behind: a goal that has the potential to shift our national culture. It is not about finger-wagging; it is about promoting a positive activity that people can feel good about. Moving from inactivity to activity is often the easiest positive lifestyle change to make, by making small changes to build physical activity into our daily routines, we can make big differences to our health.

    Moving from inactivity to activity is a catalytic change. Once achieved, people begin to feel better about themselves and more in control – and then make better choices on smoking, drinking and diet. Getting active not only brings physiological benefits – it can improve mental health too. Active young people are more alert, and less likely to suffer from stress or depression. For young people, physical activity is fundamental to their happiness and development. The evidence also suggests that children who are fit have higher academic attainment. Turning the tide of inactivity is not just one of the easiest ways for an individual to achieve healthy living, it is the cheapest route to good health and well-being for the whole population and the most cost-effective way of making our public services sustainable. It is also why we support public health being an important role for local government which has the overview of its community and the policy levers to make change happen.

    Our Guiding Principles

    In 2008, Labour commissioned the Marmot Review of Health Inequalities. The final report, Fair society, Healthy lives was published in February 2010 and recommended a change in approach. The Labour Government accepted those recommendations but their implementation was interrupted by the 2010 general election. The Marmot Review identified a series of principles that reached across a wide range of Government responsibilities that will guide the next Labour Government including:

    Early intervention

    Labour believes that that giving every child the best start in life is of crucial important in setting healthy foundations for the future. Supporting children and families in the very first months and years of life is especially important given this is a time of rapid development with a huge impact on later outcomes.
    The Marmot Review identified a number of key policy objectives that were important to achieving that healthy start.
    The priorities identified were:
    1. Reduce inequalities in the early development of physical and emotional health, and cognitive, linguistic, and social skills.
    2. Ensure high quality maternity services, parenting programmes, childcare and early years education to meet need across the social gradient.
    3. Build the resilience and well-being of young children across the social gradient.
    We are committed to acting across the broad sweep of public policy and working towards making these objectives a reality.

    Health in All Policies

    We will adopt the internationally accepted ‘Health in All Policies’ approach – putting health concerns at the centre of our programme for government. Improving our health is not in the gift any one department, organisation or agency, it is the product of many separate policies and activities not just from government but in communities, schools, workplaces, businesses and homes across the country. Successful policy must build a systematic approach that mobilises all of the relevant government departments, local authorities and community and voluntary groups to contribute to a broadly based approach to improving the health of all of our nation. This is why Labour will re-establish the Cabinet Sub-Committee on Public Health.

    Proportionate Universalism

    Our clear ambition is to reduce health inequalities. However focusing solely on the most disadvantaged will not make a big enough difference. We need to take universal action on the major problems affecting our health, but with a focus and intensity that is proportionate to the level of disadvantage in different communities and groups.

    Our programme for action

    Physical activity

    Our ambition: We should aspire to helping everyone in this country be more active. We will develop new measures for recommended levels of physical activity that can be easily understood by everyone, and are consistent across government, including a basic minimum that everyone who can should try to do, and also a recommended level that we should aspire to get at least 50% of people achieving by 2025 as part of our new national ambition.

    This will be our pre-eminent public health goal. It will be supported by a new national ’50 by 25′ campaign that we will ask council, companies, charities and voluntary organisations to join. By signing up, organisations will be agreeing to take steps to get 50% of local people, employees or their members physically active.

    Protecting children

    • We will reinstate the goal of all children doing a minimum of two hours PE a week as part of the curriculum and support the delivery of high quality sport, PE and physical activity.
    • Labour will deliver a primary school childcare guarantee, offering parents wrap-around childcare between the hours of 8am and 6pm.
      This will provide more opportunities for children to participate in up to three further hours of sport and physical activity every day.

    Empowering all

    • We will give local authorities an expanded remit to support physical activity in communities. We will look at how we can better support local communities so that they have the opportunity to use sporting facilities in schools outside school hours, including at weekends, and outside term time.
    • We will work with local authorities, learning form the measures introduced by Labour in Wales, to steadily improve the walking and cycling environment in all communities.
    • We are committed to restoring national standards to cut deaths and serious injuries on our roads and taking steps to make HGVs safer.
    • Labour wants every child to have the opportunity to learn to ride a bike.We want to see cycling education and training continue in the next parliament.
    • A national programme will be put in place to support social prescribing of physical activity, by health and social care professionals, for people who would benefit.

    Food

    At a time when families are facing a cost-of-living crisis, Labour does not believe recent calls to impose new taxes on foods are the right approach for encouraging healthier diets. That is why, instead of pursuing proposals such as a ‘fat tax’ or a ‘sugar tax’, Labour will instead take a new approach. Faced with high levels of childhood obesity and the inadequacy of relying solely on industry to make the changes that are needed, Labour will set maximum permitted levels of sugar, salt and fat in foods marketed substantially to children.

    Our ambition: To help give all children a good start in life by tackling the barriers to a healthy diet. We will achieve a sustained downward trend in levels of childhood and adult obesity; reverse the growth in cases of malnutrition; and increase the proportion of children eating healthily.

    Protecting children

    • Labour will set limits on the amount of sugar, fat and salt in food marketed substantially to children focusing on major product groups – for example cereals, crisps and soft drinks.
    • Whilst restrictions on TV advertising for unhealthy products have reduced the number of advertisements children see during children’s programming, it is still the case that many children are exposed to adverts for foods high in fat, sugar and salt that the current restrictions were designed to protect them from – for example during some family TV shows on Saturday evenings. To better protect children from TV advertising of products high in sugar, salt and fat, we will ask the Committee on Advertising Practice (CAP) and the Advertising Standards Agency (ASA) to report on how this can be more effectively done, including considering lowering the proportion of children in the audience required for a programme to be considered ‘of particular appeal to children’. If progress cannot be achieved through this route, we will regulate to protect children, with options including a time watershed for advertising of products high in sugar, fat and/or salt (HFSS). We remain committed to basing our actions on the evidence and consulting fully with all stakeholders, including the advertising and  food industries and public health experts, in the implementation of this.
    • We will also ask the CAP and the ASA to report on how children can be better protected from the advertising of products high in sugar, salt and fat in non-broadcast media, such as ‘advergames’, including considering the case for applying to non-broadcast media a differentiation between HFSS and non-HFSS foods similar to that which exists in the broadcast code.

    Empowering all

    • We do not believe that EU regulations on labelling go far enough in ensuring that all consumers have the information they need to make healthy choices. We will pursue improvements to the regulations at an EU level, including working to introduce traffic light labelling of packaged food, aiming to achieve a standardised and easily understood system of food labelling in respect of its nutritional content
    • Labour will give local authorities new powers so that local communities can shape their high streets and limit the future number of fast food outlets locally. Currently these premises can often be opened without applying for planning permission, but this change will allow local communities to require them to apply for planning permission. This will give local communities real power to stop the proliferation, clustering and over-concentration of fast food outlets.
      These steps forward on food will be part of our broader agenda on food – achieved by reinstating the Food 2030 strategy – of pursuing an integrated approach, supported by dialogue with industry, experts and campaigners. This is set out in more detail below.

    Food 2030

    Food policy needs an integrated approach that is why the last Labour Government developed the Food 2030 strategy. This was complemented by a Cabinet SubCommittee to coordinate policy across Whitehall and chaired by the Secretary of State for Environment, Food and Rural Affairs. The committee was supported in its work by a council of food policy advisors to create a forum for ongoing dialogue with industry figures, academic experts and campaigners.
    Food 2030 has been quietly shelved by the current Tory-led Government and as a result policy has been characterised by chaos, fragmentation and poor outcomes for consumers. Since 2010 public faith in our food system has been undermined by:

    • The horsemeat scandal and high levels of campylobacter in supermarket poultry products,
    • A failure to address rising obesity levels which is placing unsustainable pressure on the NHS,
    • Rising levels of malnutrition and record numbers of people relying on emergency food aid.

    The Labour Party will reinstate the Food 2030 strategy and associated committees to ensure that our food system works for ordinary people. The Cabinet Sub-Committee and council of food policy advisors will consider a range of issues in the delivery of the Food 2030 strategy. These will include:

    • Reducing levels of obesity with a particular focus on children. This will include dialogue with the Department of Health, representatives from the food industry, academic experts and campaigners on developing the best approaches to implementing measures to reduce levels of sugar, salt and fat in products marketed substantially at children. We will examine the best approaches to limiting the marketing of products with high fat, salt or sugar content reaching children via television and non-broadcast media channels.
    • Ensuring that the food industry puts the consumer first by strengthening the Food Standards Agency (FSA). Labour will reverse the machinery of Government changes that weakened the FSA to ensure that the agency has the capacity to stop food fraud, improve safety and tackle unhealthy practices.
    • Reducing dependency on food banks. This will be supported by an ongoing dialogue with the Department for Work and Pensions, church groups and other emergency food providers to monitor the use of food banks.
    • Raising earnings and improving career opportunities in the food and farming sector where low pay is all-too prevalent with an employment culture often characterised by agency-work, short-term and zero-hours contracts. The Government’s abolition of the Agricultural Wages Board exacerbated this
      situation by removing protections for rural and agricultural workers. Labour will work with the food industry – one of the most important employers in rural areas – to raise skills and wages, and help small firms and food businesses access the investment they need to expand and train. We have set out plans to raise the minimum wage to £8 an hour and empower the Low Pay Commission to work to with low paying sectors to raise wages.

    Tobacco

    Two thirds of adult smokers took up smoking as children. So alongside helping people to quit smoking, supporting those who have quit not to relapse and reducing exposure to second hand smoke, we want to focus on protecting children and helping them not take up smoking in the first place.

    Our ambition: To reduce smoking prevalence to 10 per cent by 2025. Over the longer-term we will have as a goal that children born in 2015 will become the first “smoke-free generation” in hundreds of years.

    Protecting children

    • Standardised packaging of tobacco products will be introduced immediately to halt the industry’s increasingly sophisticated methods of recruiting new, young smokers.
    • Schools will be able to use the curriculum freedoms open to them to provide opportunities for public health programmes, such as tobacco education via peer-based learning initiatives.

    Empowering all

    • We will continue to monitor the emerging evidence on the appropriate use of devices such as e-cigarettes in smoking cessation and take action if required.
    • A levy on tobacco companies will be used to ensure they make a greater contribution to the cost of tackling tobacco-related harm.

    Alcohol

    We will focus on tackling the public health problems associated with excessive drinking and particularly drinking by children. We will do this by targeting the high-strength, low-cost products that are affordable to children, fuel binge drinking and do most harm to health, but this will not affect the vast majority of people. As with our proposals on food, we will have a particular focus on those products that harm young people.

    Our ambition on alcohol: We want to support people to make healthy choices on drinking, helping to reduce the proportion of the population who regularly drink excessively, and we will also tackle the problems of underage drinking, to cut significantly the proportion of children who drink.

    Protecting children

    • Labour will crack down on the high-strength, low-cost alcohol products that fuel binge drinking and do most harm to health, such as ultra-lowpriced 7.5% white cider sold in large plastic bottles, and we are considering the following options for action to achieve this:
      (i) Prohibiting or discouraging the sale of cider in three-litre bottles. This could be achieved either by regulating the permissible size of the containers in which high-strength cider is sold, for example, prohibiting the sale of cider in bottles of more than one litre in size, or by taxing larger volume cider containers more heavily.
      (ii) Creating a new, higher duty band specifically for high-strength ciders. This would have the effect of increasing the price of high-strength, ultra-low-priced ciders without affecting mainstream ciders, in the process helping shift consumption to lower strength products.
      (iii) Whether there is a case for increasing above 35 per cent the minimum apple juice content that cider is required to contain. White ciders tend to have a low juice content which is in part what allows the price to be so low. This measure would alter the definition of cider for duty purposes requiring the producers of white cider to either pay higher duty rates or change the content of the drink.
    • We will review the promotion of alcohol, particularly in relation to children. This will include working with sport governing bodies to look at the impact of sport sponsorship.

    Empowering all

    We support the need for improved alcohol labelling so that all alcoholic beverages include the clear and visible information people need to make informed choices about what they drink (including alcohol and calorific content, and recommended daily guidelines), and we will pursue this at an EU level.

    • We will make it a mandatory requirement for all alcoholic beverages sold in UK to carry a visible warning about the risk of drinking alcohol during pregnancy.
    • We will make public health a licensing objective and we would like to include the Director of Public Health as a key consultee in the creation of a licensing statement.
    • We will ensure public health is engrained throughout the licensing system so that measures promoting public health (which could range from measures such as plastic glasses and bottles to a ban on superstrength beer and cider) are included in the licensing statement.

    Community resilience

    As well as are supporting personal responsibility, there is much more that we can do to help communities look after each other.

    One area where we can make an immediate difference is on the chances of surviving sudden cardiac arrest. Many countries are moving to increase the availability of Automated External Defibrillators (AEDs) in major public places and buildings and we should do the same. And we need to train as many people as we can – particularly young people – in the skills needed to step in and help in an emergency.

    So Labour will introduce a new ‘heart-safe’ programme:

    • Working with the third sector we will support schools and young people so that by the time every child leaves school they will have had access to emergency first aid training for Cardiopulmonary Resuscitation (CPR) and the use of defibrillators.
    • To improve the chances of surviving sudden cardiac arrest, we will work to locate AEDs in major public venues – such as shopping centres, railway stations, airports and sports stadia – and support local fundraising efforts to provide them to schools and sports clubs. In government, we will set out a strategy to drive this forward.
    • We will create a National Open Register of AEDs – available via digital apps – to give people instant information on where to locate the nearest one in an emergency situation.
    • We will ask the National Screening Committee to consider a new national screening programme for young people considered at highest risk of sudden cardiac arrest.

    Cold Homes

    Fuel poverty is a long-standing health issue: the impact of cold housing on health and the stresses brought on by living in fuel poverty have been recognised for decades by researchers, medical professionals and policy makers alike. Countries which have more energy efficient housing often have lower Excess Winter Deaths (EWDs). Children living in cold homes are more than twice as likely to suffer from a variety of respiratory problems than children living in warm homes. Mental health is negatively affected by fuel poverty and cold housing for any age group.

    Despite the progress made under the previous Labour Government, in particular through the Decent Homes programme for social housing, which resulted in the installation of over 1 million new central heating systems and the re-wiring of 740,000 homes, and Warm Front, which helped over 2 million households improve their energy efficiency and insulation, Britain has among the least energy efficient housing stock anywhere in Europe. Poor energy efficiency is the single biggest reason why so many households are in fuel poverty.

    It is clear that the policies of the current Government do not meet the scale of this challenge. The Energy Company Obligation has resulted in a significant fall in the installation of energy efficiency improvements and will leave nine out of ten fuel poor households in fuel poverty.

    Labour proposes a fundamental overhaul of the country’s approach to energy efficiency. Learning the lessons of previous energy efficiency programmes, we propose an ambitious, long-term programme to end the scandal of cold homes and lift and protect people from fuel poverty, support millions of households and businesses to improve their energy efficiency and establish energy efficiency as a national infrastructure priority. We intend to take six key actions to achieve this:

    • Free energy efficient improvements for 200,000 households in or at risk of fuel poverty a year, with an ambition to upgrade all such homes and end the scandal of cold homes within 15 years, saving the average household over £270 a year.
    • Interest free loans to cover the costs of energy efficiency improvements for up to one million households during the next Parliament.
    • A new target to upgrade properties in the private rented sector to a minimum of an Energy Performance Certificate (EPC) C by 2027.
    • Energy efficiency designated as a national infrastructure priority under Labour’s proposed National Infrastructure Commission.
    • Streamlined regulations and a long-term strategy to support investment in energy efficiency in non-domestic buildings.
    • Provide half a million personalised home energy reports a year, detailing how households could save money on their energy bills through insulation and
      energy efficiency.

    Sexual health

    Ambition: We want to ensure that everyone, particularly young people have the information they need to make informed and safe choices about their relationships and sexual health.

    Our ambition is to stop and then reverse the rise in cases of sexually transmitted diseases including syphilis and gonorrhoea and to significantly reduce the level of undiagnosed and late-diagnosed HIV.

    Protecting children

    Empowering all

    • We will make reducing undiagnosed and late-diagnosed HIV a national priority, working to challenge the stigma of HIV and promote increased availability of testing.
    • We will tackle inequalities in access, quantity and quality of sexual health services across the country and promote better linkages between contraceptive and sexual health services.

    Mental Health in Society

    Good mental health doesn’t start in hospital or the treatment room; it starts in our workplaces, our schools and our communities. So we need a mental health strategy outside as well as inside the National Health Service. The Taskforce on Mental Health in Society, led by Sir Stephen O’Brien, was set up to explore how society needs to change to prevent mental health problems and promote good mental health, and how we can better support those affected by or recovering from mental health problems.
    Three findings have consistently emerged from the work they have done in these areas:
    1. Population mental health: A wide variety of social and environmental factors can affect mental health, so interventions to address these and build resilience can promote good mental health and help to prevent mental health problems
    2. Early Intervention and action. Early help and support to tackle problems upstream is far better both for individuals and families and for the country as a whole than allowing problems to develop
    3. Supporting those living with mental health problems: There already exist inspiring examples of how people living with mental health problems can be supported to live fulfilled lives, but we need a radical shift in attitudes, policy and practice if we are to make this a reality for all
    The Taskforce has explored how these three issues figure in some of the major  contexts in which we live our lives: home, community, school and workplace – both the problems that exist and the opportunities to be grasped if we act. Their final report will be published in early 2015.

    A public health system that works for communities & families

    Labour wants to give Directors of Public Health more influence when it comes to tackling public health problems and we want to strengthen the position of Public Health England in wider policy-making and public debate.

    Directors of Public Health

    In January 2013, the Association of Directors of Public Health published the results of a survey of its members which found that only 17% believe their Council understood the importance of public health (down from 33% the previous year). A key reason for this is that many Directors of Public health are subordinate to other officials within local authorities and have not been incorporated into local government with the level of seniority and influence that is needed for them to work effectively. The Association of Directors of Public Health found that less than half of Directors of Public Health report to the CEO or equivalent post. 20% report to another Director, usually the Director of Adult Social Services.

    Labour will ask Public Health England to investigate the governance and accountability arrangements of Directors of Public Health to ensure they have sufficient influence. Directors of Public Health must be free to speak out without fear or favour on the challenges facing the health of their local population. Directors of Public Health are currently required to write an annual report, which is published by the local authority. As part of the annual reporting requirements, Labour would expect the Director of Public Health to  include forward planning in this process, setting out the public health problems facing their community and outlining the action needed over the coming year to tackle them.

    Public Health England

    The Health Select Committee has said that: ‘Public Heath England was created by Parliament to provide a fearless and independent national voice for public health in England’ but ‘does not believe that this voice has not yet been sufficiently clearly heard.’ A key criticism of Public Health England has been its failure to speak out against government policy decisions on public health, such as delaying the introduction of standardised packaging of tobacco.

    At present Public Health England is an executive agency of the Department of Health and some organisations, including the Faculty of Public Health and the British Medical Association, have called for Public Health England to be given greater independence. Labour will review whether the status of Public Health England as an executive agency is appropriate and consider what further steps are needed to ensure Public Health England is able to provide policy advice free of political considerations. This review will include consideration of whether the regionally-based Public Health Observatories, that under the previous Government provided information and analysis on public health programmes, should be reestablished and given responsibility for providing public health surveillance and intelligence functions in support of local authorities and other public and community bodies.

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    Create A Cabinet Minister For Children To Address National Child Obesity Epidemic!

    The All-Party Parliamentary Group on a Fit and Healthy Childhood claims that without a strategic,  co-ordinated approach, the country will be faced with a child obesity epidemic of ‘ intractable  and devastating effect ’ and has called for a new post of  Cabinet Minister for Children to drive policy to promote child health and fitness  across all Government  Departments.

    In a report based upon contributions from 23 cross-sector organisations, The All Party Parliamentary Group on A Fit and Healthy Childhood has made detailed recommendations to address a current crisis whereby 40% of children living in Birmingham are classified as overweight and findings from an Early Bird Diabetes Trust survey of 300 Devon children reveal that over 90% of excess weight gained by girls and over 70% gained by boys is acquired before school age.

    ‘Healthy Patterns for Healthy Families’ advocates a ‘whole family’ approach proposing  new strategies and approaches to ante-natal care, early years provision and professional  training,  play and leisure, nutrition within  the school environment and socio-economic policy.

    It recommends an increased role for lifestyle weight management programmes in improving levels of family fitness and wellbeing and new responsibilities for local government in the planning system and public health

    Commenting on the report, Jenny Caven, Slimming World Head of Public Affairs said:

    “If we don’t take steps now to do something to support families to adopt healthier patterns, our children will die before us. Tackling obesity across the family needs a whole system approach that includes health professionals, carers, teachers, parents and young people themselves.”

    The All Party Group on a Fit and Healthy Childhood is Chaired by Baroness (Floella) Benjamin, who commended the report:

    ‘I’d like to thank all the organisations and individuals who advised the Working Group and enabled us to come up with some really strong and constructive recommendations. It is now widely acknowledged that the nation is in the grip of a child obesity epidemic. This report will help families and the professionals who support them to turn the tide and establish new and healthy patterns of living for all our children.Helen Clark, Chair of the Working Group and author of ‘Healthy Patterns for Healthy Families’ added:

    ‘Everyone who has participated in this process has experienced a learning curve. Some of our findings are extremely disappointing, but families are trying to do their best in a climate that is not properly supportive of their needs.

    We have found example of good practice and some sensible initiatives taken both by this Government  and its predecessor – but much more is required  and  many people are simply unaware of what help is already available to them.

    As the General Election approaches, I hope that politicians of all parties will consider our proposals and if there is one recommendation above all that the All Party Parliamentary Group on a Fit and Healthy Childhood would urge an incoming Government to adopt, it is to appoint a Minster for Children to drive the policy and co-ordinate a strategy to promote child health and fitness across all Departments.

    This should be a Cabinet post.

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