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    It is a pleasure to be speaking with you about something that I know all of us in the room are passionate about changing in this country – health inequality.

    It comes as no surprise that the Office for National Statistics found earlier this month that the least deprived men at birth in 2014 to 2016 could expect to live almost a decade longer than the most deprived. This decade has seen a slowdown in improvements in life expectancy, an appalling consequence of this Government’s failure to improve the chances of the worst-off, as years of underfunding in health and social care take their toll.

    Similarly, the north south divide remains as relevant as ever. For both males and females, the healthy life expectancy at birth is the highest in the South East, at 65.9 years for men and 66.6 for women. I am sure you can guess which region is the lowest!

    Here in the North East healthy life expectancy for men is 59.7 years and for women it is 59.8 years – significantly lower than the England average. That means that inequality gap in healthy life expectancy at birth for the South East and North East is 6.2 years for men and 6.8 years for women.

    There are lots of factors that play into these figures, and life expectancy here is increasing faster than anywhere else in the country, but it is simply not good enough that those from deprived areas are having their life expectancy shortened. That is why we all need to make a pledge to change this.

    Today I’m going to speak about three public health epidemics that affect, not just the North East but the whole country: smoking, obesity and malnutrition. If we are able to tackle these epidemics, then we will be a step closer to achieving the goal of the UK having some of the healthiest people in the world.

    Smoking

    Smoking continues to be the leading cause of preventable deaths – in 2015, 16% of all deaths in people aged 35 or over in England were estimated as being attributable to smoking. It is estimated that 474,000 hospital admissions a year in England are directly attributable to smoking, which represents 4% of all hospital admissions. Smoking causes around 80% of deaths from lung cancer, around 80% of deaths from bronchitis and emphysema, and about 14% of deaths from heart disease. Therefore, smoking and its related health problems leave a heavy burden on our already financially strapped NHS, costing more than £2.5 billion each year.  Addressing smoking in our society could therefore help reduce that high financial cost and money could be directed towards improving our NHS and ensuring that we have a healthy society.

    Smoking prevalence is decreasing across the country, and I’m pleased to say that smoking rates in the North East is declining faster than the national average. This is due to great support from programmes such as Fresh North East, which since 2005 has been tackling high smoking rates here. They have clearly been doing an excellent job, as since 2005, the North East has seen a fall of nearly a third with around 165,000 fewer smokers. However, the North East still has the highest lung cancer rates in the country and smoking rates still remain high, especially among those who are unemployed or members of lower socioeconomic groups and it is deeply concerning that those groups, for whom poverty is rife, are not being sufficiently helped to quit smoking.

    I welcome the Government’s Tobacco Control Plan – even though it was delayed by 18 months – but the Government must move away from warm words and empty promises and commit to the right funding for smoking cessation services so that smoking rates can decline across the country.

    Obesity and malnutrition

    I have also been calling on the Government to go further in their commitment to reduce obesity levels.  The UK has one of the worst obesity rates in Western Europe, with almost two in every three people being either overweight or obese. I am one of those two, but I am back on a strict diet now to try and become the one, I hope that there will soon be a lot less of me! It is hard though, if it was so easy no one would be overweight.

    However, I was a skinny kid and a slim teenager and proud to say a size 10 when I got married and I still ended up overweight as time went by. So therefore I worry greatly when I see all the stats for this country’s children when a pattern now emerges at a very early age. In 2016/17 almost a quarter of reception children, aged between 3 and 4, were overweight or obese. In the same year, for pupils in year 6, it was over a third. An obese child is also over five times more likely to grow up into an obese adult, so the Government should be doing all that it can to ensure that child obesity rates are reduced as a matter of urgency.

    The Government’s Child Obesity Strategy to tackle this was welcome, but left much to be desired. I am sure some of you will know that it was published in the middle of summer recess, during the Olympics and on A- Level results day. At first, I thought the strategy must have been missing some pages. But it turned out, this world-first strategy really was just thirteen pages long. For whatever reason, many of the commitments David Cameron had promised and desired as his legacy had been taken out by Theresa May and her staff. We now know that May’s former joint chief of staff, Fiona Hill, is said to have boasted about “Saving Tony the Tiger”, the Frosties Mascot. Now that Fiona is out of the picture, we are expecting a second Childhood Obesity Strategy this summer, so I hope that there will be more than thirteen pages!

    Of course, there is no silver bullet to tackling childhood obesity. As I said, if staying slim and losing weight was easy then we wouldn’t have the problem we have now.  However, there are two policy suggestions that I have been championing recently: restricting junk food advertising until the 9pm watershed on all channels not just on children’s channels and restricting the sale of energy drinks to young people.

    Advertising is so much more powerful than we all think. There is a reason they spend many millions on it!  According to a University of Liverpool report, 59% of food and drink adverts shown during family viewing time were for foods high in fat, salt and sugar and would have been banned from Children’s TV.  The same report also found that, in the worst case, children were bombarded with nine junk food adverts in just a 30- minute period, and that adverts for fruit and vegetables made up just over 1% of food and drink adverts shown during family viewing time. It is therefore no wonder that there are so many children in this country who are overweight or obese. That is why I’ve been calling for restrictions on junk food advertising on TV, but I know that other modes of advertising need to be investigated more widely too like advergames and food brands which are high in fat, salt and sugar sponsoring sporting events that are popular with children.

    This leads me to my next point of energy drinks, because to pin point just one brand, Red Bull who sponsor several extreme sports competitions which are not necessarily marketed to children, but are watched by children. When my son was a teenager, I would go so far as to say that he was addicted to energy drinks. And it was a huge problem for me, especially as he could legally buy them as he told me every day in his defence, in his eyes I was being ridiculous! He and his friends would buy and drink bottles and cans of them every day and it would completely change his personality. I’m pleased to say that ten years on he is older and much more sensible now, thanks to me warning him of the health dangers of energy drinks.

    Although that was a decade ago, the trend still remains that children, as young as ten, are buying energy drinks for as little as 25p. The UK has the second highest consumption of energy drinks per head in the world.  You might expect America to have the highest consumption, but it is actually Austria, home to Red Bull headquarters. A 500ml can of energy drink contains 12 teaspoons of sugar and the same amount of caffeine as a double espresso.  You wouldn’t give a child have 12 teaspoons of sugar or a double espresso, so why are we allowing them to drink it in an energy drink?

    If we want our children to be the healthiest in the world, we cannot sit idly on this any longer. Thankfully, many supermarkets and some retailers have now taken the step to restrict the sale of energy drinks to children. Supermarkets such as: Waitrose, Aldi, Asda, Sainsburys, Morrisons, Tesco, Lidl have restricted the sale. Boots lead the way in being the first non-food retailer to restrict the sale of energy drinks to children a few weeks ago, and just this week they were joined by Shell Petrol Stations and WH Smith. I am still calling on all supermarkets and retailers to take steps to do this.

    The Government have got to do better if our children are going to be encouraged to live a healthy lifestyle and eat a healthy diet.

    However, there are millions of people up and down the country who do not have access to healthy and affordable fresh food or the skills to cook up tasty meals or even the cooking equipment or the energy such as gas or electric especially when poor and on key meters, which leads us to another issue which certainly does not get the attention it deserves: malnutrition. Malnutrition affects over three million people in the UK, 1.3 million of which are over the age of 65.  Like obesity, malnutrition is a Public Health epidemic, but because it is literally less visible, it does not receive the attention or outcry that you would expect. On this Government’s watch, we have seen a 54% increase in children admitted to hospital with malnutrition and in the last decade, we have seen the number of deaths from malnutrition rise by 30%.  It should be at the forefront of this Government’s conscience that in one of the 6th richest economies in the world in 2018, malnutrition is increasing instead of being eradicated.  I’m proud to say that Labour will make it a priority to invest in our health services and ensure people don’t die from malnutrition in 21st century Britain.

    Both obesity and malnutrition are costly to our NHS, estimated at £5.1 billion a year for obesity and £13 billion a year for malnutrition. That is why prevention is so important and why I am a key campaigner for Universal Free School Meals, because it gives all children access to a hot and healthy meal, encourages a healthy relationship with food and is beneficial to their mental and physical development. Healthy food needs to be both affordable and accessible, and individuals need the skills to prepare and cook a fresh and healthy meal.

    NHS funding

    Finally, we all know that the NHS lacks the funding and the time it needs to do all of the things I have just mentioned. Since local authorities became responsible for public health budgets in 2015, it is estimated by the Kings Fund that, on a like-for-like basis, public health spending will actually fall by 5.2%. This follows a £200 million in-year cut to public health spending in 2015/16 and further real-term cuts to come, averaging 3.9% each year between 2016/17 and 2020/21. On the ground this means cuts to spending on sexual health services by £30 million compared to last year, tackling drug misuse in adults cut by more than £22 million and smoking cessation services cut by almost £16 million. Spending to tackle obesity has also fallen by 18.5% between 2015/16 and 2016/17, again with further cuts still in the pipeline in the years to come.

    The North East Commission for Health and Social Care Integration area spends £5.2bn on health and care each year. Over 60% of this is spent on tackling the consequences of ill health through hospital and specialist care, compared to the 3% devoted to public health. That is over twenty times more spent on consequences rather than prevention. So if the UK is going to be one of the healthiest countries in the world, then the Government really does need to recognise the importance of prevention and public health.  If we invest in our NHS and public health services, then we invest in the health of everyone in this country and that is why public health is so important.

    I look forward to working with you all now and in the future to ensure that one day we can proudly say that people in the UK are some of the healthiest in the world.

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    Non Communicable Diseases are the biggest cause of mortality, morbidity, disability, healthy life years lost and a major cause and consequence of health inequalities

    The priorities for action should have the biggest impact, the shortest timescale, be most sustainable, most equitable in reducing health inequalities and injustices for the vulnerable and across generations, achieve the maxim co-benefits for the environment and reducing demand on public services and realisation of human rights.

    Linked Avoidable Non Communicable Diseases and conditions:

    • CHD and Stroke -cardiovascular
    • Circulatory diseases
    • Cancers
    • Respiratory diseases
    • Liver disease
    • Type 2 Diabetes
    • Kidney disease
    • Obesity
    • Neurovascular and mixed Dementia
    • Musco-skeletal etc.
    Deaths by cause in UK men 2014

    Deaths by cause in UK men 2014

    Impact on healthy life expectancy and life expectancy

    Non Communicable Diseases are a cause and manifestation of health inequalities in current and future generations.  These are diseases that “break the bank “

    Impact on economic growth and sustainability of public services

    • Estimated at $47 trillion over the next two decades.Approximately 75% of the 2010 global gross domestic product (GDP). Source: World Economic Forum / Harvard School of Public Health. 2011
    • Alter demographics
    • Stunts country level development
    • Two –punch blow to development- national economies and individuals in poverty
    • Not a mark of failure of individual will power, but politics at the highest level

    What are the real determinants of this spread?

    Multi-national capitalists

    • Transnational corporations are major drivers of NCD epidemics and profit from unhealthy commodities
    • Public regulation and market intervention can prevent harm caused by unhealthy commodity industries

    Public health measures

    Some key potential priorities for consideration:

    • Something like the  Office for Budget Responsibility for the Public’s Health
    • A comprehensive review of the marketing of unhealthy commodities and services to children, young people and the vulnerable
    • Levys on the unhealthy commodity industries to provide additional public health funding to cover the societal costs as well as reduce their consumption
    • Ensuring new trade agreements protect and promote the publics health
    • A new public health bill – the state has powers to monitor in real time the commercial risks to the publics health, to ensure the state has (reserve)powers to tackle unhealthy commodity industries and services, set out duties for public bodies to consider the health of future generations and the planet and address health inequalities and the right to health

    An OBR for health?

    • Health should be properly considered in all fiscal, economic and market policies (human and planetary ill health and poor wellbeing are anthropogenic)
    • Sustainability of Public Services especially the NHS and social care (“the miscalculation of sublime proportions”). NHS is set to cost 1.6 times GDP by 2065
    • Health as an asset to prosperity and productivity- Health Creating (not damaging) Economy
    • Focus on health life expectancy and health inequalities
    • House of Lords review – Sustainability of NHS and Social Care (2017) proposed an  Office for Health and Care Sustainability
    • Mechanism for health in all policies
    • Minimum Unit Price alcohol/Air Pollution etc.
    • Lead technical Agency – Public Health England

    Processed food marketing and promotions:

    healthy food

     

    The recommended diet vs the advertised diet

    Around three-quarters of food advertising to children is for sugary, fatty and salty foods. For every £1 spent by the WHO promoting healthy diets, £500 is spent by the food industry promoting unhealthy foods

    We need a comprehensive review of the marketing regulators and codes

    • Regulators and codes not fit for purpose
    • Regulators essentially accountable to industry – self regulation
    • Statutory instruments focus on protecting market and plurality and the protection publics health is a low order objective
    • Action is after the event and codes are produced by the industry so are not effective as their production is conflicted
    • Self regulation is a failure for children, young people and the vulnerable

    Unhealthy commodity Industry Levys

    • Could be applies to tobacco, alcohol and ultra processed food products and services (gambling etc.)
    • Reduce consumption
    • Some of these industries pay little tax- needs reviewing
    • Pay for the externalities and provide additional funding for public health
    • Sugar Drink Industry levy – way forward – Minimum Unit Pricing of alcohol in England
    • Tobacco – estimated £500 million- support for tobacco licensing scheme, smoking cessation support, Social marketing, Tso’s regulatory support etc.

    We need a new Public Health Act. The last one was in 1936. The legislation addresses the epidemics of yesterday

    • Non Communicable Diseases  require new forms of health protection
    • Duties for Public Bodies – consider health of future generations and the planet and address the causes of health inequalities
    • Realisation of human rights (Social rights and the progressive realisation)
    • Statutory monitoring and surveillance of unhealthy industries and services
    Dieselgate

    #Dieselgate

    Trade agreements have an effect on health. They could be used to protect our health.  We could learn from the experience of other countries.

    Some key potential priorities for consideration:

    • An OBR for the Public’s Health
    • A comprehensive review of the marketing of unhealthy commodities and services to children, young people and the vulnerable
    • Levy’s on the unhealthy commodity industries to provide additional public health funding to cover the societal costs as well as reduce their consumption
    • Ensuring new trade agreements protect and promote the publics health
    • A new public health bill – the state has powers to monitor in real time the commercial risks to the publics health, to ensure the state has (reserve) powers to tackle unhealthy commodity industries and services, set out duties for public bodies to consider the health of future generations and the planet and address health inequalities and the right to health

    More details in the proposals for a health-creating economy. 2017. UK Health Forum

    This was presented at our conference Public Health Priorities for Labour

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    The disgraceful failure by the private sector to provide vulnerable addicts with the safest and best quality treatment available was exposed at the end of last month in a damning report issued by the Care Quality Commission (CQC).

    72% of private providers of residential-based detoxification were found to have been failing in at least one of the fundamental standards of care that everyone has a right to receive. Shamefully, providing ‘safe care and treatment’ was where the CQC found the most breaches: 63% of providers failed to meet this standard at the time of their first inspection.

    Detoxification under clinical supervision is often the first stage of a person’s addiction treatment. Often difficult and unpleasant, it is vital that they receive the best possible treatment to support their onward rehabilitation and recovery.

    And yet systemic faults were found in the way these services are provided by the private sector. Many were basic and entirely avoidable errors.

    No alcohol for me

    For example, some staff were caught giving paracetamol to people within their care more frequently than every four hours, despite the heightened risk of liver damage among heavy alcohol users. In other cases, staff failed to plan how they would manage fits during withdrawal, despite knowing that the people in their care were at risk of having seizures.

    Training in basic life support, consent, mental capacity and safeguarding were all found to be severely lacking. At times staff were found to be administering medication, including controlled drugs like methadone, without the appropriate training or being assessed as competent to do so.

    This is extremely serious. People undergoing residential-based medical detoxification from alcohol or drugs often have complex physical and mental health problems alongside their addictions. According to the Royal College of Psychiatrists, the potential dangers of erroneous detoxification include fits and hallucinations, suicide risk and risk of prescription opiate drug overdose.

    That’s why it is essential staff looking after these vulnerable patients are properly trained, follow national clinical guidelines and have appropriate 24-hour medical cover.

    So what explains this appalling failure?

    My own research in September revealed that the Tories have cut vital alcohol and drug treatment programmes by £43 million this year, forcing many people to turn to the independent sector for help. These cuts are part of wider damaging public health cuts, to the tune of £800 million by 2021.

    Specifically, 106 local authorities are reducing their drug treatment and prevention budgets this year, with a combined cut across England of £28.4 million. Similarly, 95 local authorities are reducing their alcohol treatment and prevention budgets this year by a total of £6.5 million. Equally concerning, services for children needing help with drink and drugs will be slashed by £8.3m across 70 town halls.

    Last month the Children’s Society revealed that parent’s alcohol abuse is damaging the lives of 700,000 teenagers across the UK. Frustratingly, at a time when demand for councils’ children’s services is rising, severe funding cuts from central Government are leaving more and more families to deal with these huge problems alone.

    Yet without support at an early stage as problems emerge, families can quickly reach crisis point and the risks for the children involved grow.

    The children of addicts must not be forgotten and supporting them is a personal priority of mine. Having grown up with an alcoholic father, I’m acutely aware that as a society we simply aren’t doing enough to deal with the effects of addiction.

    We know that children growing up with an alcoholic parent can often themselves go on to develop problems with alcohol or drugs or suffer mental health problems.

    That’s why during our party conference I reiterated my pledge to implement the first ever national strategy to support children of alcoholics and drug users.

    We also mustn’t ignore other forms of serious addiction. My colleague Tom Watson, Labour’s Deputy Leader, has powerfully exposed the Government’s abject failure to treat problem gamblers.

    According to the Gambling Commission the number of people with a serious habit has risen to 430,000, with a further 1.6 million at risk of developing a problem.

    And yet, shockingly, the government has no idea how many problems gamblers are being treated by the NHS or how much their addiction is costing. Like alcohol and drug addiction, we must start viewing gambling addiction as a mental health problem and not a moral failing.

    Theresa May’s mishandling of Brexit and her narrow majority in the Commons has left her with little ability or inclination to tackle these ‘burning injustices’ across society. Addiction treatment services have unquestionably suffered as a result.

    Forcing people to turn to inadequate private sector treatment is entirely unacceptable. That’s why Labour will continue the fight to ensure our health and care system, including addiction services, remains public, free at the point of use and there for all who need it.

    First published by Our NHS

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    The mental health and smoking action report

    Despite many years of progress, smoking remains still the single biggest cause of preventable and premature death in England killing almost 80,000 people every year.

    What is more, smoking is a leading cause of inequalities. Smoking rates amongst people with a mental health condition are particularly concerning. Around one third of adult tobacco consumption is by people with a current mental health condition and whilst less than 20% of the general population smoke, this figure is around 40% in those with a mental health condition, and up to 70% in people discharged from a psychiatric hospital.

    This difference in prevalence has dire consequences. People with mental health conditions die on average 10-20 years earlier than the general population and smoking is the single largest factor in this shocking difference. People with a mental health condition are just as likely as other smokers to want to quit, but because they are more likely to be heavily addicted to smoking, they need more support to be successful. This support is sadly lacking: when ASH asked smokers with a mental health condition if anyone providing inpatient care had offered them help to stop smoking two thirds told us no one had. Clearly there is an urgent need for action.

    ASH has published a new report entitled The Stolen Years: The mental health and action smoking report setting out the urgent action needed to get smoking rates falling in this population. The report has been endorsed by 27 leading mental and public health organisations, including Rethink Mental Illness and the Royal College of Psychiatrists and has been informed by a wide range of people, from experts by experience to those working in mental health, public health and the NHS.

    Our ambition is that smoking among people with a mental health condition declines to be less than 5% by 2035, with an interim target of 35% by 2020. This is an undeniably ambitious target and there is no single measure that will help us get there. Key areas identified in The Stolen Years for action include:

    • National targets and leadership to drive action across the country
    • A strong focus on the skills and training of the workforce
    • Availability of evidence-based services alongside peer support for all those who need them
    • Better access to the medications that will help people to quit
    • Improved understanding that electronic cigarettes provide a less harmful alternative to smoking
    • Moving to smokefree mental health settings alongside provision of the right support to smokers

    The publication of this report is only the start of work on this agenda. After decades of stagnation, change is only possible with collective action. If we are to achieve our ambition and drive real change in this area all parts of the health and social care system from national government through to local authorities, the NHS and care providers will need to play their part. Failure to act now would be to condemn thousands of people with a mental health condition to early death and debilitating disease and would widen the already appalling gap in life expectancy.

    ASH is a public health charity that works locally, nationally and internationally to try and achieve a vision: a society free from the harm caused by tobacco. You can access “The Stolen Years: the mental health and smoking action report” here.

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    Alcohol produces externalities – costs that are imposed on others without their consent. For example, drinking is associated with crime and violence, road traffic accidents, costs to the healthcare system and lower economic productivity. Externalities are problematic because they are not reflected in market outcomes: consumers typically only consider the costs and benefits of drinking to themselves, and fail to consider the impact their drinking has on others.

    According to standard economic theory, externalities should be corrected through taxes which raise prices to reflect the social harm of a product. For example, if a pint of beer typically imposes £1 of costs on others, then a tax of £1 should be levied on each pint to reflect this cost.

    The UK Government has estimated the externalities caused by drinking to be £21 billion a year in England and Wales. This number is controversial, but the economists behind it acknowledge that if anything it is an underestimate. In any case, the Government has reaffirmed this £21 billion figure repeatedly in parliament. Yet alcohol duty only raises £9 billion a year, suggesting that the price of alcohol does not adequately reflect the harm it does to society.

    Some people might object that it is only a problem minority that causes social harm, and worry that duty is a blunt instrument, which negatively affects moderate drinkers at the same time. This is debatable, but even if such a distinction can be drawn, the burden is minimal. Moderate drinkers may have to pay more for their alcohol due to duty, but this money allows the government to fund services and cut other taxes. Taxes may also discourage moderate consumers from drinking, and cause them to switch to less enjoyable products. However, our estimate of this loss of enjoyment suggests that it accounts for at most 2 per cent of market value, £1.2 billion, and likely considerably less, under current levels of duty. Besides, it is dwarfed by the reduction of crime, healthcare and economic costs as a result of alcohol duty – which total at least £4.4 billion. All things considered, many – perhaps most – moderate drinkers could benefit from higher alcohol duty.

    A key implication of all this is that higher alcohol taxes can be justified solely on the basis of the harm that drinking causes to wider society. The argument does not depend on the benefits to the individual drinker. Yet such considerations provide additional reasons to raise alcohol duty.

    There are a number of reasons to suspect that many people make poor choices around alcohol and could benefit from higher duty that discourages excess drinking. Alcohol is addictive and psychoactive, and as a result many consumers drink while dependent or intoxicated. Many people are not fully informed of the risks of drinking, or believe that they are immune – for example, only half of people in the UK are aware alcohol causes cancer. People suffer weakness of will – where they are unable to follow through on their reflective desire to cut down drinking. More generally, myriad non-rational influences encourage people to drink, including habit, availability and social influence. Raising the price of alcohol does not reverse all these effects, but can go some way to mitigating excessive overconsumption.

    Taken together, these arguments make for a compelling case in favour of raising alcohol duty. On the Government’s own estimates, current levels of tax fail to account for the social cost of drinking. Raising rates of duty would address this harm without unduly affecting moderate drinkers. Moreover, higher duty would reduce the private costs to individuals resulting from excessive consumption. Come Wednesday, we will learn whether the Government has taken heed.

    This post is based on the Institute of Alcohol Studies report ‘Dereliction of Duty: Are UK alcohol taxes too low?’ Download the full report from the IAS website here.

    First published on the British Politics and Policy blog

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    How do they fit into the public health agenda?

    The growing prevalence of non-communicable diseases (NCDs) is triggering substantial policy concern, evident, for example, in the 2011 UN high level meeting on NCDs. Yet, it’s clear that there are very different ways of thinking about this ‘epidemiological transition’. For some, including the current UK government it seems, the rise in such diseases is viewed primarily as a consequence of the choices that individuals make. In contrast, many of those working in public health understand the problem to be largely a consequence of the strategies that corporations pursue. These different views lead to different conclusions about appropriate and effective responses.

    For those who take the view that the growing NCD burden is a consequence of economic development (via, for example, more sedentary and unhealthy lifestyles), then it’s logical to focus policy responses on trying to inform the choices that individuals make. From this perspective, we can all ‘choose to be healthier’ by doing more exercise, eating healthier foods and avoiding, or limiting, our consumption of health-damaging products such as tobacco and alcohol.  The CEO of Pepsi Co, Indra Nooyi, endorses this viewpoint, arguing that PepsiCo is an ‘ethical’ company because it provides consumers with a choice of products, ranging from healthy to less healthy.

    This emphasis is frequently reinforced in the media through advertising, news stories and television programmes that promote the idea that individuals choose unhealthy lifestyles, and via a focus on individual-level solutions to improve health. From this viewpoint, corporate interests involved in the production and marketing of health damaging products should be ‘part of the debate’, or even ‘part of the solution’ to the emerging health crisis (e.g. via reformulated products, changing labelling and implementing self-regulatory codes).

    Yet, if we turn to tobacco, a sector which has been extensively researched for several decades now, a very different approach is evident. Here, the prevailing view in public health and increasingly in policy, is that the tobacco industry is a primary ‘vector’ of the growing NCD burden. Investigative journalism and research centring on internal tobacco industry documents has made public the extent to which senior managers of tobacco companies have (amongst other things): lied about the addictiveness of nicotine, worked to make their products more addictivetargeted young children as ‘new markets’; and worked to limit tobacco control policies.

    Consequently, the political and public legitimacy of tobacco industry actors has plummeted, triggering some desperate efforts to regain a seat at the policy table. Analysis of a European Union consultation on smokefree legislation has demonstrated that we are now at a stage (at least in the EU) where tobacco industry actors are almost entirely separated from public health policy debates – although the rise of e-cigarettes is beginning to challenge the cohesiveness of the tobacco control movement. In part, this reflects public health efforts to ‘denormalise’ tobacco and routine business practices of the tobacco industry; efforts which have gained particular traction in the UK. The clear differences in perception of the tobacco industry, on the one hand, and the food and alcohol industries on the other, warrant deeper consideration: why are these three industries perceived so differently and is this distinction justified?

    How different are the tobacco, alcohol and processed food industries?

    There are two obvious ways in which it might seem appropriate to distinguish between tobacco, alcohol and food industries. First, we might consider that the harms associated with tobacco products are greater than those associated with alcohol and food. Yet, assessments of the contribution of alcohol and obesity to adverse health outcomes (e.g. adverse pregnancy outcomes) suggests they are often as high as tobacco. Likewise, comparative estimates of the costs of alcohol, tobacco and ultra-processed food often suggest the costs are similar and, in fact, probably higher for food-related problems, such as obesity. So this first rationale seems unconvincing.

    A second reason concerns the behaviour of the industries. It is certainly the case that more is known about the efforts of tobacco companies to misrepresent research and to shape policy in their interest than is known about the efforts of alcohol and food companies. But this is beginning to change. For example, in his book Lethal but Legal Nicholas Freudenberg shows that the practices of these industries in marketing, product design, lobbying, and sowing doubts about evidence of harm are remarkably similar.

    640px-Bulgogi_burger

    How different are the processed food and tobacco industries? (Credit: Alan Chan CC BY-SA 2.0)

    These similarities are also evident in research examining alcohol industry efforts to influence policy in the context of minimum unit pricing debates in the UK. Like the tobacco industry, the alcohol industry pursues highly integrated strategies and employs many of the policy-influencing tactics identified within the tobacco industry, including extensive lobbying at all stages of the policy process, the use of thinks tanks and front groups, attempts to shape the scientific content of policy debates, and to influence public perception of their industry and policy proposals. Again, such tactics are evident in work which has compared, for example, how tobacco and soda companies have used corporate social responsibility campaigns to influence the political landscape. In fact, the soda industry goes even further than tobacco in its explicit goals to increase consumption and target children. This suggests that commercial strategies to influence public and policy debates are very similar across industry sector. Hence, the second rationale (different industry behaviour) doesn’t seem valid either.

    Yet, in interviews I have undertaken over the past four years, the view that tobacco represents a radically different case from alcohol and food seems deeply engrained in the way many policy makers, researchers and advocates think. It seems likely that this is at least partly a result of importance attached to individual-level behaviour in neoliberal economies but it may also reflect the success of ‘tobacco exceptionalism’, a core tenant of which is the idea that other industries are different from tobacco and not necessarily worthy of the same, strict rules to protect public health policies from industry interference. This has worked well for tobacco control advocates in the UK so far but may have unintended consequences for other dimensions of public health.

    A new interlinked public health agenda: assessing the role of industry

    If we are serious about tackling the rising burden of NCDs then we need to revisit the popular and persistent distinction between tobacco, alcohol and food industries. From a research perspective, the following five questions seem like a good place to begin better understanding, and perhaps challenging, widely held distinctions between the various industries involved in producing and marketing unhealthy commodities:

    1. What are the interactions between the actors that constitute each of these industries and how close are these connections?
    2. How similar are food and alcohol industry approaches to influencing public, political and policy debates to tobacco? (Since these industries have not had to provide access to their internal documents on the same scale as tobacco, we need to develop innovative methodologies and find new data sources.)
    3. How do members of the public and key policy actors view each industry and their products and why? Does this appear to vary by context or change when presented with different kinds of evidence?
    4. What are the potential policy alternatives that might contribute to achieving healthier future scenarios and how do these differ across alcohol, tobacco and food?
    5. Reflecting this, to what extent can the case study of tobacco control be used to provide lessons for developing and implementing evidence-based policies to promote and protect people’s health beyond tobacco?

    These suggestions are, of course, simply a means of contributing to this emerging debate. What seems essential is that we begin to develop a new research agenda in public health, and policy and politics more broadly, which frees us from our current silo-based view of these interlinked public health problems.

    First published on the British Politics and Policy blog

    These colleagues contributed to the piece: Professor Oliver Razum, Dean of the School of Public Health at Bielefeld University, Germany; Professor Nicholas Freudenberg, City University New York; Dr Lori Dorfman, University of California, Berkeley, Dr Benjamin Hawkins, London School of Hygiene and Tropical Medicine,Dr Shona Hilton and Dr Heide Weishaar, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.

     

     

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    Yesterday, new regulations came into force that prohibit smoking in cars where children are present. This is a landmark moment in the fight for better public health.

    The new regulations only came about because of a marathon effort from my predecessor as Labour’s Shadow Public Health Minister, Luciana Berger, our health spokesperson in the House of Lords, Philip Hunt and the great work of the British Lung Foundation. The Lords is where Labour forced a vote last year to give the Health Secretary the power to ban smoking in cars with children.

    Following this demonstration of Parliamentary opinion, Ministers tabled their own amendment, laying out how Labour’s proposed ban could be written into law. This concession by the Government put us right on the brink of a precious victory for child health. The Commons voted overwhelmingly in favour of the new regulations, and a Parliamentary committee finally gave the green light in February this year.

    This move builds on Labour’s strong record on public health. After Labour came to power in 1997 we put in place a highly effective comprehensive tobacco strategy. In just a decade the proportion of children who smoke fell by a half and adults by a quarter, a total of two million fewer smokers.

    We showed leadership in bringing about real change on tobacco control. We introduced the smoking ban in pubs and enclosed spaces, ended sports sponsorship and billboard advertising, raised the legal age of purchasing cigarettes and put graphic warnings on cigarette packs.

    Now, Labour leadership has taken us one step further, even though we are in opposition. Some complain that these regulations infringe on their liberties – but if adults wish to smoke when children are not present in the vehicle, then that is their choice. However, what the Commons approved is not a question of adult choice, but one of child protection.

    We know beyond doubt that passive smoking in an enclosed space can do serious harm to a person’s health and that hundreds of thousands of children are being subjected to passive smoking in a car every single week.

    Every child has the right to start their adult life free of avoidable health problems, and that is exactly what we want to ensure. This is not about penalising smokers. This is about sending a message that inflicting smoke on children is not acceptable. We only need to look to the law on wearing seat belts to see the effect it had. Research by the World Health Organisation has shown that the number of people using seat belts rose from 25 per cent to over 91 per cent after it was made illegal not to wear them.

    So I would like to thank Luciana, Philip and the British Lung Foundation for all their campaigning for a car smoking ban over the last few years.

    We have taken a big step forward.

    First published on Labour List

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    Current legislation has created an environment where the link between organised criminals and the most vulnerable is strong and almost freely exploitative. Despite all the efforts to reduce the supply and the demand, drug misuse continues, and we must ask: what we can do differently. If the aim is to stop people taking drugs, and stop people committing crime in order to fund their habit, we must follow the evidence and support people to recover rather than send them to prison.

    REDUCING SUPPLY-PAST FAILURES

    Enforcement agencies, over time, have had pockets of success in seizing significant quantities of drugs, but this has not limited the long-term supply. This is largely due to the fact that the criminals have altered their supply routes and methods, and exploited changing technologies such as the dark web and postal services (such as track my parcel), and it is now more common for suppliers to exploit the postal service by sending drugs more frequently in smaller quantities- no longer do we see over 100kg seizures of Class A drugs entering the UK.

    As a former police officer, I have lost count on the number of large scale early morning raids that I have participated in. Yet, the simple truth is that these activities-which take months, sometimes years in the planning- do no more than disrupt the supply market for the very shortest of periods. In one undercover policing operation which took 6 months to plan, cost over £0.5 million and saw 30 people arrested for their involvement in the supply of Class A drugs, 2 recovering addicts who had been arrested were asked how long we had strangled the supply of Heroin; one estimated 4 hours and the other estimated 2. The principal reason is supply, demand and profit.  With steady demand from addicted people, dealers move into the market place.

    And even if we do succeed in reducing the supply of drugs, the demand is still there. So I have no doubt that that demand will be filled, possibly by New Psychoactive substances or other chemically produced drugs. We must reduce demand.

    REDUCING DEMAND-DECRIMINALISATION

    What we need is a means of making the market in controlled drugs less lucrative. This requires a different approach; one that reduces demand for the product. Addicts should be treated and supported into recovery, removing them as consumers. Their entrapment in criminal justice is a waste of police time, a waste of public spend, does not help addicts to recover, provides a continued market to dealers, and dissuades addicts from revealing themselves for treatment for fear of the criminal consequences.

    The strategy of decriminalising addiction, in order to support recovery, would be the most effective in avoiding their route to criminality.  If we take Colorado as an example, since the regulation of cannabis, the state has benefited from a decrease in crime rates, a decrease in traffic fatalities, an increase in tax revenue and economic output from retail cannabis sales, and an increase in jobs.

    HEALTH-BASED APPROACH in COUNTY DURHAM and DARLINGTON

    The crux of the strategy we are working towards in County Durham and Darlington involves redefining the problem- individual drug addiction- as a health and community safety issue, not a criminal justice issue. The Police already work in partnership with Directors in Public Health to deliver strategies that work whilst continuing to target the organised criminals who seek to make a profit by shattering the lives of others.

    Durham is leading the way nationally for the ‘Drug Test on Arrest’ initiative which is rolled out across all of the force’s custody suites and is using equipment that indicates not only heroin or cocaine use, but other controlled substances as well. It allows the Force to steer a number of users away from the criminal justice system and towards health-based resolutions with the end aim of supporting recovery. Testing is carried out on people arrested for certain “trigger” offences, such as dishonesty crimes including shop thefts, burglaries and robberies. As of 16.02.15, there have been 711 tests completed; within these tests, only 135 people have tested negative for no substances, this represents 19% (1 in 5) of all people tested.

    The Women’s Diversion Scheme in Durham and Darlington offers a credible alternative to prosecution for many low level adult female offenders, focusing on why the subject has offended and seeks to address those issues to prevent reoffending. Out of 158 women who took part in the scheme, 62% have not gone on to reoffend, and of those who failed, a further 64% of those who had been offered the scheme but failed to engage had reoffended.

    Developing this further, Durham Constabulary has introduced Checkpoint. It is potentially a revolutionary way of tackling reoffending.  It is a culture changing initiative for the police and partners. The intention under this initiative is to provide a credible alternative to prosecution by intervening at the earliest opportunity to prevent someone from offending again. The programme offers a ‘contract to engage’ for the arrested person, based on the critical pathways of offending. Specialist navigators will identify underlying lifestyle issues linked to offending and divert them away from the Criminal Justice System by signposting them on to appropriate services. Failure to engage or complete the contract will trigger the prosecution procedures to continue as they would normally do.

    CONCLUSION

    We can’t go on telling kids that if they take drugs it will ruin their lives, with the follow up being that if we catch them taking drugs we will ruin their lives. We must move away from the criminalisation of addicts, and focus on treatment and recovery. We should be focusing on the best way to minimise harm, and help these people recover from their addiction, so that we can improve their life chances, help them make a positive contribution to society, and cut off the income streams of the organised crime groups-the real criminals making money out of others’ misery.

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    Start Well, Live Better is the Faculty of Public Health’s manifesto for improving the public’s health during the next parliament. A child born today is very much more likely to live to be 100 than at any time in the past so we see our manifesto as a charter for the health and the future of those who can’t yet vote.

    Whoever forms the next government, we want them to take up our demands: to give every child a good start in life; to introduce good laws to prevent bad health and save lives; to help people live healthier lives and to take national action to prevent global problems.

    The good laws we call for are standardised cigarette packs, a minimum unit price for alcohol, a sugar tax, controls on the marketing of high sugar, high fat, high salt foods to children and a national 20mph speed limit in built-up areas. We believe that national government action is necessary to enable health to improve and it should not have to wait until everything else has been tried.

    Local government is shackled in its efforts to tackle the obesity epidemic and control alcohol-related violence and ill health, because governments have failed to implement good laws to help the sector. There is long history of local action preceding national legislation for the public’s health in this country. The first Public Health Act of 1848 came in only a year after the first wave of cholera but it was still six years after Chadwick’s sanitary report. It would then be 27 years before the second Public Health Act gave real and coherent powers to require clean water and sanitation, reduce shoddy housing and require the appointment of a medical officer and sanitary inspector. Many councils, notably Liverpool, Leicester and the London boroughs, were on the case 30 years before that 1875 Public Health Act and had implemented local nuisance control laws of their own. More recently, Liverpool’s threat to implement a public smoking ban in 2004, and Greater Manchester’s high-profile proposal to introduce a minimum unit price on alcohol in 2010 gave stimulus to national policy debate. On the smoking ban, some might say the government was shaken or shamed into action. The prime minister supported Manchester on the minimum unit price but failed to follow up. Many types of council are now looking at local minimum unit price policies.

    Traditionally national politicians seem to exhaust all other possibilities before having recourse to law making. The 20-year waits for seatbelt legislation and for the public smoking ban hide a catalogue of premature death and disability which should have been a cause of national shame. The illusory defence of individual freedoms and individual responsibilities has deflected blame from politicians who have failed to protect and improve the public’s health.

    Politicians, to their credit, have finally moved to standardise cigarette packs. Buoyed by this, a minimum unit price for alcohol should follow in the first 100 days of the next parliament. A tax on sugar-sweetened drinks would reduce the number of obese adults by 180,000. Controls on the marketing of processed food to children would arrest the continuing rise of obesity in year 11 children and adults. These changes would give councils a fighting chance in obesity prevention and reduction through active transport policies and healthy town planning and through weight management services. For any local authority, there will be more child death audits involving road accidents than there are other children’s safeguarding issues; 20mph residential zones can be done by local authorities, so why aren’t they?

    We need a national standard through law. Cicero put it best: “The health of the people is the highest law.” We quote it freely and it appears in our manifesto. His words engraved are on a plaque above a health centre built by Southwark LBC in 1937 under the last Poor Law, and should be ingrained in every policy and every action taken by councils.

    The Faculty of Public Health believes councils are fighting with one hand tied behind their backs on public health. Protecting the public’s health should be a partnership; good national laws should complement the local action councils are taking to secure a better future for all our citizens.

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    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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    Shelia Duffy argues that tobacco use is a key driver of health inequalities

    The current economic climate is creating a range of challenges for families and communities up and down the UK, felt most acutely in the most deprived areas. With new concerns dominating the agenda it can be difficult to find time to talk about the impact of smoking on Scotland’s poorer communities – even without the lingering myth that tobacco is a prop which people fall back on in difficult times, and ‘one of the only pleasures left’ for people on lower incomes (as ex Cabinet Minister John Reid put it).

    Yet with rates of smoking four to fives times higher in the poorest areas than in the richest, tobacco use is a key driver of health inequalities, which are higher in the UK than in the rest of Central and Western Europe. And for the nearly 70% of smokers who say they want to quit, this is no prop but an unwilling addiction.

    Tobacco continues to impact on people’s health and well-being in such a familiar way that it risks going un-noticed. Meanwhile a quarter of all adult deaths in Scotland are attributable to smoking – with tobacco killing half of its long term users. Crisps and sugary drinks just do not do this. 32% of these deaths were in Scotland’s most deprived areas – twice that of the most affluent groups. In these communities people smoke more heavily and are less likely to succeed in quitting. This killer destroys families, impacts on health and the day-to-day quality of life, while generating enormous profits for the tobacco companies. The cost of keeping up a tobacco addiction means that families have less to spend on food and housing.
    It is time that we, as a society, did more to protect our more vulnerable citizens. Where is the sense of anger against an industry which long ago gave up any interest in the health of its customers, with a long track record of lies and deception and which every day put its own profits before the well-being of people? While so much is said about the ethical performance of the banks, very few smokers can even name the tobacco companies behind the all-too-familiar brands.

    Yet the behaviour of the tobacco companies has been so bad that an international treaty, signed by our Government and nearly 170 others, sets out “an irreconcilable conflict between the tobacco industry’s interests and public health policy interests.” What other industry can claim such an accolade? And now, as if worried that others might take over the villain spot, we hear that British American Tobacco, with brands such as Lucky Strike and Rothmans and profits of nearly £6billion, doesn’t pay a single penny in UK corporation tax.

    The Scottish Government is about to launch a new 5-year strategy on tobacco and health, with tackling inequality as a core theme running through the document. It is in the heart of our poorest communities where the battle will be most keenly fought. By working with communities to understand the role of tobacco in their lives, by supporting young people to make healthy choices on tobacco and by providing flexible stop-smoking support that can be tailored to the needs of all users we can aspire to the next generation growing up free from the harm and inequality caused by tobacco.

    Shelia Duffy is the Chief Executive of ASH Scotland

    From Healthier Scotland: the Journal

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    Part of our response to the Labour Party Policy consultation June 2012
    1. At the least, ensure that there is good, safe medical cover on psychiatric wards. There is almost none now.
    2. Support more work on services for patients with unexplained medical conditions. If we can get this right, we will reduce Outpatient demand significantly.
    3. As far as possible, put psychiatric and physical health in the same institution.
    4. Alcohol and drug services integrated with physical health and linked with the Local Authority
    5. More private investment in the prevention of illness and disease. This means making workplaces safer, lower stress, more productive and more engaging of front line workers’ ideas for reform.
    6. NHS occupational services need to be aggressively expanded to all small and medium enterprises.
    7. At national level we need to look at how we incentivise volunteering among active older people.  Those who volunteer have lower  mortality rates, greater functional ability, and lower rates of depression later in life than those who do not volunteer.
    8. These are two separate questions. Mental health is established in childhood and young adulthood, so resources should be targeted at parents and children to promote mindfulness, self-efficacy and positive coping strategies; New Labour did this well with Sure Start but there needs to be an extension of this thinking into the teenage years, involving Education as well as the NHS.
    9. Well-being is subjective ‘feel-good’ experience that is distributed across the age span in a U-shaped form, with peaks in childhood and adolescence, and in later life. The trough in well-being is in the 30s and 40s, perhaps earlier for women than men. This is the young parent population, which experiences substantial economic stress and which is also the most critical of the NHS. Rising well-being seems to be associated with consumption (eat, drink and be merry?) that is not necessarily healthy, and with increasing reluctance to prioritise health care. So, at the individual level there is some evidence that those with higher life satisfaction are less likely to act on threatening symptoms, and a social level there may be political resistance to spending on health services.
    10. Public health needs to straddle both local authorities and the NHS, becoming an “owned” resource for both  the opportunity to continue the good work Labour did in government. The teenage pregnancy strategy was an amazing achievement – the lowest rates in 30 years. It’s hard work, it’s well evidenced partnership work and the rates will rise if the work slides. Attractively, Kings Fund figures show every £1 spent on contraceptive services saves £11 – and that’s an in year saving. Ensuring men & women of all ages can have full control of their fertility us something Labour should be wholeheartedly behind.
    11. Risk taking behaviour more generally should be prioritised & linked to mental health & emotional well being. Labour did great work in schools (I think SEAL was one programme) ensuring children & young people were emotionally literate. Labour very nearly made Sex & Relationship Education compulsory – we should continue to promote this so that children & young people are protected from abuse & equipped to meet puberty and the pressures of later life n our very sexualised society.
    12. By having the power to determine policies that affect health – for example alcohol marketing and prices, gambling, employment practices, planning – beyond the traditional sphere of health services.
    13. Restore effective health screening in schools (currently this is now just in reception and year 6, and then only minimalist), and do away with the pernicious over-emphasis on parental choice, both in terms of school choice and in terms of referral – for example for seriously obese children.
    14. Again, however, there needs to be a radical rethink of how our society operates – the NHS within the context of a caring, socially inclusive society rather than as a mitigation of a system that exists for the perpetuation of capital. Transformation of this sort would take a generation and requires investment in community development (more singing for example) linked to new democratic and participative processes and structures – sorry but you can’t deal with these big questions with a narrow focus on the NHS.
    15. Drugs/smoking/alcohol – prohibition is not the answer. Sensible restrictions and policies make a difference – for example plain packaging on cigarettes will make a difference, the new legislation on covering displays of tobacco is making a difference. More policies like this are needed.
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