Second Wanless report welcomed by public health experts
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《英国医生杂志》
Public health leaders believe that a report from a former banker has created a "once in a lifetime" opportunity to put the prevention of disease at the top of the agenda for the NHS and across government.
Derek Wanless, a former chief executive of the NatWest bank, was asked by the government to review the state of public health in England and to make recommendations for improving it. Significantly, he took his brief not from the Department of Health but from the Treasury.
Last week Mr Wanless called for an end to "30 years of talking" and the introduction of a coherent policy framework for public health. Mr Wanless also wants tough targets on smoking and obesity, for local government as well as the NHS. The government is to publish a white paper on public health this summer.
Securing Good Health for the Whole Population is the second health report that Mr Wanless has produced for the Treasury. His first report, in 2002, on the long term financial prospects of the NHS, led to an unprecedented increase in UK health care spending (BMJ 2002;324:998). Public health doctors are hoping that the second Wanless report will do the same thing for public health.
Professor Sian Griffiths, president of the Faculty of Public Health, believes that it could. "The combination of the Wanless report and the white paper consultation offer public health a once-in-a-lifetime chance to be taken seriously, not seen as a bit of froth on the side," she said. "We have to use this report to engage not just those of us who are enthusiastic about public health but a far wider audience."
Mr Paul Lincoln, chief executive of the National Heart Forum (a UK alliance of national organisations working to prevent coronary heart disease), said that the report "heralds a new era if things are followed through in the right way, and sets a rock solid foundation for the future." He said that it "amplifies what people have been saying for some time and is an extremely robust framework for strengthening public health."
The report makes 21 recommendations, including a ban on workplace smoking, a tax framework to discourage unhealthy habits, and a review of the public health workforce. It calls for systematic assessment of both the clinical and cost effectiveness of interventions
However, the report does not provide many details on how these changes could be achieved or how much they would cost.
"Under-whelmed" was the response from Ms Angela Mawle, chief executive of the UK Public Health Association. "I guess I was hoping for rather too much given the time they had to produce it," she said. "But the cauldron is being stirred now. We抳e got an opportunity and we抳e got to take it."
The report highlights obesity as a major public health threat, but it is "soft" on taxation and regulation of the food industry, said Professor Tim Lang, professor of food policy at City University, London. However, he welcomes its broader themes. "I think the Wanless process is a very important shift within the heartlands of government, with public health seen not just as something we spend money on as an afterthought, but as something to be built into a vibrant economy. The Wanless report has opened the door, but everything will depend on the political response."
Among the recommendations were:
?The Government should set a clear national framework of objectives for all the key risk factors such as smoking and obesity. Primary care trusts and local authorities should agree joint targets.
?HM Treasury should produce a framework for the use of economic instruments to guide government interventions in relation to public health (similar to the framework that exists for environmental taxes).
?A consistent framework (such as the methodology developed by NICE) should be used to evaluate the cost-effectiveness of interventions and initiatives across both health care and public health.
?Productivity measures in health services should move away form narrow definitions of outputs to overall measures of health outcomes.
?CHAI should develop a robust mechanism for the performance assessment of the public health role of primary care trusts and special health authorities.
?The secretary of state for health should be given the role of ensuring that Cabinet assess the impact on the future halt of the population of any major policy development..(London Colleen Shannon)
Derek Wanless, a former chief executive of the NatWest bank, was asked by the government to review the state of public health in England and to make recommendations for improving it. Significantly, he took his brief not from the Department of Health but from the Treasury.
Last week Mr Wanless called for an end to "30 years of talking" and the introduction of a coherent policy framework for public health. Mr Wanless also wants tough targets on smoking and obesity, for local government as well as the NHS. The government is to publish a white paper on public health this summer.
Securing Good Health for the Whole Population is the second health report that Mr Wanless has produced for the Treasury. His first report, in 2002, on the long term financial prospects of the NHS, led to an unprecedented increase in UK health care spending (BMJ 2002;324:998). Public health doctors are hoping that the second Wanless report will do the same thing for public health.
Professor Sian Griffiths, president of the Faculty of Public Health, believes that it could. "The combination of the Wanless report and the white paper consultation offer public health a once-in-a-lifetime chance to be taken seriously, not seen as a bit of froth on the side," she said. "We have to use this report to engage not just those of us who are enthusiastic about public health but a far wider audience."
Mr Paul Lincoln, chief executive of the National Heart Forum (a UK alliance of national organisations working to prevent coronary heart disease), said that the report "heralds a new era if things are followed through in the right way, and sets a rock solid foundation for the future." He said that it "amplifies what people have been saying for some time and is an extremely robust framework for strengthening public health."
The report makes 21 recommendations, including a ban on workplace smoking, a tax framework to discourage unhealthy habits, and a review of the public health workforce. It calls for systematic assessment of both the clinical and cost effectiveness of interventions
However, the report does not provide many details on how these changes could be achieved or how much they would cost.
"Under-whelmed" was the response from Ms Angela Mawle, chief executive of the UK Public Health Association. "I guess I was hoping for rather too much given the time they had to produce it," she said. "But the cauldron is being stirred now. We抳e got an opportunity and we抳e got to take it."
The report highlights obesity as a major public health threat, but it is "soft" on taxation and regulation of the food industry, said Professor Tim Lang, professor of food policy at City University, London. However, he welcomes its broader themes. "I think the Wanless process is a very important shift within the heartlands of government, with public health seen not just as something we spend money on as an afterthought, but as something to be built into a vibrant economy. The Wanless report has opened the door, but everything will depend on the political response."
Among the recommendations were:
?The Government should set a clear national framework of objectives for all the key risk factors such as smoking and obesity. Primary care trusts and local authorities should agree joint targets.
?HM Treasury should produce a framework for the use of economic instruments to guide government interventions in relation to public health (similar to the framework that exists for environmental taxes).
?A consistent framework (such as the methodology developed by NICE) should be used to evaluate the cost-effectiveness of interventions and initiatives across both health care and public health.
?Productivity measures in health services should move away form narrow definitions of outputs to overall measures of health outcomes.
?CHAI should develop a robust mechanism for the performance assessment of the public health role of primary care trusts and special health authorities.
?The secretary of state for health should be given the role of ensuring that Cabinet assess the impact on the future halt of the population of any major policy development..(London Colleen Shannon)