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Public health programmes will have to prove they are cost effective
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     Public health programmes will have to prove they are working—and providing good value for taxpayers?money—when a new inspection regime is launched in the NHS next year.

    This warning came from Professor Ian Kennedy, chairman of the Healthcare Commission (previously the Commission for Healthcare Improvement). The commission, which monitors clinical quality in the NHS, also has a duty to ensure cost effectiveness.

    "You will have to persuade the least readily persuadable people in the land—the Treasury—that this is money well spent," he told public health experts meeting last week at the King抯 Fund, an independent healthcare think tank. Professor Kennedy recognised the inherent difficulties in showing a cause and effect link between public health interventions and clinical outcomes. He also pointed out that the timescales for public health are much longer than those for politics.

    The Department of Health is currently drawing up Standards for Better Health, a new set of targets for the NHS in England. Public health enjoys a dominant position as one of seven core areas, alongside fundamental areas such as safety and clinical effectiveness. The targets are likely to include health improvement, disease prevention, and reduction of health inequalities.

    Convincing ministers that public health interventions are paying off could prove difficult. Even practitioners can find the literature "lofty and impenetrable," said David Woodhead, deputy director of public health for Salford Primary Care Trust. He appealed to academics, asking for clear and practical guidance in an accessible format.

    The amounts of money invested in UK public health research "are so tiny, they are almost invisible," said Anthony Harrison, a fellow at the King抯 Fund. He cited a recent report from the Wellcome Trust, Public Health Sciences: Challenges and Opportunities, which highlights the low level of spending and a correspondingly small research output. Less than 2% of the money for cancer research is used to investigate prevention, and just 0.4% of UK biomedical research publications in 2003 were relevant to public health interventions.

    The health minister Melanie Johnson told the conference that the forthcoming white paper on public health, due for publication this summer, would be underpinned by a programme of practical research. The minister emphasised the importance of identifying and disseminating the best practices in the NHS.

    Monitoring of public health programmes will need to include measures of productivity, said Derek Wanless, the former banker who has drawn up two influential health policy plans for the Treasury. "Good economics needs to be introduced into public health," he told the conference. "We need to know where we are creating value and where investment is sensible."

    His first report, in 2002, concluded that investment in public health would ultimately reduce costs for the NHS. The second report, which came out early in 2004, called for an ongoing programme of "natural experiments" to assess the effectiveness of public health programmes as a matter of routine.

    Public Health Sciences: Challenges and Opportunities, a report of the Public Health Sciences Working Group convened by the Wellcome Trust, is accessible at www.wellcome.ac.uk/en/1/awtpubrepphs.html(London Colleen Shannon)