The Sustainable Development Commission fully supports the terms of reference contained in the document 'Securing good health for the whole population : final report'. In looking at how Government can implement cost-effective approaches to improving population health, prevention and reducing health inequalities, consistent with the 'fully engaged' scenario, the Sustainable Development Commission considers that the review should particularly focus on the strategic approaches to health improvement.Publisher PD

Sustainable Development Commission

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                  Securing good health for the whole population - Wanless Review - submission from the SDC     24.11.03      Securing Good Health for the Whole Population (Wanless Review) Submission from the Sustainable Development Commission    Overview of submission  1. The Sustainable Development Commission (SDC) fully supports the terms of  reference of the review on Securing Good Health for the Whole Population.  In  looking at how Government can implement cost-effective approaches to improving  population health, prevention and reducing health inequalities, consistent with the  “fully engaged” scenario (as envisaged in Securing our Future Health: Taking a  Long-Term View), the SDC considers that the review should particularly focus  on the strategic approaches to health improvement.  In this regard we would  recommend that the review looks closely at the effects of current cross-cutting  government policies and makes recommendations focused on the achievement of  greater synergies and improved delivery.  2. In this light we suggest the following areas for consideration: • The link between sustainable development, public health and reduced health  inequalities; • The role of the NHS in promoting sustainable development, public health  and  reduced inequalities through the NHS’ corporate activities; • The role of Government in promoting improved public health, and reduced  health inequalities, through pursuing sustainable development;  • Co-ordination of activities across central and local government; • Public spending in areas other than the NHS; • Ways to create a “public health culture”.  More detail on each of these issues and why the Sustainable Development Commission considers them to be important to this Review is given below.  3. In the course of the review the assessment of available evidence and the adequacy  of the evidence base will be considered.  Here we would particularly recommend  consideration of the evidence of links between sustainable development and health  documented in the recent report Claiming the Health Dividend  (King’s Fund  2002).  We also offer below some further guidance on broader Government policy  that should be taken into account when looking for evidence of delivery.  4. It is the case that there are gaps in the evidence base itself or gaps in testing that  evidence base because the research has not yet been done that might prove  effectiveness one way or another.  We hope that the review will feel able to point  up the gaps and lack of testing and make recommendations to address those issues  where appropriate.      Areas for Consideration  The link between sustainable development, public health and reduced health inequalities 5. Promotion of sustainable social, environmental and economic development will  bring improvements in relation to the wider determinants of health, such as  nutrition and access to healthy food, the local environment, air quality, traffic and  travel, employment and the development of strong, sustainable local communities  and economies.  Sustainable development is therefore central to achieving better  public health, reducing health inequalities and managing demand on health  services.  Acting sustainably will also result in a more efficient health service and  healthier working conditions.  • We would encourage the review to assess how well current cross-cutting policy  approaches are making the link between sustainable development, public  health and reduced health inequalities.  The role of the NHS in promoting sustainable development, public health and reduced inequalities through the NHS’ corporate activities 6. The NHS’ key role is to promote health (or currently – at least to treat ill health),  but the way it behaves as a corporate organisation can also have a major impact on  the health of patients, staff, visitors and the communities it serves.  By spending,  consuming and behaving in ways, which promote sustainable development, the  NHS can not only improve the efficiency of its services, but also maximise its  contribution to a healthier population, a better environment and stronger economies  and communities.  7. For example, decisions about where to locate a new hospital, how to provide  transport to and from health services, how to manage waste and energy, and whom  to employ, all impact on the health and well-being of patients, staff and visitors, the  local environment, community and economy.  Promoting sustainable communities,  environments and economies will also help improve the NHS’ interaction with  local populations, and is therefore an essential part of moving towards the “fully  engaged” scenario.  8. The role of the NHS in promoting sustainable development (and in turn, improved  public health) is explored further in the King’s Fund report, Claiming the Health  Dividend and through the SDC’s Healthy Futures project.  • We hope your review will assess how sustainable development, public health  and reduced inequalities are being promoted through the NHS’ corporate  activities.  The role of Government in promoting improved public health, and reduced health inequalities, through pursuing sustainable development 9. The Government more widely has a role to play in achieving the “fully engaged”  scenario and promoting public health - not just the Department of Health and NHS.   For example: • measures to encourage reduced car use will impact not only on greenhouse gas  emissions, but also on health and exercise; and the planning process can promote      sustainable, healthier communities in a variety of ways, including through  provision of green space and access to public services; • the education sector, and spending on education, can clearly influence public health  and engagement with health issues; • Government has helpfully encouraged improved public health through the recently  launched joint initiative by the Department for Transport and the Department for  Education and Skills encouraging children to walk, cycle or take the bus to school • We would strongly endorse an approach that considers the various levers and  instruments available to Government, such as regulations and measures to  influence personal behaviour, which can impact (both directly and indirectly)  on public health.  10. The UK Sustainable Development Strategy (UKSDS) and the associated indicators  are now entering a year long process of review and consultation.  This presents an  opportunity to review the effectiveness of and where necessary strengthen the link  between the Quality of Life indicators and their impact on public health.  Achieving  the results envisaged through these indicators will have positive results for the  “fully engaged” scenario.  For example, improved housing conditions, education  and increased employment will all impact positively on public health.  • We would encourage you to flag up for the review of the UKSDS the need to  appraise the role of the strategy itself and the indicators in delivering the  “fully engaged” scenario.  Co-ordination of activities across central and local government 11. An important part of delivering the “fully engaged” scenario will be to ensure that  government initiatives (both those which are health-related, and those which are  not) are coordinated.  Improved local cohesion, between Primary Care Trusts,  local authorities, community and well-being strategies, and social inclusion and  neighbourhood renewal agendas will also be needed.    • We would welcome the review exploring the potential for Primary Care Trusts,  through Local Strategic Partnerships and other partnerships, to work more  closely with local communities to move towards the “fully engaged” scenario.  Public spending in areas other than the NHS 12. There are some positive examples of Government spending policies helping to  deliver sustainable development.  For example: • all new central government department contracts must, as of 1 November 2003,  apply the minimum environmental standards when purchasing certain types of  product, which cover aspects such as energy efficiency, recycled content and  biodegradability; • the current Ministry of Defence’s Project Allenby Private Finance Initiative has  shown how sustainable development can be mainstreamed into the PFI contract       • We would strongly support the review in looking across Government, to  explore how spending in areas other than health can help achieve the “fully  engaged” scenario.   • We also encourage the review to reappraise investment policies (and  encourage Government to do so, too), by looking at wider public health  benefits of policies and public spending – so that the goal of public spending is  not simply economic growth, but overall well-being.  Creating a “public health culture” 13. We understand that the overall aim of the Review is to encourage Government and  the NHS to move towards a “public health culture”, which aims to promote and  address public health, rather than address health care.  This “public health culture”  would require responsibility for health, to be shared between Government,  communities and individuals. This three-way ‘contract’ was set out in Our  Healthier Nation (Department of Health 1998) but does not appear to have had  much impact on health policy development since then.  • We hope the review will enquire what more needs to be done to ensure that the  ‘contract’ in Our Healthier Nation is delivered and is effective.   Sustainable Development Commission November 2003  

Securing good health for the whole population (Wanless Review) : submission from the SDC

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