The future of public health in Europe Free

Future public health can only be achieved if the whole society invests in it—building partnerships is essential here

Partnerships are key to tackling health challenges. But they will only have credibility if they achieve results, by focussing on action, not simply words. They also need to focus on key issues.

Many of the global, and European, epidemics are man-made. Obesity is an example—all over the world, obesity levels are rising. Globally, one billion adults worldwide are now overweight. Three hundred million are clinically obese. About 22 million children aged <5 years are overweight.

Comprehensive strategies are needed to reverse the trends, and many partners need to be involved. This includes, for example, governments, the health service, food and catering industry, and the fitness industries as well as transport planners in local government. Obesity strategies need to be as comprehensive and integrated as the tobacco strategies that many countries have developed, and include action to address provision (of food and opportunities for exercise), information, regulation (for example, on food promotion and marketing), and work with industry.

The long term benefits of public health should be taken seriously by policy makers

Improved public health and prevention could have a significant impact on health status and ultimately the demand for health services and thus costs. In England, Derek Wanless was commissioned by Ministers to examine future health trends and the resources needed over the following two decades to deliver the health visions of Government policy. “Securing Good Health for the Whole Population”¹ was published in 2004. Wanless concluded that the UK should devote a significantly larger share of its national income to health care and to public health and prevention, and step up change in public health resources and delivery. He predicted significantly better health outcomes for the same or lower expenditure—for example, the ‘fully engaged scenario’ led to the best health outcomes at least cost, and by 2022 would cost £30 billion less than the slow uptake scenario.

Public health should form an integral part of the political agenda in all fields

Public health is wider than health systems—and needs to involve all sectors of government. For example, in England, all government departments are encouraged to ‘design’ health considerations into their policies. Our recent White Paper on public health, Choosing Health (2004)², involves departments across government in tackling current public health problems such as obesity, smoking, and sexual health. Health Impact Assessment forms part of Regulatory Impact Assessment, which is carried out for European and domestic policy changes which could affect public or private sectors, or the voluntary sector, and help ensure that health is taken into account in policy decisions. We also have a Minister for Public Health, in the Department of Health, a cross-Government Ministerial public health committee, and targets shared by government departments. For example, our national childhood obesity target is shared by departments of health, education, and sport. Article 152 of the Treaty in Europe is an important vehicle to ensure health is taken into account in policies in Europe.

Public health policy should be based on assets rather than disease

Public health policy needs to focus on health benefits and positive health, and the changes that can be made to improve health, as well as disease. My own report on physical activity, At Least Five A Week³ for example, focuses on the importance of increasing physical activity levels to improving health of the population. But concerns about disease and personal risk may also act as a motivator for health improvement among those with a family history of a disease, such as cancer or heart disease; and concerns about increased prevalence of disease, such as diabetes, and the threat of epidemics, with the implications for health service costs, may also motivate politicians.

Research remains a solid basis for the development of public health policy and practice

Good research is essential to good public health. Although there is a growing evidence base, there is a need for investment across Europe, and particularly on the effectiveness of interventions, including the impact of wider policy on public health. The health theme of the proposed 7^th research framework programme, which aims to improve the health of European citizens, and the social economic sciences theme, as well as the public health programme, provide good opportunities.

Research should focus on the needs of policy and practice

It is vital that public health research focuses on policy and practice. During the UK's Presidency of the EU, in our work on health inequalities, we concluded that research and evidence must underpin health inequalities strategies, and that there is a need for further investment, by member states, and EU research funding bodies (including DG Research and others), to further develop the evidence base. The priority for policy makers is research on effective interventions and policies to reduce the health gap, including critical success factors and economic assessments. We also concluded that there is a need to develop mechanisms across the EU to share and disseminate research outcomes and information on effective action, to policy makers and practitioners.

Researchers should learn how to interact with politicians and practitioners

Interaction between researchers and politicians and practitioners is important to ensure that research focuses on and addresses current health needs. In England, for example, our new Clinical Research Networks bring together practitioners, government, and researchers to ensure that research can best inform and translate into practice. Our research strategy, Best Research for Best Health⁴ and our investment, share these aims.

Innovative ways to promote health should be encouraged

We need to be innovative in how we promote health, and learn from experienced marketers in other sectors. Using marketing techniques, and working with those who reach consumers in a way governments cannot is vital.

In England, for example, we have used innovative approaches to improve diet and nutrition, and tackle obesity, through, for example our 5 A DAY programme and our School Fruit and Vegetable Scheme. Our 5 A Day programme is a partnership between government, the food industry, and the voluntary sector. The 5 A DAY logo was launched in 2003, and now over 550 organisations are licensed to use it on their products and materials—it now appears on over 700 fruit and vegetable products in shops and restaurants. The School Fruit and Vegetable Scheme complements the programme, and provides a piece of fruit or vegetable to all 4–6 year olds (some 2.5 million) across England each school day—it is the first of its kind in the world.

Equally, my own work with the food industry to reduce the salt content of food has been very successful. Approximately 75% of salt is in processed or manufactured foods, and it has therefore been important to work with the food industry to achieve change. I set a salt target of 6 g in the UK—which the Government had not previously done. We held a Ministerial Summit with the industry and health bodies, and then, with the the Food Standards Agency, we held a series of meetings (over 70 in all), and targets with good monitoring, as well as a consumer awareness campaign.

The Commission's work on the Platform on Diet, Physical Activity and Health is critical in considering these issues.

The future of public health practice: think globally, act locally

Global problems need global solutions, and most current public health problems are multinational and man-made.

Tobacco is the second major cause of death in the world, killing ∼5 million people every year. It is a global scourge. In Europe, tobacco is the leading cause of preventable death and one of the main causes of the health gap between rich and poor, and Europe faces nearly 33% of the worldwide burden of tobacco-related diseases. There is a need to confront the problem on a global level, for example, through bans on the advertising and promotion of tobacco, and by tackling smuggling and illicit sales, and taxation. Action is needed in the EU to limit the cross-border movement of tobacco: I would personally advocate a legal limit on the legal allowance for cross-border movement of tobacco to 200 cigarettes, or 250 g of hand-rolling tobacco. But national action, through bans on smoking in public places, with local enforcement, are also critical.

Patient safety is a key issue of concern globally as well as in Europe. The scale of the problem is substantial—recent estimates based on the best available research suggest that between 3 and 6.5 million hospital inpatient episodes each year in Europe may result in some form of unintended harm. Around half of these incidents may be preventable. But while we need to work globally, to learn from each other, and work with the pharmaceutical industry, local action is also vital, to improve the safety of patient care in all healthcare systems.

What can EUPHA do?

European Public Health Association (EUPHA) is important in reaching public health professionals across Europe and helping to ensure that we tackle things together. The UK held the Presidency of the EU last year, and our two health themes were health inequalities and patient safety. For both, international action, and working with other member states, is critical to tackle the issues effectively—whether this is smuggling and illicit sales of tobacco, promotion and marketing of food and alcohol to children and young people, or improving patient safety. EUPHA has an important role in making sure that these and other public health issues are effectively tackled by member states and the Commission, as well as by international agencies such as the World Health Organization.

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