Life Saver...

The main thrust of the Government's white paper, Saving Lives: Our Healthier Nation, is to improve the health of all, especially those who are more vulnerable to disease and illness because they are socially and economically disadvantaged.

"We are putting forward the first comprehensive Government plan focused on on the main killers: cancer, coronary heart disease and stroke, accidents, mental illness." This is to ignore the last government's Health of the Nation which pioneered the setting of targets in relation to these very conditions and also health behaviours such as drinking and smoking. The white paper claims, however, that its targets are "tougher" than those of the Conservative administration.

They are:

By the year 2010:

CANCER: to reduce the death rate in people under 75 by at least a fifth.

• CORONARY HEART DISEASE and STROKE: to reduce the death rate in people under 75 by at least two fifths.

• ACCIDENTS: to reduce the death rate by at least a fifth and serious injury by at least a tenth.

• MENTAL ILLNESS: to reduce the death rate from suicide and undetermined injury by at least a fifth.

If we achieve these targets, we have the opportunity to save lives by preventing up to 300,000 untimely and unnecessary deaths."

The base-line for these aims are the 1995/96 levels of mortality.

To achieve these ambitious targets the Government says it is:

• "putting in more money: £21 billion for the NHS alone to help secure a healthier population

• tackling smoking as the single biggest preventable cause of poor health

• integrating Government, and local government, work to improve health

• stressing health improvement as a key role for the NHS

• pressing for high health standards for all, not just the privileged few."

Focusing on the social, environmental, and economic factors leading to ill health involves co-operation between a wide range of government departments and local authorities. This is emphasised by the number of ministerial signatories to the white paper. Besides the Department of Health, they come from Social Security, the Treasury, the Privy Council, the Home Office, Education and Employment, Trade and Industry, Agriculture, Fisheries and Food, Environment, Transport and the Regions, and International Development. The Prime Minister provides a foreword. It is clearly a flagship document and implies a huge co-ordinated government effort over the coming years.

The white paper acknowledges the background of the considerable improvements in health over many years - factors such as increased longevity, the disappearance of many infectious diseases, rarity of death in childbirth - and says that this trend can be maintained by the efforts of individuals. "People can improve their own health, through physical activity, better diet and quitting smoking." Part of this can be achieved by educating people:

"We are introducing new Healthy Citizens programmes to help make decisions:

• NHS Direct - a nurse-led telephone helpline and Internet service providing information and advice on health

• Health Skills programmes for people to help themselves and others

• Expert Patients programmes to help people manage their own illnesses."

The Health Education Authority will be replaced by the Health Development Agency. The new body will have a wider field of activity, including "commissioning and carrying out evidence-based national health promotion programmes and campaigns which are integrated with the Department of Health's overall communications strategy and linked with regional and local activity." The Agency will have the responsibility of giving advice on the targeting of health initiatives on the most disadvantaged members of society. In addition, it will advise on the ability of those involved in public health to implement Ministers' strategy and on the education and training needs of the workforce.

The "community factors" which affect health, says the paper, are poverty, low wages, unemployment, poor education, sub-standard housing, crime and disorder, and pollution. It stresses the coherence of the Government's policies over the range of these issues and the expected tendency towards improved health.

Although communities, individuals, and many government departments will be involved in the achievement of the targets, the National Health Service will necessarily have a central rôle:

"We will reorient the NHS to ensure that for the first time ever, health improvement will be integrated into the local delivery of health care:

• health authorities have a new role in improving the health of local people

• primary care groups and primary care trusts have new responsibilities for public health.

• Local authorities will work in partnership with the NHS to plan for health improvement:

• health action zones will break down barriers in providing services

• healthy living centres will provide help for better health."

At the beginning of the white paper the Chief Medical Officer, Liam Donaldson, thoughtfully provides the Ten Tips for Better Health displayed below.

To increase people's access to information about what is happening on the ground, the Government is establishing a database of practice - Our Healthier Nation in Practice - as part of the Our Healthier Nation internet site on www.ohn.gov.uk. where people will be able to find information of the progress of the various initiatives.

Ten Tips for Better Health: