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Public Health (England)

As a Minister in the Home Office, I was responsible for the national drugs strategy. Now, at the Department of Health, I am responsible for drug treatment, and I am pleased that the hon. Gentleman acknowledges how successful our strategy has been in that regard. We are way beyond the target that we set ourselves for the number of drug misusers in treatment, and we have now set an even more effective challenge for retention in treatment. There is no point in people dipping in and out of treatment without achieving any success. I have thought about this matter in a considered way. For the most part, we are talking about people who are addicted to heroin and other illegal substances. Let us face it, that is not the most popular area when it comes to providing resources. That is why, in this instance, we felt that we had to ring-fence the money. Comparisons may be drawn with public health, but I am trying to demonstrate that public health is a much wider area for engagement than drug treatment. People may disagree with that, but it is a view that I have come to. The bigger game in this area is that we should not compartmentalise public health. Every health professional—the cancer surgeon, the GP, the district nurse—must be an advocate for prevention and for good public health. Public health goes beyond the health service and beyond the Government. It must be based firmly in the real world and address the circumstances in which people adopt particular habits or lifestyle choices. It must also encourage them to make changes. Fundamentally, public health must view people as individuals. It must look holistically at where they live, what kind of education they are getting, what kind of work they have access to, and how they will be able to continue to work if they suffer ill health. It needs to consider whether their community is safe. Is it an environment in which people will go out and walk and cycle and use the outdoor amenities? Or is it a community in which it is unsafe to do those things, and in which demotivation is likely to set in? Public health is about viewing people not merely as Mrs. Patel the diabetic, Mr. Brown the coeliac or Ms Jones the breast cancer patient. It is about identifying people’s lifestyles and preferences, so as to reach the right people with the appropriate messages. The Department of Health is leading the way in utilising the tools of social marketing, in which we have been greatly assisted by the National Consumer Council and other organisations. This will help us better to understand what gets in the way of people improving their health, to identify how to get round the problem, and to provide the resources nationally that can be picked up by local government, employers, the local health service and community organisations to provide smarter, more targeted messages, rather than indiscriminate mass communication. It will also help us to support stronger commissioning to provide the right services—rather than a one-size-fits-all model—to reach into a community or an individual’s sense of well being to get some really different results. The hon. Member for Billericay (Mr. Baron) raised the issue of health inequalities. I hope that everything that I have said so far is interwoven in some way with the challenge of health inequalities. One of the difficulties is that there is a moving target. The reality is that everybody is living longer. People might say that, in some respects, we have never been better off. However, people who are more affluent, more educated, live in better surroundings and have access to the internet—that probably includes many people in the House—are running forward faster than people who live in poorer communities, where housing is poorer, where the environment outside people’s front doors is hostile, where, through the generations, a style of eating or a habit of inactivity has set in, and where people do not feel that they have got the most out of the education system. Those challenges are daunting, but not insurmountable. I have to tell Members on the Opposition Front Bench that we are credited throughout the European Union with being at the forefront of tackling the problem. We are looked to by other European Union countries, which, in many ways, are only just starting to tackle this difficult area. We are seeing some progress, although we want more. Three fifths of the spearhead areas—the local authority areas in our most deprived neighbourhoods—are on track to narrow the life expectancy gap for men or women, or both. The reduction in the average death rate from cardiovascular disease among the under-75s in spearhead areas has exceeded the national average reduction since the mid-1990s. On infant mortality, we have seen a widening, and now a stabilisation. I am not complacent about that. One year’s figure is not good enough as a basis for a theory about how we are doing. However, in the last year and a bit, we have undertaken some national in-depth analysis of why some communities seem to be doing better than others on the target areas of life expectancy and infant mortality. That has allowed us to have far greater insight into the ways in which the partnerships at a local level should identify both the people most at risk and the options to effect change and close that gap faster than ever before. We know that, for infant mortality, the 43 highest rates are in 43 particular local authority areas. I know that there is the will and the commitment from those working in our health service, and in our local authorities and beyond, to bear down on this issue and make a difference. We cannot do everything from the centre, but the Department of Health has a right to be able to do the things that cannot be done at local level: providing an overview and also national support, based on sharing best practice, to effect the quickest change. As I said before, one has to start by acknowledging health inequalities. Difficult though it may be, setting a target is one of the ways in which we can focus our attention. Clearly, we will be answerable in that respect in a way that the Conservative Governments of previous years were never answerable.