SMOKING
The Proposal: All restaurants and pubs preparing and serving food would be smoke free, with others bars left to choose whether or not to allow smoking. However, ministers have also pledged that all workplaces and public places will be smoke free by the end of 2008. In addition, there will be tighter restrictions on tobacco advertising, and a consultation on the most effective way to use picture warnings on tobacco products. There will also be more emphasis on helping smokers to quit, including phone, email and text message support schemes.
Reaction: The proposals appear to have failed to satisfy campaigners on either side of the debate. Deborah Arnott of the group Action on Smoking and Health (ASH) warned that the proposed ban might be unworkable. “We know from Ireland that what makes a ban work is to have a simple, level playing field where you can’t smoke in any workplaces,” she said.
Cancer Research UK chief executive Professor Alex Markham said it was a “huge missed opportunity”.
“The government has failed in its fundamental duty to protect our citizens’ health and safety by opting out of a total ban on smoking in public places,” he said. “It’s like having the legislation to fit all cars with seatbelts because we know seatbelts save lives and then stopping some passengers from wearing them.”
But Simon Clark, director of pro-smoking organisation Forest, said most voters would agree with more no-smoking areas and better ventilation, describing a ban as a “systematic attempt to demonise smokers and their perfectly legal habit”.
Chris Ogden of the Tobacco Manufacturers Association described the proposal for a ban as “pragmatic”, but argued that, “it probably goes further than it needs to do”. The British Beer and Pub Association warned that some establishments would stop serving food to avoid the imposition of a smoking ban. “It does seem strange that the Department of Health is pursuing a policy that will drive us to drink,” said spokesman Mark Hastings.
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IN GENERAL
The Proposal: A new service, Health Direct, will provide information on health choices by telephone, direct television information services and via the Internet, while, as was predicted by the media, doctors will be able to refer patients to NHS trainers to give advice on how to improve their lifestyles, labelled “health MOTs”.
The Reaction: A number of organisations have indicated support for the proposal to recruit NHS trainers. “Health MOTs could be a positive step forward in preventing ill health and we believe tailored exercise programmes will form a crucial part of this process,” said Grahame Pope of the Chartered Society of Physiotherapy.
However, the Royal College of GPs argued that such a move should be part of the existing primary health care team.
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MENTAL HEALTH
The Proposal: Next year, the Department of Health will publish guidelines on the management of mild to moderate mental ill health in the workplace, and by next year, ministers have pledged that measures will be put in place under the Sure Start programme to protect the long-term mental health of children and young people. In particular, the white paper includes a pledge to tackle inequalities in mental health care services experienced by people from minority ethnic communities.
The Reaction: A number of mental health charities have argued that this issue is too great to be included in a white paper on public health, and has not been treated with a sense of urgency that is needed. “The public could be forgiven for thinking that Britain’s health problems are confined to smoking and unhealthy eating,” said Richard Brook, chief executive of Mind. “Healthy lifestyles are important - thank cannot be denied. But we would like to see the government recognise that improving the nation’s mental health is an integral part of a much bigger picture.”
Marjorie Wallace, chief executive of Sane, echoed his comments. “We are disappointed that the government should choose targets which we believe do not recognise the urgent needs of the thousands of people with mental illness now who are at risk of self-harm, abuse of drugs or suicide,” she argued.
But the Mental Health Foundation welcomed the measures as a new beginning in the treatment of patients with mental health conditions.
“The paper’s focus on strengthening individuals and communities provides a solid foundation for what the charity hopes will be a new era of strategic thinking on public mental health,” said a spokeswoman.
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DIET AND EXERCISE
The Proposal: By the middle of next year, foods will be clearly labelled to indicate their fat, salt and sugar content for shoppers. An independent task force will be established to look into the best ways of preventing and treating obesity, while schools will be tasked with providing healthier meals, free fruit and sport for their pupils, with more than £1 billion invested in physical education and school sport. More specialist sports academies will be developed, while protection for school sports fields will be strengthened. Children will be encouraged to cycle to school, and adults to get active at work. In addition, the communications watchdog Ofcom will examine how foods are advertised to children, with a view to setting out voluntary restrictions on “junk food” advertisements. Ministers have signalled that if these measures fall short of what they want, new legislation will be introduced in 2007.
The Reaction: The most popular aspect appears to be the focus on educating and encouraging children to become healthier. In particular, the proposed restrictions on junk food advertising have been warmly welcomed. “Marketing to children is incredibly sophisticated,” said Dame Deidre Hutton of the National Consumer Council. “We want to see advertisers being much more creative in promoting healthy foods to children.”
There was also a positive reaction from the Royal College of Paediatrics and Child Health, but president Professor Sir Alan Craft argued that restrictions alone would not combat the problem of childhood obesity. “What we must also see from the government is a sustained, high-profile campaign to motivate children as well as adults to eat a healthier diet and adopt a more active lifestyle,” he said.
Proposals for clearer food labelling and a “national partnership” on tackling obesity have also been well received. “It is only when government, industry and the professions start to work together that we will really see the improvements in obesity and its associated diseases that are so desperately needed,” said Dr Ian Campbell, president of the National Obesity Forum. “There has never been a more urgent need to act and act decisively.”
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ALCOHOL
The Proposal: The government has promised to increase investment in NHS services to tackle alcohol problems at an early stage, and to work with the Portman Group to devise an initiative to tackle binge drinking. Ofcom will be asked to strengthen the rules governing the broadcast advertising of alcohol, particularly those aimed at underage drinkers, while alcohol manufacturers will be encouraged to include messages in favour of sensible drinking on their packaging and in their advertising.
The Reaction: The Royal College of Physicians has criticised ministers for missing an opportunity to tackle alcohol misuse, arguing that the problem had been given a “low profile” in the white paper. In contrast, cancer charities have welcomed the measures.
“Regularly drinking alcohol can increase the risk of developing breast cancer,” said Antonia Bunnin from the charity Breakthrough Breast Cancer.
“However, our recent research shows that very few women are aware of these risks. We now want to see government action to raise awareness of these risks and help the public make informed choices about their lifestyles and the impact on their future health.”
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SEXUAL HEALTH
The Proposal: Ministers have announced that there will be a new national advertising campaign aimed at people aged between 16 and 24, deemed most at risk of catching a sexually transmitted infection or having an unplanned pregnancy. By 2007
Chlamydia screening will be rolled out across England, and by 2008, every patient referred to a Genito-Urinary Medicine clinic should have an appointment within 48 hours.
The Reaction: Many organisations have supported the proposals as a sign that the issue of sexual health is moving up the political agenda. “The measures outlined in the in the white paper will support the excellent work that is already being done around the country, but we specifically welcome any steps which will further increase young people’s access to confidential ‘teen-friendly’ contraceptive information and services,” said Gill Frances, deputy chairwoman of the Independent Advisory Group on Teenage Pregnancy.
But others have criticised the government for the narrow scope of the plans. “We are very disappointed that the specific needs of gay and African communities are largely ignored and that the particular challenges around HIV, including stigma and discrimination, are not addressed,” said Deborah Jack, chief executive of the National Aids Trust.
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