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Public health policy: prevention or cure?

Lynn Young
Primary Healthcare Adviser for the RCN

Lynn Young urges government departments to combine hearts and minds and take drastic action to improve the state of the nation's health ...

Anyone with a modicum of common sense and intelligence will know that 2010 is likely to be a tough year for nurses, regardless of the setting in which they happen to work. In the past, it has been all too common for there to be cuts in public health spending when NHS cash runs dry, but the future does not have to resemble previous times.

Many of us would argue that the tougher the financial situation, the more crucial it is for the nation's economy to sustain the funding of preventive action with the aim of improving public health and, with great hope, diminishing the need for ludicrously expensive hospital admission.

The UK has to wake up, stand up and take unpopular, but effective action on the abuse of alcohol, over-indulgence in fatty, sweet foods and idle inactivity. Yes, I am beginning to sound like a complete health fascist and my lifestyle is far from pure; but although still relatively rich, the UK simply cannot afford to treat a pandemic of preventable diseases.

It is heartbreaking to witness so many children and young people leading a lifestyle that is clearly destined to bring ill health, misery and a premature death. In a time of financial austerity, rising levels of unemployment and increased insecurity for households, it is beholden to the government of the day to seize the moment and rigorously implement strategies that lead to better, not declining, health.

Public policy matters as much as health policy in terms of health improvement. All policies, regardless of the government department from which they originate, should aim to contribute to health gain. The cabinet should be obsessed with health, and ensure that the Houses of Parliament are therapeutic in all their intentions.

Public funds, in their billions of pounds, can no longer be devoted to treating illnesses that should never have occurred in the first place. Sometimes it takes a nasty crisis to really exercise minds and gather consensus, and for previously opposing forces to work together on a shared objective. A statement could be released by the government that is honest, bold and challenging to health professionals and the public, such as the following:
"The economy is in a dire state, NHS funding has to be radically reduced, and an annual spend of £100bn (and that's England only) can no longer be afforded. The prevention of disease is our new top priority and resources are to be redirected so that we can work with people to help keep them well."

This sounds as though I lack compassion for people who struggle to lead a reasonably healthy lifestyle; but the truth is the reverse. It is compassion for the suffering of others that motivates me to keep travelling on the public health train, hoping very much that it is not going to lose out when the inevitable cuts in funding are made.

If I was in charge of the nation's health, the price of alcohol would be rapidly quadrupled; happy hour would be banned; and all bottles of booze would be removed from the shelves of supermarkets. Smoking would become even more difficult than it has been since the ban in public places. More effort could be devoted to helping our children and young people enjoy an active, rather then sedentary life, as success in this area seems to elude us.

Confronting the issues relating to modern technology and leisure pursuits that seem to involve hours of sitting in bedrooms watching an active screen is difficult, but surely not impossible? Government departments need to combine hearts and minds to encourage sport, dance, team games and other activities that young people are attracted to.

It is important to acknowledge that the government has acted, and continues to act, on these matters - my argument is that a time of economic hardship means that success becomes even more crucial.

May you all enjoy a health-enhancing 2010.