Ministers pledge £4bn to tackle smoking, drinking and obesity

Guardian careers

Health white paper hands responsibility to councils as health experts question 'nudge' tactics and lack of detail

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• Sarah Boseley, Health editor
• guardian.co.uk,
• Tuesday 30 November 2010 19.08 GMT



 

A man drinking a pint of beer. Photograph: Martin Godwin for the Guardian 

The government today promised ringfenced funding of £4bn to improve the nation's health by tackling issues such as smoking, obesity and excessive drinking. But the much-heralded white paper on public health, which hands money and responsibility to local authorities, received a cool welcome from some experts, who warned that the government's preferred option of "nudging" people into good habits may not work. "We agree that 'nudging' people to be healthy may be more effective than only telling them how to live their lives," said Dr Vivienne Nathanson, of the British Medical Association. "However, if people live in an environment where they are surrounded by fast-food advertising and glamorous alcohol marketing, nudging will have a limited effect. We need an environment that helps us make healthy choices and sometimes tougher action is needed to achieve this." She urged decisive action immediately to ban cigarette displays in shops. Today's document centred on structural change, handing responsibility and power to local authorities, together with the ringfencing of the budget. Under the previous government, public health funds were raided in a frantic attempt to pull cash-strapped hospitals out of deficit. The money promised, although it is said to be only a baseline, is just a fraction of total NHS spending, which is more than £100bn and expected to rise to £114bn over the next four years. Part will go to local authorities, while the rest will be spent by a new central body, Public Health England, which will organise national programmes such as immunisation and screening. The money will also fund research into ways of persuading people to take better care of their health. "People's health and wellbeing will be at the heart of everything local councils do," said the health secretary, Andrew Lansley. "It's nonsense to think that health can be tackled on its own. "Directors of public health will be able to champion local co-operation so that health issues are considered alongside housing, transport and education." Detail on specific interventions will not be available until next year. Plain packaging for cigarettes and minimum pricing for alcohol are subject to consultation, although the Treasury announced a hike in the duty on high-strength beer. Beer stronger than 7.5% alcohol by volume will be subject to the higher duty from next autumn, while tax on low-alcohol beers with a strength of 2.8% or less will be reduced. Prof Ian Gilmore, chairman of the alcohol committee of the Royal College of Physicians, pointed out on Radio 4's World at One that only 1% of beers had 7.5% alcohol. He called the government's measures "window-dressing", adding that it "looks less like the 'big society' and more like big business". Five networks, on food, alcohol, physical activity, health at work and behaviour change, where industry is sitting down with health department officials and the voluntary sector to discuss changes in practice, have yet to report. A "public health responsibility deal" will be launched early next year. The white paper says there will be moves on reducing salt in food, better food labelling, and the "promotion of more socially responsible retailing and consumption of alcohol". The president of the Royal College of Physicians welcomed ringfencing and the attempt "to bring to the field a much-needed strategic focus and coherence". But, said Sir Richard Thompson, the RCP was disappointed by a lack of detail, especially on how to deal with alcohol misuse, obesity and smoking. "We wait keenly to see if the promised subsequent strategies will fill in the gaps." He warned that voluntary agreements with industry would not necessarily deliver. "On a whole raft of issues it has been clearly demonstrated that a laissez- faire attitude does not work, either in terms of promoting responsible behaviour among the manufacturers and retailers of potentially harmful products or in creating an environment that would allow individuals to make healthier choices."