- Email: [email protected]
Sustainable development and public health: A national perspective
ARTICLE IN PRESS Public Health (2006) 120, 1102–1105
www.elsevierhealth.com/journals/pubh
UKPHA Mini - Symposium
Sustainable development and public health: A national perspective Fiona Adsheada, Allison Thorpea,, Jill Rutterb a
Department of Health, Richmond House, 79 Whitehall, London SW1A 2NS, UK Department of the Environment, Food and Rural Affairs, Area 4E, 9 Millbank, c/o Nobel House, 17 Smith Square, London SW1P 3JR, UK
b
KEYWORDS Sustainable development; Public health; National policy; Linked agendas
Summary The increasing policy focus on sustainable development offers new opportunities to align the public health narrative with that of sustainable development to promote both sustainable health for the population, and a sustainable health care system for England. This paper provides some insights into ways in which potential linkages between the two areas can be made meaningful across a wide range of policies at a national level. & 2006 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.
Introduction Sustainable development is, like health improvement and health inequalities, a cross-cutting government priority in the UK. Policy documents and speeches regularly reiterate high-level commitment to achieve it for the new millennium, with departmental action plans providing tangible demonstrations of the political commitment to support and progress sustainable development.1 However, translating these high-level policies into momentum on the ground requires the reconciliation of complex social influences and a commitment to maximizing the contribution of existing opportunities. As this paper discusses, appropriate linkage of the public health agenda to that of Corresponding author.
E-mail address: [email protected] (A. Thorpe).
sustainable development can and should play a key role in this process.
The national picture There is an extensive body of literature available on sustainable development. Definitions vary, but in the main they draw out environmental, economic and social dimensions of the concept, emphasizing that progress to date has been achieved at huge cost. The 2005 UK sustainable development strategy sets out five principles,2 which resonate strongly with the practice of public health:
living within environmental limits; ensuring a strong healthy and just society; achieving a sustainable economy; promoting good governance; using sound science responsibly.
0033-3506/$ - see front matter & 2006 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2006.10.003
ARTICLE IN PRESS Sustainable development and public health
1103
The agenda is clearly articulated in strategy and policy documents, underpinned by a series of 68 detailed indicators, many of which are also direct public health indicators, e.g. healthy life expectancy, mortality rates, smoking, childhood obesity, to measure progress across the four priority areas:
nity to position the public health narrative alongside that of sustainable development to promote both sustainable health for the population, and a sustainable health care system for England. This is a challenge we cannot afford to ignore—and that means acting on the evidence we have.
A congruent agenda
sustainable consumption and production; climate change and energy; promoting natural resources and enhancing the environment; creating sustainable communities and a fairer world.3
Yet despite this, we are told: ‘Sustainable development is one of those things that everybody supports, but no-one really knows what it means in practice!’.4 Over the years, similar things have been said about the practice of public health, with a brief overview of the literature drawing out many parallels between the two areas. Throughout history, many classic pollution control measures have been underpinned by a public health rationale—for example, air and water quality; control of hazardous substances; and the new chemicals regulation under REACH (Registration, Evaluation an Authorization of Chemicals). For both, success is accrued in long term outcomes and trendsa, with a shared strategic focus which moves beyond individualism to look at populations, health inequalities and social justice. Even the policy papers have similar names.5,6 Yet perhaps the greatest congruence is around the delivery mechanisms, with the literature recognizing that for both the emphasis is on early upstream interventions, promoting behavioural change, and that strong partnership working approaches both across individual government departments but also the whole of society are fundamental to achieving their goals.
Linking sustainable development with public health practice But whilst this provides a clear view that there are areas of possible convergence, making sense of the public health agenda, and making its link to that of sustainable development both explicit and meaningful, requires unrelenting effort, and a conscious focus on maximizing the opportunities for joint working. The indicators provide a shared opportua
Which, as the Prime Minister recognizes, makes them politically more difficult than other more visible short-term policy priorities.
The cost and long-term sustainability of our health system is the focus of increasing interest across the whole of the UK. Despite massive investment, with current health expenditure in the UK running at around 7.7% of national GDP and expected to reach 0.3% of global GDP by 2008,7,8 the economic statistics make stark reading and reveal the scale of the challenge. For example:
recent economic analysis suggests that the total cost of preventable illness is around £187 billion per annum, or 19% of total GDP for England;9,10 obesity and its consequences are estimated to cost the NHS around £1000 million in hospital admissions, clinic appointments and prescriptions;11 smoking, which is the biggest single preventable cause of death12 and ill health is estimated to cost up to £1700 million per year in terms of GP visits, prescription, treatments and operations, with extra costs incurred from passive smoking, smoking-related diseases, and associated costs;13 mental health problems are estimated to cost some £12.5 billion for care provided by the NHS, local authorities, privately funded services, family and friends, with an additional £23.1 billion in lost output in the economy caused by people being unable to work (paid and unpaid).14
We have the evidence to show that more needs to be done on preventing these conditions from arising if we are to achieve a sustainable health service as well as marked improvements in people’s quality of life. But we also know that having the evidence is not enough—we need to act on it. In many cases we need to seize new opportunities to join up messages appropriately, and this has implications for both the economic sustainability of the country and health and well-being status of the population in the long term. Take smoking, for example. In smoking cessation, we have a widely acknowledged cost-effective intervention,15 yet a survey of 4000 heart patients leaving acute hospitals in England in 2005 reported that 41% had not received information on smoking cessation,
ARTICLE IN PRESS 1104 50% had received no dietary advice, and 35% no advice about physical activity.16 As Wanless recognized,17 ‘it is evident that a great deal more discipline is needed to ensure problems are clearly identified and tackled, that the multiple solutions frequently needed are sensibly co-ordinated and that lessons are learnt which feed back directly into policy’. And implemented in practice—by working with people and across society to support sustainable behavioural changes, and working across government to ensure that public health and sustainable development dimensions are properly integrated into the whole range of policies.
Making a difference By reinforcing the relationship between the health of the nation and the economic health of the country, recognizing that better health and wellbeing go hand in hand with economic prosperity, and can both be enabled by and contribute to better environments, effective public health policies are an essential part of sustainable development strategies. But to translate rhetoric into measurable achievements we need to increase our reach outside the traditional health service silos, across government, into local government, the voluntary sector, and communities themselves. Many of the foundation stones for delivering on this challenging programme are already in place. At a national level, the portfolio of the Minister for Public Health implicitly recognizes the enormous potential of making creative links between the public health, health inequalities and sustainable development agendas. The recent addition of a cross governmental responsibility for physical activity provides a unique opportunity for public health, with a great potential for encouraging cross-agency working for mutual advantage. Every day sustainability of the environment is being directly linked to health improvement. The government has recently commented on the dually positive impact of walking and cycling on the environment and the health of our population.18 But the vision is most clearly articulated within the successful 2012 Olympics bid, which provides a unique opportunity to demonstrate that economic sustainability can be linked to regeneration, environmental improvement and the long-term health and prosperity of the population. Whilst work is already demonstrating an impact at a local level,19 the greater challenge will be to systemize this impact for a sustainable legacy across the whole of the UK.
F. Adshead et al. At a regional and local level, extant action plans focus attention on the key role the NHS can play in assuring sustainability. With increasing levels of investment, the NHS is more than a provider of services. It is the largest single organisation in the UK, representing on average 10% of regional economies.20 Mobilizing this level of investment, using existing corporate powers and resources in a more systematic way to benefit local economies’ sustainable development strategies offers the potential for the NHS to make a significant difference to people’s health and to the well-being of society, the economy and the environment through its day-to-day activities. With the launch of the Corporate Citizenship toolkit, developed as a result of Choosing Health, NHS managers now have a practical weapon in their arsenal to help realise this potential. It provides detailed guidance, examples of good practice, and supporting evidence to help NHS managers identify and assess their contribution to sustainable development in six key areas: Transport; Procurement; Facilities Management; Employment and Skills; New Buildings; and Community Engagement. It has proven popular, with 10,500 visits to the website since its launch, and 248 organizations registered to use the self-assessment model, of which 130 are NHS bodies.21 So we know that things are already happening— but we need to sustain and accelerate this process to achieve our twin goals of sustainable development and health improvement. National policy reflects our understanding that government cannot do this alone—a proactive, systemic approach which draws on and promotes effective partnership with others, engages communities in supporting themselves, and provides a supportive environment for individuals to help them make the right choices for themselves will be key to realizing our vision. From social marketing, to health trainers drawn from local communities, our policies are exploring new ways of connecting to people, helping people to realize their own goals for a healthy and sustainable future. Delivering on sustainable development will be a challenge—but the synergies between this agenda and the public health agenda mean it is a challenge with which public health professionals are increasingly ‘fully engaged’. And we cannot afford not to be—getting this right now could shape the way we live for generations to come.
References 1. 10 Downing Street website, Big Issues, Climate change: facing the challenge, /http://www.nymber-10.gov.uk/output/Page9020.aspS accessed 23 August 2006.
ARTICLE IN PRESS Sustainable development and public health 2. HM Government. Delivering sustainable development together: shared UK principles for sustainable development, /http://www.sustainable-development.gov.uk/what/ principles.htmS accessed 23 August 2006. 3. Department of the Environment, Food and Rural Affairs. Sustainable development indicators in your pocket. London, DEFRA, 2006 /http://www.sustainable-development. gov.uk/progress/documents/sdiyp2006_a6.pdfS accessed 23 August 2006. 4. NHS Purchasing and Supply Agency. Sustainable development: what every supplier should know. Factsheet 2, March 2004. 5. Wanless D. Securing our future: taking a long-term view. London: HM Treasury; 2002. 6. HM Government. Secretary of State for Environment, Food and Rural Affairs. Securing the future: delivering UK sustainable development strategy, 7 March 2005. 7. Office for National Statistics. Health spending up, 16 December 2003 /http://www.statistics.gov.uk/pdfdir/ healthex1203.pdfS accessed 22 June 2006. 8. Le Grand J, Stoate H. Sixty years on, how Bevan’s vision is bearing up. HSJ debate. Health Serv J 2006;116(27): 20–3. 9. Lister G, Fordham R, Mugford M, Olukoga A, Wilson E, McVey D. The societal costs of potentially preventable illnesses: a rapid review for the national social marketing strategy. London: National Consumer Council; 2006. 10. National Social Marketing Strategy for Health. It’s our health! London: National Consumer Council; 2006.
1105 11. Nuffield Council on Bioethics. Public health: ethical issues. A consultation paper. London: Nuffield Council on Bioethics; 2006. 12. Department of Health. Annual report of the Chief Medical Officer 2004. London: Department of Health; 2005. 13. Department of Health. Smoking kills. A white paper on tobacco. London: The Stationery Office; 1998. 14. The Sainsbury Centre for Mental Health. Economic and social costs of mental health in England. London: Sainsbury Centre for Mental Health; 2003. 15. Stapleton J. Cost effectiveness of NHS smoking cessation services. London: King’s College; 2001. 16. Healthcare Commission. Survey of 4000 heart patients leaving acute trusts in England. Reported 8 June 2005. 17. Wanless D. Securing good health for the whole population. London: HM Treasury; 2004. 18. Alexander D. Speech by secretary of state for transport, 26 June 2006 to Transport, Atmosphere and Climate Conference /http://www.dft.gov.uk/stellent/groups/dft_susttravel/ documents/page/dft_susttravel_611958.hcsp.S accessed 29 August 2006. 19. Newham Council, Government minister congratulates Newham. Press release 19 June 2006 /http://www.newham.gov.uk? News/2006/June/GovernmentMinsitercongratulatesNewham. htmS accessed 30 August 2006. 20. East of England Regional Assembly and east of England Sustainable Development Round Table. A sustainable development framework for the East of England. 21. Gibbs M. Personal communication, 19 September 2006.
www.elsevierhealth.com/journals/pubh
UKPHA Mini - Symposium
Sustainable development and public health: A national perspective Fiona Adsheada, Allison Thorpea,, Jill Rutterb a
Department of Health, Richmond House, 79 Whitehall, London SW1A 2NS, UK Department of the Environment, Food and Rural Affairs, Area 4E, 9 Millbank, c/o Nobel House, 17 Smith Square, London SW1P 3JR, UK
b
KEYWORDS Sustainable development; Public health; National policy; Linked agendas
Summary The increasing policy focus on sustainable development offers new opportunities to align the public health narrative with that of sustainable development to promote both sustainable health for the population, and a sustainable health care system for England. This paper provides some insights into ways in which potential linkages between the two areas can be made meaningful across a wide range of policies at a national level. & 2006 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.
Introduction Sustainable development is, like health improvement and health inequalities, a cross-cutting government priority in the UK. Policy documents and speeches regularly reiterate high-level commitment to achieve it for the new millennium, with departmental action plans providing tangible demonstrations of the political commitment to support and progress sustainable development.1 However, translating these high-level policies into momentum on the ground requires the reconciliation of complex social influences and a commitment to maximizing the contribution of existing opportunities. As this paper discusses, appropriate linkage of the public health agenda to that of Corresponding author.
E-mail address: [email protected] (A. Thorpe).
sustainable development can and should play a key role in this process.
The national picture There is an extensive body of literature available on sustainable development. Definitions vary, but in the main they draw out environmental, economic and social dimensions of the concept, emphasizing that progress to date has been achieved at huge cost. The 2005 UK sustainable development strategy sets out five principles,2 which resonate strongly with the practice of public health:
living within environmental limits; ensuring a strong healthy and just society; achieving a sustainable economy; promoting good governance; using sound science responsibly.
0033-3506/$ - see front matter & 2006 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2006.10.003
ARTICLE IN PRESS Sustainable development and public health
1103
The agenda is clearly articulated in strategy and policy documents, underpinned by a series of 68 detailed indicators, many of which are also direct public health indicators, e.g. healthy life expectancy, mortality rates, smoking, childhood obesity, to measure progress across the four priority areas:
nity to position the public health narrative alongside that of sustainable development to promote both sustainable health for the population, and a sustainable health care system for England. This is a challenge we cannot afford to ignore—and that means acting on the evidence we have.
A congruent agenda
sustainable consumption and production; climate change and energy; promoting natural resources and enhancing the environment; creating sustainable communities and a fairer world.3
Yet despite this, we are told: ‘Sustainable development is one of those things that everybody supports, but no-one really knows what it means in practice!’.4 Over the years, similar things have been said about the practice of public health, with a brief overview of the literature drawing out many parallels between the two areas. Throughout history, many classic pollution control measures have been underpinned by a public health rationale—for example, air and water quality; control of hazardous substances; and the new chemicals regulation under REACH (Registration, Evaluation an Authorization of Chemicals). For both, success is accrued in long term outcomes and trendsa, with a shared strategic focus which moves beyond individualism to look at populations, health inequalities and social justice. Even the policy papers have similar names.5,6 Yet perhaps the greatest congruence is around the delivery mechanisms, with the literature recognizing that for both the emphasis is on early upstream interventions, promoting behavioural change, and that strong partnership working approaches both across individual government departments but also the whole of society are fundamental to achieving their goals.
Linking sustainable development with public health practice But whilst this provides a clear view that there are areas of possible convergence, making sense of the public health agenda, and making its link to that of sustainable development both explicit and meaningful, requires unrelenting effort, and a conscious focus on maximizing the opportunities for joint working. The indicators provide a shared opportua
Which, as the Prime Minister recognizes, makes them politically more difficult than other more visible short-term policy priorities.
The cost and long-term sustainability of our health system is the focus of increasing interest across the whole of the UK. Despite massive investment, with current health expenditure in the UK running at around 7.7% of national GDP and expected to reach 0.3% of global GDP by 2008,7,8 the economic statistics make stark reading and reveal the scale of the challenge. For example:
recent economic analysis suggests that the total cost of preventable illness is around £187 billion per annum, or 19% of total GDP for England;9,10 obesity and its consequences are estimated to cost the NHS around £1000 million in hospital admissions, clinic appointments and prescriptions;11 smoking, which is the biggest single preventable cause of death12 and ill health is estimated to cost up to £1700 million per year in terms of GP visits, prescription, treatments and operations, with extra costs incurred from passive smoking, smoking-related diseases, and associated costs;13 mental health problems are estimated to cost some £12.5 billion for care provided by the NHS, local authorities, privately funded services, family and friends, with an additional £23.1 billion in lost output in the economy caused by people being unable to work (paid and unpaid).14
We have the evidence to show that more needs to be done on preventing these conditions from arising if we are to achieve a sustainable health service as well as marked improvements in people’s quality of life. But we also know that having the evidence is not enough—we need to act on it. In many cases we need to seize new opportunities to join up messages appropriately, and this has implications for both the economic sustainability of the country and health and well-being status of the population in the long term. Take smoking, for example. In smoking cessation, we have a widely acknowledged cost-effective intervention,15 yet a survey of 4000 heart patients leaving acute hospitals in England in 2005 reported that 41% had not received information on smoking cessation,
ARTICLE IN PRESS 1104 50% had received no dietary advice, and 35% no advice about physical activity.16 As Wanless recognized,17 ‘it is evident that a great deal more discipline is needed to ensure problems are clearly identified and tackled, that the multiple solutions frequently needed are sensibly co-ordinated and that lessons are learnt which feed back directly into policy’. And implemented in practice—by working with people and across society to support sustainable behavioural changes, and working across government to ensure that public health and sustainable development dimensions are properly integrated into the whole range of policies.
Making a difference By reinforcing the relationship between the health of the nation and the economic health of the country, recognizing that better health and wellbeing go hand in hand with economic prosperity, and can both be enabled by and contribute to better environments, effective public health policies are an essential part of sustainable development strategies. But to translate rhetoric into measurable achievements we need to increase our reach outside the traditional health service silos, across government, into local government, the voluntary sector, and communities themselves. Many of the foundation stones for delivering on this challenging programme are already in place. At a national level, the portfolio of the Minister for Public Health implicitly recognizes the enormous potential of making creative links between the public health, health inequalities and sustainable development agendas. The recent addition of a cross governmental responsibility for physical activity provides a unique opportunity for public health, with a great potential for encouraging cross-agency working for mutual advantage. Every day sustainability of the environment is being directly linked to health improvement. The government has recently commented on the dually positive impact of walking and cycling on the environment and the health of our population.18 But the vision is most clearly articulated within the successful 2012 Olympics bid, which provides a unique opportunity to demonstrate that economic sustainability can be linked to regeneration, environmental improvement and the long-term health and prosperity of the population. Whilst work is already demonstrating an impact at a local level,19 the greater challenge will be to systemize this impact for a sustainable legacy across the whole of the UK.
F. Adshead et al. At a regional and local level, extant action plans focus attention on the key role the NHS can play in assuring sustainability. With increasing levels of investment, the NHS is more than a provider of services. It is the largest single organisation in the UK, representing on average 10% of regional economies.20 Mobilizing this level of investment, using existing corporate powers and resources in a more systematic way to benefit local economies’ sustainable development strategies offers the potential for the NHS to make a significant difference to people’s health and to the well-being of society, the economy and the environment through its day-to-day activities. With the launch of the Corporate Citizenship toolkit, developed as a result of Choosing Health, NHS managers now have a practical weapon in their arsenal to help realise this potential. It provides detailed guidance, examples of good practice, and supporting evidence to help NHS managers identify and assess their contribution to sustainable development in six key areas: Transport; Procurement; Facilities Management; Employment and Skills; New Buildings; and Community Engagement. It has proven popular, with 10,500 visits to the website since its launch, and 248 organizations registered to use the self-assessment model, of which 130 are NHS bodies.21 So we know that things are already happening— but we need to sustain and accelerate this process to achieve our twin goals of sustainable development and health improvement. National policy reflects our understanding that government cannot do this alone—a proactive, systemic approach which draws on and promotes effective partnership with others, engages communities in supporting themselves, and provides a supportive environment for individuals to help them make the right choices for themselves will be key to realizing our vision. From social marketing, to health trainers drawn from local communities, our policies are exploring new ways of connecting to people, helping people to realize their own goals for a healthy and sustainable future. Delivering on sustainable development will be a challenge—but the synergies between this agenda and the public health agenda mean it is a challenge with which public health professionals are increasingly ‘fully engaged’. And we cannot afford not to be—getting this right now could shape the way we live for generations to come.
References 1. 10 Downing Street website, Big Issues, Climate change: facing the challenge, /http://www.nymber-10.gov.uk/output/Page9020.aspS accessed 23 August 2006.
ARTICLE IN PRESS Sustainable development and public health 2. HM Government. Delivering sustainable development together: shared UK principles for sustainable development, /http://www.sustainable-development.gov.uk/what/ principles.htmS accessed 23 August 2006. 3. Department of the Environment, Food and Rural Affairs. Sustainable development indicators in your pocket. London, DEFRA, 2006 /http://www.sustainable-development. gov.uk/progress/documents/sdiyp2006_a6.pdfS accessed 23 August 2006. 4. NHS Purchasing and Supply Agency. Sustainable development: what every supplier should know. Factsheet 2, March 2004. 5. Wanless D. Securing our future: taking a long-term view. London: HM Treasury; 2002. 6. HM Government. Secretary of State for Environment, Food and Rural Affairs. Securing the future: delivering UK sustainable development strategy, 7 March 2005. 7. Office for National Statistics. Health spending up, 16 December 2003 /http://www.statistics.gov.uk/pdfdir/ healthex1203.pdfS accessed 22 June 2006. 8. Le Grand J, Stoate H. Sixty years on, how Bevan’s vision is bearing up. HSJ debate. Health Serv J 2006;116(27): 20–3. 9. Lister G, Fordham R, Mugford M, Olukoga A, Wilson E, McVey D. The societal costs of potentially preventable illnesses: a rapid review for the national social marketing strategy. London: National Consumer Council; 2006. 10. National Social Marketing Strategy for Health. It’s our health! London: National Consumer Council; 2006.
1105 11. Nuffield Council on Bioethics. Public health: ethical issues. A consultation paper. London: Nuffield Council on Bioethics; 2006. 12. Department of Health. Annual report of the Chief Medical Officer 2004. London: Department of Health; 2005. 13. Department of Health. Smoking kills. A white paper on tobacco. London: The Stationery Office; 1998. 14. The Sainsbury Centre for Mental Health. Economic and social costs of mental health in England. London: Sainsbury Centre for Mental Health; 2003. 15. Stapleton J. Cost effectiveness of NHS smoking cessation services. London: King’s College; 2001. 16. Healthcare Commission. Survey of 4000 heart patients leaving acute trusts in England. Reported 8 June 2005. 17. Wanless D. Securing good health for the whole population. London: HM Treasury; 2004. 18. Alexander D. Speech by secretary of state for transport, 26 June 2006 to Transport, Atmosphere and Climate Conference /http://www.dft.gov.uk/stellent/groups/dft_susttravel/ documents/page/dft_susttravel_611958.hcsp.S accessed 29 August 2006. 19. Newham Council, Government minister congratulates Newham. Press release 19 June 2006 /http://www.newham.gov.uk? News/2006/June/GovernmentMinsitercongratulatesNewham. htmS accessed 30 August 2006. 20. East of England Regional Assembly and east of England Sustainable Development Round Table. A sustainable development framework for the East of England. 21. Gibbs M. Personal communication, 19 September 2006.