Importance of education, research, and ethical considerations The cancer service framework, for example, shows how this might be done and what the difficulties are. In terms of the NHS, the development of National Service Frameworks will provide some of the strategic input into providing a service to the whole community with equality of access and of quality of care. Perhaps something similar would be useful now. The 1848 act had a board of health-a high level committee to oversee the changes proposed. There is a need for both capacity and capability and for a multidisciplinary organisation that could bring together in a powerful coalition all those concerned with improving the health of the people of England. The chief medical officer’s project to strengthen the public health function, which has been in progress for the past year, has begun to identify ways in which this strategic view can be put into practice. Through four key areas, and national targets which can be monitored on a regular basis, this approach allows a range of interests to be worked on with a common agenda. The Health of the Nation strategy and the recent strategy set out in Our Healthier Nation 1 provide the vehicle for setting out a strategic approach, across government, to improving health.
2 How do they relate to current health issues? These principles have been expanded recently in a book.
#POPULOUS VS POPULACE SERIES#
So how can we continue to improve health in England? For the past six years I have published as part of the chief medical officer’s annual report on the state of the public health a series of principles that set the tone for assessing health issues and my response to new problems. Environmental problems, though different, are a continuing cause for concern. The role of women still needs strengthening. Inequalities in health exist, and may even have become more marked. There is still excess winter mortality-not so marked in other northern countries. Mortality in young men is still too high. Life span, mortality, disappearance of diseases, and quality of life have all improved considerably. What then has changed over the past 150 years, and do we need a new act to continue to improve health in England? Health has improved immeasurably in all variables studied. I have wondered at times whether renaming my department the Department of Health and Happiness would send a signal about the relation between health and feeling better and improving the common weal. Health is not just about living longer, but about a better quality of life and wellbeing.
Improving health is a multidisciplinary task, and all professionals need to participate. Interestingly, the 1848 act heavily involved the church and church wardens, and religious organisations remain a relatively untapped resource for improving health.
This encourages health authorities, local government, trade unions, employers, voluntary bodies, universities, local groups, etc to become fully involved. The development of health improvement plans, health action zones, and healthy living centres and the creation of a strategy for health (set out in Our Healthier Nation 1) provides the framework for action. The appointment of a minister for public health provides top level political input. Most of the principles outlined above apply at present. Those who drafted the 1848 act had no such doubts, though they were concerned mainly with public health and health protection, rather than with the health of individuals.
It still leaves open to question the “nanny state” and how far government can go in legislating for improved health and protection of health. It can require great courage and perseverance to take this process through to a conclusion in the light of opposition from groups or individuals. The process is carried out openly with debate, discussion, and where appropriate amendment, before the final act is given royal assent. Should the state intervene with laws and bylaws, or should information be provided and individuals have choice and be allowed to make up their own minds? How far should the state go to protect the health of its citizens? The 1848 act took the view that as many of the problems affected the population as a whole, water, or sewerage, then health improvement was the responsibility of national and local government, and “inspectors of nuisances” would be appointed to deal with problems.Ĭould this be done now? Would the vested interests of the blood or tripe boilers mean that legislation would be delayed? The process of legislation is one in which an idea for improving health or health care is championed by an individual or group and is translated into a clear policy which then provides the framework for the parliamentary draftsman. The role of the state is a fundamental public health issue.
0 kommentar(er)
