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New public health approach planned

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The Government is planning to take a 'less intrusive' approach to public health

The Government will take a “less intrusive” approach to public health – nudging people rather than restricting their choices, the Health Secretary is due to say.

Andrew Lansley will set out plans for changing “social norms” around obesity, smoking, alcohol and exercise so that healthier choices are easier for people to make.

The Government’s white paper will describe the creation of a new public health service from existing organisations and will promise to ring-fence public health budgets.

There has been criticism in the past over NHS trusts raiding public health finances to plug deficits and gaps in other services. Under the plans, responsibility for public health will be transferred back to local government and away from NHS trusts, where it currently sits.

Public health directors will be moved to local councils to work as “champions” of healthy living. A Health Inclusion Board, chaired by Professor Steve Field from the Royal College of GPs, will look into the causes of deprivation and health inequalities.

A new public health premium will be introduced – a payment by results incentive for delivering improvements and reducing health inequalities between different groups in society. Mr Lansley will say the Government intends to keep out of people’s everyday lives as much as possible but will support them in making healthy choices.

He will point to a model called the Nuffield Ladder of Interventions, which is a scale designed to encourage people to change their behaviour. It starts with realising that some behaviour trends fizzle out on their own and no interventions are required.

The next step is to give people information and education to make a choice for themselves based on evidence. Following that, there is “enabling choice” – giving people a nudge in the right direction so they can change their behaviour.

This might include creating or improving access to public exercise facilities, cycle paths and playgrounds. Another tactic is to try to change social norms followed by guiding choice through “incentives”. This might include a “points mean prizes” approach, for example children who walk to school earning points towards an activity day.

At the end of the ladder are more direct interventions, such as increasing taxes to discourage people from smoking or drinking, and restricting or banning things, such as unhealthy fats.

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