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Tuesday, July 6, 1999 Published at 12:16 GMT 13:16 UK


Crusade on nation's health

Targets on cancer and heart disease depend on less smoking

Dr Iona Heath, BMA and Rita Gunatilleke, HV: Danger is that health inequalities will be exacerbated
The government is set to unveil its ambitious targets for improving England's health in the next 10 years.

A White Paper on public health will contain improvements that ministers expect the NHS to achieve in cancer, heart disease, mental health and stroke care.

Anna Coote, King's Fund charity: White paper will address inequalities
Ministers also want to close the gap between the health of the poor and the better off.

The paper, which is expected to be debated at the annual conference of the Association of Community Health Councils on Tuesday, will also propose a shake-up of the way that health authorities and government can influence and improve public health.

[ image: Dentists would like all drinking water to be fluoridated]
Dentists would like all drinking water to be fluoridated
Another controversial proposal which the paper is expected to contain is that the fluoridation of tapwater is extended to cover more areas of the country.

Currently only 10% of areas receive fluoridated water, which studies have shown to reduce the incidence of tooth decay in the young.

The BBC's James Westhead: "Defibrillators are becoming essential emergency equipment"
And, in an attempt to reduce the number of deaths from heart attacks, the government will propose that defibrillators, which give electric shocks to restart the heart, are placed in public places such as railway stations.

Grotesque inequalities

The government released its consultation paper on the targets, Our Healthier Nation, at the beginning of 1998.

Health Secretary Frank Dobson told the BBC: "We can expect a healthier nation as a result of what we are doing. We have a specific wish to reduce the grotesque inequalities in health which really mar our society."

Health Secretary Frank Dobson: Nation's health will improve in near future
Mr Dobson said a range of government policies would help to improve health, including the introduction of a minimum wage, family tax credits and the New Deal to get people back into work.

He said the government was also spending £15bn over three years to tackle the problem of homeless, a major cause of ill health.

If the government's four broad targets were met, they should save at least 15,000 lives a year.

  • Heart disease and strokes: To reduce the number of deaths in people under 65 by a fifth by 2010. This would save 8,000 lives a year.
  • Cancers: To cut the number of deaths from all cancers in people under 65 by a fifth by 2010, This should save 6,000 lives a year.
  • Accidents: To reduce accidents in the home, on roads and at work by a fifth by 2010.
  • Mental Health: To cut the number of suicides and deaths by "undetermined causes" by a sixth by 2010. This would save another 800 lives.

However, the proposals could be even more ambitious in some areas, demanding a cut of two-fifths of heart disease and stroke deaths in under-75s, and one fifth of cancer deaths in people under 75 rather than 65.

[ image: Exercise promotion could cut deaths from heart disease]
Exercise promotion could cut deaths from heart disease
These two targets depend greatly on achieving a significant reduction in the number of smokers in the UK, and government has already pledged to ban tobacco advertising and raise cigarette prices.

Other measures which could form part of the White Paper include a telephone help line to advise patients about "health scares" such as that which raged over the MMR vaccination for babies.

And the Health Education Authority, the government body in charge of promoting public health, looks likely to be replaced with a more powerful agency which will produce guidelines on health development programmes.

Doctors' expectations

Dr Sarah Taylor, chairman of the BMA's Public Health Committee, said she hoped the white paper would be ambitious.

She said: "We regard their proposals as not bad, and certainly better than nothing at all. But we are disappointed that they isn't very radical."

[ image: Health Education Authority could be replaced]
Health Education Authority could be replaced
The British Dental Association has also campaigned for fluoridation of water, and says that the White Paper should make it easier to introduce it into new areas.

Dr Liam Fox, Conservative Health spokesman: Health getting worse under Labour
Currently many water companies claim they have the final discretion over whether fluoridation is introduced or not.

A spokesman said: "What we are looking for is a government commitment to legislation to ensure water companies are obliged to fluoridate water supplies when asked to do so by the local community."

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