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Last Updated: Tuesday, 16 November, 2004, 13:30 GMT
Mixed reaction to public health reforms
Overweight man
Traffic light coding could be used to warn people about unhealthy food

Ministers have announced a range of proposals to improve public health.

They have acted after the 2002 Wanless Report warned unless the nation becomes healthier NHS costs could rise by an extra 30bn by 2020.

Planned measures include a smoking ban and clearer labelling on food.

Improved access sexual health services is also need, Health Secretary John Reid said.


The White Paper proposes a ban on smoking in restaurants, cafes, offices and pubs which serve food.

But the measures have not gone far enough for many.

Deborah Arnott, of Action on Smoking and Health (ASH), said the proposals might be unworkable.

"We know from Ireland that what makes a ban work is to have a simple, level playing field where you can't smoke in any workplaces."

Ashtray in pub
The proposed smoking ban does not go far enough, many say

Prof Alex Markham, chief executive of Cancer Research UK, said it was a "huge missed opportunity".

"The government has failed in its fundamental duty to protect our citizens' health and safety by opting out of a total ban on smoking in public places.

"Its like having the legislation to fit all cars with seatbelts because we know seatbelts save lives and then stopping some passengers from wearing them."

Fiona Castle, widow of show business personality Roy Castle who died as a result of passive smoking, said she was "appalled" people in England were not going to be offered the same protection as places where there were blanket bans.

And British Medical Association chairman James Johnson said he was concerned pubs would find loopholes in the law.

But Forest director Simon Clark said most people would be happy with more no-smoking areas and better ventilation and a ban was a "systematic attempt to demonise smokers and their perfectly legal habit".

And Chris Ogden, of the Tobacco Manufacturer's Association, said: "The solution that seems to have been reached is a pragmatic one.

"But it probably goes further than it needs to do."

Mark Hastings, of the British Beer and Pub Association, said some pubs would drop their food menus to allow smoking to continue.

"It does seem strange that the Department of Health is pursuing a policy that will drive us to drink."


The government has said it wants to see the advertising industry impose voluntary restrictions on the advertising of high-fat and high-sugar foods to children. Other measures - including legislation - would be considered if the government judges too little has been done by the 2007 deadline.

Marketing to children is incredibly sophisticated
Dame Deirdre Hutton

Dame Deirdre Hutton, of the National Consumer Council, welcomed the proposal.

"Marketing to children is incredibly sophisticated."

She added: "We want to see advertisers being much more creative in promoting healthy foods to children."

The BMA's Mr Johnson said he was pleased the White Paper was tackling obesity, calling the proposed ban a "bold initiative".

Professor Sir Alan Craft, president of the Royal College of Paediatrics and Child Health, also welcomed the planned ban.

However, he said: "What we must also see from the government is a sustained, high-profile campaign to motivate children as well as adults to eat a healthier diet and adopt a more active lifestyle."

Peter Hollins, director general of the British Heart Foundation, said: "Clearly the focus on children is a welcome investment in the future and we look forward to further details of legislation to protect children from a barrage of unhealthy messages."


Supermarket shelves
Red, amber and green stickers could be attached to food

Food sold in supermarkets could be labelled so consumers can tell what is good and bad, perhaps using a traffic light system - red for unhealthy, green for healthy.

Dame Deirdre praised the proposal. "Consumers need some simple practical ways to help them choose a healthy diet.

"At the moment it is really difficult to tell what some processed foods have in them. They can be stuffed full of salt, fat and sugar."

Dr Vivienne Nathanson, head of science and ethics at the British Medical Association, said: "Colour coding food according to fat and salt is a really good idea."

And Dr Ian Campbell, president of the National Obesity Forum, added the measures were what was hoped for, particularly the recommendation for an "independent national partnership on obesity".

"It is only when government, industry and the professions start to work together that we will really see the improvements in obesity and its associated diseases that are so desperately needed.

"There has never been a more urgent need to act and act decisively."


Under the White Paper proposals, Ofcom may strengthen rules on broadcast advertising of alcohol, particularly adverts aimed at underage drinkers.

Regularly drinking alcohol can increase the risk of developing breast cancer.
Antonia Bunnin
There will also be investment in NHS services to tackle alcohol problems at an early stage and the government will work with the Portman Group, a support organisation which encourages responsible drinking, to reduce binge drinking.

Antonia Bunnin, from the charity Breakthrough Breast Cancer, said the measures to reduce excess drinking were particularly welcome.

"Regularly drinking alcohol can increase the risk of developing breast cancer.

"However, our recent research shows that very few women are aware of these risks.

"We now want to see government action to raise awareness of these risks and help the public make informed choices about their lifestyles and the impact on their future health."

But the Royal College of Physicians said the government had missed an opportunity to tackle alcohol misuse.

Professor Ian Gilmore, chair of the RCP's Alcohol Committee, said alcohol had been given a "low profile" in the White Paper and it did not build on previous initiatives.

"We do not feel that the Ofcom regulations have been strengthened enough."


NHS patients could be referred to personal lifestyle gurus for "health MOTs" to help them address their health problems.

Grahame Pope, of the Chartered Society of Physiotherapy, said: "Health MOTs could be a positive step forward in preventing ill health and we believe tailored exercise programmes will form a crucial part of this process."

Dr Mayur Lakhani, chair of the Royal College of GPs, said: "We applaud the idea in principle. However GPs and nurses already do offer lifestyle advice to patients.

"We would welcome more resources to extend this work as long as they are part of the existing primary health care team."


The government plans to introduce new information campaigns for young people and deliver 48-hour access to genitourinary clinics by 2008 to help improve sexual health.

Couple kissing
The issue of sexual health is moving up the agenda, say campaigners

Mr Reid also promised to complete an early roll out of the chlamydia screening programme by 2007.

Baroness Joyce Gould, chair of the Independent Advisory Group for Sexual Health and HIV, said sexual health was moving up the agenda.

"The White Paper outlines many positive developments."

Gill Frances, deputy chair of the Independent Advisory Group on Teenage Pregnancy, added: "The measures outlined in the White Paper will support the excellent work that is already being done around the country, but we specifically welcome any steps which will further increase young people's access to confidential, "teen-friendly" contraceptive information and services."

Nigel Edwards, director of policy for the NHS Confederation, also welcomed the proposals.

"Sexual health in particular has been one of the forgotten parts of the NHS by government, so more funding and a grater focus on this is an important step forward for better patient care in this sector."

But Deborah Jack, chief executive of the National AIDS Trust, said: We are very disappointed that the specific needs of gay and African communities are largely ignored and that the particular challenges around HIV, including stigma and discrimination are not addressed."


Measures have been put forward to tackle inequalities experienced by people from ethnic minority communities in accessing services.

And by 2005, Sure Start should include provisions to deal with mental health problems developing in later life and guidelines should be published on the management of mild to moderate mental ill health in the workplace.

Richard Brook, chief executive of mental health charity Mind, said: "The public could be forgiven for thinking that Britain's health problems are confined to smoking and unhealthy eating.

"Healthy lifestyles are important - that cannot be denied. But we would like to see the government recognise that improving the nation's mental health is an integral part of a much bigger picture."

Marjorie Wallace, chief executive of the mental health charity Sane, said: "We are disappointed that the government should choose targets which we believe do not recognise the urgent needs of the thousands of people with mental illness now who are at risk of self-harm, abuse of drugs or suicide."

But the Mental Health Foundation welcomed the White Paper as a new beginning, placing mental health firmly in the public health sphere.

A spokeswoman said: "The paper's focus on strengthening individuals and communities provides a solid foundation for what the charity hopes will be a new era of strategic thinking on public mental health."


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