Prevention better than cure for damaging lifestyles

The Welsh Government is currently considering responses to its consultation on proposals for a Public Health Bill for Wales. A new paper jointly commissioned by the UK Health Forum, the Institute of Healthcare Management and the Royal Society for Public Health to inform the consultation was published last week (here). It examines the different uses of public health law around the world – including public health acts – to respond to the growing burden of non-communicable diseases by addressing the major, modifiable risk factors: smoking, poor diet, alcohol and sedentary behaviour.

The paper discusses four broad types of legislation from the UK, US, Canada, Australia, New Zealand and European countries. These legislative approaches include requirements to use Health Impact Assessments, duties to reduce health inequalities, legislation on the prevention of ill health, and legislation to strengthen community action around health protection and health improvement.

Non-communicable diseases (NCDs) are increasingly responsible for serious health and economic burdens to governments around the world. NCDs stem from the modifiable risk factors of tobacco use, harmful use of alcohol, lack of physical activity, and the overconsumption of salt, sugar and saturated fat. Because treatment of these diseases is expensive, prevention is therefore highly cost-effective. One way for governments to respond to the NCD epidemic is through the use of public health law as a way to reduce population exposure to these risk factors.

A central question in public health law and policy is the degree of intervention which is appropriate to improve population health. In 2007, the Nuffield Council on Bioethics presented a vision of the stewardship role of the State. Under this model, it is understood governments have a “duty to look after important needs of people individually and collectively”.

From this perspective, the aim of public health programmes should encompass reduction of risk, environmental protections, protections for vulnerable populations, health promotion, enabling populations to make healthy choices, access to medical services and a reduction of health inequalities.

The law can be used to advance public health in a number of different ways. A 2011 WHO Regional Office for Europe report sets out four major roles:

1. Defining the objectives of public health and influencing its policy agenda.
2. Authorizing and limiting public health action with respect to protection of individual rights, as appropriate.
3. Serving as a tool for prevention.
4. Facilitating the planning and coordination of governmental and nongovernmental health activities.

In most European countries and elsewhere in the world, public health legislation is contained in separate acts and regulations because of the scope of the issues and stakeholders. Another approach however is to develop a law specifically addressing public health. This is what Wales is proposing. In practice, most jurisdictions use a combination of the above approaches, with a specific public health law as well as provisions integrated into other legislation.

Legislation of this type would change the way non-health sectors and industry function within Wales – for example, requiring organisations to undertake Health Impact Assessments of their activities. We could expect immediate consequences for activities such as education, urban planning and transport.

However, despite the significant impact such a Bill could have in Wales, there has been little discussion within the public health community on what this would mean. Public health legislation would be a crucial first step in promoting such a debate. Wales could lead the UK on addressing key World Health Organisation objectives for health in all policies.