Listening to you: Your health matters - Consultation on proposals for a Public Health Bill

Introduction:SummaryEvery one of us can benefit if Wales has good health. A healthy population is good for economic growth and prosperity. Poor health is bad for individuals, bad for communities and has a negative impact on prosperity.The responses to the consultation on our Green Paper on Public Health indicated strong support for legislation as a way of driving further improvements in people’s health across Wales. The Welsh Government has taken account of this call for action in two distinct ways, through developing proposals for a Public Health Bill and ensuring health is a key element in the forthcoming Future Generations Bill.The ‘Listening to you – Your Health Matters’ White Paper presents a series of proposals for primary and secondary legislation which seek to address priority public health issues such as tobacco, alcohol misuse and obesity, and could be taken forward within the scope of our current powers. Together, they can have a real and lasting impact on health and wellbeing. The proposals are presented as part of three strands of activity, reflecting our commitment to action across the life course, to build healthy communities and to regulate certain activities.In addition to the proposals for a Public Health Bill, the Welsh Government has also responded to suggestions calling for legislation which directs organisations to consider health in all their policy development. The Future Generations Bill will require the whole of the public service in Wales to contribute to healthy thriving communities, a healthy environment and a vibrant culture. This will help ensure health is taken into account with regard to how they operate, set their priorities and allocate resources. Health will therefore be positioned within a broader framework which supports sustainable development rather than be treated as a stand alone issue.The case for action1.1 The health of the population of Wales is continuing to improve. In general, people are living longer and enjoy better health than ever before. However, it is also clear that Wales, with other countries, faces a number of specific and significant health challenges.1.2 The Welsh Government has ambitions to accelerate the pace of improvement and share it more equally. We are fully committed to taking action wherever appropriate to help further improve and protect health for everyone. The Programme for Government contains a number of commitments intended to help us deliver on this ambition.1.3 Until fairly recent times, the main focus of government in improving health was protecting the public from major health threats. Those included infectious diseases, occupational disease and injury, unsafe air, water and food, and poor sanitation, housing and transportation. Legislation has played an important part in all these areas, though other factors such as advances in medicine, technology and engineering have also played a significant role.1.4 Governments over time have needed to keep pace with emerging public health priorities and be in a position to respond appropriately and in a timely manner. We are in a society which is developing quickly and over the last half century a number of new challenges have appeared. These include:-a rise in lifestyle-related diseases; continued and new challenges associated with communicable diseases, such as the management of antimicrobial resistance and public complacency about the importance of vaccination and immunisation in protecting both individuals and the public at large; changing health and social needs related to an ageing population (which is in itself a consequence of successes in increasing life expectancy); real and potential health problems associated with climate change; and the stress and anxiety resulting from economic/financial conditions, and resulting pressures on living standards and public services.1.5 Every one of these argues for more preventative action and a closer and more engaged relationship between government and the public. Otherwise we simply cannot afford the human and societal costs that these will produce.1.6 The Welsh Government, like governments worldwide, needs to respond firmly and effectively to such challenges – and new ones as they emerge. Among the levers available, legislation can be one of the most powerful.1.7 A prime illustration of how legislation can make a positive contribution to public health can be found in Welsh tobacco legislation, consisting of a ban on smoking in public places, and on selling tobacco through vending machines and point of sale regulations. Such measures have made a real difference to many people, in terms of cigarette smoking, exposure to second hand smoke inhalation, and societal norms about smoking.1.8 These types of measures are wholly consistent with principles of prudent health care2, as they seek to intervene at the point where there is maximum return for investment. The example of the tobacco control measures outlined above provides a clear illustration of how legal intervention can contribute to a long term positive impact in terms of health gain. Such actions are considered to be both proportionate and preventative in terms of protecting public health, as they help avoid far larger damage to the health of individuals in the future, together with the greater costs involved. They also have a powerful impact on health inequality, because we know that many of the dangers which can be addressed through public health legislation fall disproportionately on the most disadvantaged individuals, families and communities. A Public Health Bill gives us an opportunity to continue to intervene at the point where there is maximum return for our investment and pursue further legislation, where appropriate, for improving health.A shared responsibility1.9 Health is everyone’s business. Government needs to deliver on creating the social conditions and environments that are conducive to good health, and providing the services necessary for this. There is a corresponding responsibility on all of us to look after our own health, and access services appropriately when we need to.1.10 This reciprocal responsibility depends on everyone striving for good health and working for it. It underpins the proposals outlined in this White Paper and is consistent with well-established international principles such as those of the Ottawa Charter for Health Promotion3 and the 2010 Adelaide Statement on Health in All Policies.1.11 It is a fundamental principle of the Welsh Government that everyone in Wales should have a fair opportunity to lead a healthy life. We should reduce and, if possible, eliminate unfair, avoidable differences in health which harm particular groups or individuals over a lifetime or across generations.1.12 Whilst people are responsible for their own behaviour, we know behaviours such as smoking are also influenced by family and friends, communities and the wider cultural and economic environment. These factors are of particular consequence to people with lower incomes and low educational achievement, and can contribute to well recognised inequalities in health outcomes and healthy life expectancy.1.13 We acknowledge that there can be a fundamental tension between a government intervening to address major challenges to public health, and an individual’s freedom to ultimately live their life in the way he or she chooses. There is also a debate to be held, however, about the extent to which people who choose to engage in all kinds of unhealthy behaviours which are known to be risky to their own health and wellbeing should also expect to bear the consequences of such decisions. In an age of austerity, that debate cannot avoid encompassing the fact that treating avoidable illness arising from smoking, misuse of alcohol or obesity draws disproportionately on the pool of resources available to provide health services for all. Compelling Welsh evidence indicates that even modest increases in uptake of healthy behaviours could considerably reduce the population burden of vascular disease, dementia and death from heart disease.1.14 The Welsh Government believes it is duty bound to consider all levers available for improving and protecting health. However, we also accept that any intervention has to be in keeping with prudent health care; justifiable, appropriate and proportionate. Other factors also need to be assessed, such as the associated costs, and whether the intervention needs to be supported by an enforcement regime. Such considerations have been taken into account in the development of the policy proposals outlined in this White Paper and have informed the consultation questions included in each Chapter.