The new public health manifesto from the Conservatives aims to shift responsibility from national schemes to local communities. Nick Hughes reports

Anyone complaining of a lack of choice in British politics should have a flick through the Conservative Party's Healthier Nation paper. The 30-page document, which forms the party's public health manifesto, could hardly represent a starker contrast to Labour's approach.

Proposals to localise public health initiatives, use social psychology and behavioural economics to inform strategy, and create a new dedicated and fully budgeted Public Health department are a clear indication that, at least where public health policy is concerned, Labour and the Tories are on markedly different wavelengths.

Talk is cheap, however, and the Tories will be judged on whether they can deliver if and when they gain power. The early signs are less than positive. In the press statement that accompanied the manifesto, shadow health secretary Andrew Lansley declared his intention to "mandate the display of GDAs on food packaging". This is not the UK government's to mandate. Any legislation on nutritional labelling will be passed at EU level, with little prospect of a provision for national schemes. It's impossible-to-keep promises like this that risk undermining what many believe to be a progressive policy.

"We strongly support an approach based on government, retailers and others working together to achieve shared public health goals, and the paper's commitment to proper evaluation and basing policy on evidence," says BRC chief executive Stephen Robertson.

The Conservative strategy is pegged on a promise to reduce health inequalities. Central to achieving this goal is the belief that a local, rather than national, approach to public health is better equipped to help the poorest in our society. The plan is to devolve responsibility for problems such as obesity to communities on a new payment-by-results basis. Local directors of public health will be required to partner with schools, businesses, councils and GPs to promote healthy choices.

In contrast, the current government's efforts have largely been built around high-profile national schemes such as Change For Life, which the Tories argue are poorly researched and evaluated and fail to target specific groups.

"Separating the public health budget from that of the health service is a bold move and the commitment to reducing health inequalities is a profound, but welcome change in Conservative thinking," says Dr Anna Dixon, acting chief executive of health improvement charity the King's Fund

The real questions, she observes, are "how much funding public health will receive and are the Conservatives committing to an increase in current spending on health inequalities?"

Estimates suggest about £4bn or 4% of NHS spending currently goes on public health. The paper fails to put a figure on how much communities will receive. It only talks of a 'Health Premium', where more funding will be given to communities that are deprived or that deliver results. It also promises more rigorous monitoring and evaluation of public health policies, including the use of supermarket sales data to track the impact of campaigns on purchasing.

This was one of the key recommendations put forward by the Public Health Commission, set up by Lansley in 2008. Another key recommendation was that Tory public health policy should straddle all government departments and focus on balancing calories in with calories out. The advice has been heeded. A Conservative public health policy would see planning, education and transport departments working together. The Tories propose a School Olympics, funded through the national lottery. Urban spaces, meanwhile, would be designed with cyclists and pedestrians in mind.

The food industry will still have to bear its share of responsibility. A Conservative government will extend voluntary restrictions on marketing to children to all media, pursue further targets on reformulation and portion size reduction and ensure alcoholic drinks provide an indication of calorie content.

Latest polls suggest the Tories will have the opportunity to put their words into action. The proof, as ever, will be in the delivery.

Read more
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Is health report blueprint for next government's strategy? (analysis; 11 July 2009)