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In February 1998, the British government published two green papers (consultative policy statements) for England and Scotland: Our Healthier Nation and Working Together for a Healthier Scotland. These outline a strategic approach to public health that build on earlier target setting exercises that have met with limited success.
The green papers are especially noteworthy in that the New Labour administration explicitly recognises the strong association between poverty and poor health and the need to tackle the former (as well as lifestyle and behaviour) in the context of a comprehensive health promotion strategy.
For England, 12 year targets will be set to reduce mortality and morbidity in four priority areas: heart disease and stroke, accidents, cancer, and mental health (suicide). Targets do not feature prominently (although they are not ruled out) in the Scottish paper which, in addition to the above four areas, flags up a number of others, particularly teenage pregnancy and dental health.
The green papers have been broadly welcomed by public health professionals. Disappointment has been expressed however on two main counts. First, no targets have been set to monitor progress towards reducing the widening socioeconomic inequalities in health in the UK. Second, the proposed action seems weak on specific, sustained, and adequately resourced measures designed to make a major impact on the underlying social, environmental, and economic causes of ill health. Moreover, while the poorer health (including injury) record of the Scots is acknowledged, this is not backed up by a commitment to mount a proportionately more vigorous health improvement programme north of the border.
For injury prevention professionals, the statements are a mixed blessing. On the positive side, “accidents” have held their place as priority areas in both England and Scotland. Unfortunately, the writers of the green papers have clung to an outmoded and discredited terminology, have offered virtually no new ideas to address the injury problem, and have proposed targets that are likely to be met in the absence of any further policy initiatives whatsoever. Cynics might argue that therein lies the huge political appeal of the target setting exercise!
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