We were hoping for something bold and ambitious. In the end, it is a missed opportunity

On Monday night, the government released its much anticipated green paper (read, consultation) on prevention with no fanfare; not even a press release.

Published amid reports of a row between the Health Secretary Matt Hancock and outgoing prime minister Theresa May, it’s probably unsurprising that the paper lacks ambition. 

Matt Hancock’s original prevention vision took aim at the Ageing Society Grand Challenge—five years additional healthy life expectancy by 2035 while narrowing inequalities. This was published at a time of unprecedented stalling in healthy life expectancy and widening of health inequalities, and the green paper now sensibly admits that it “will not deliver the whole ‘5 years’”. But if a prevention green paper isn’t going to deliver this target, then what is?

We were hoping for something bold and ambitious; something that would reorient the health and care system towards prevention and put health creation at the heart of government policy. In the end, it is a missed opportunity.

In terms of what is included, the paper rather surprisingly reports chapter 3 of the childhood obesity plan. But the expected extension of the soft drink industry levy to include milk drinks, has been watered down to something which “may” be implemented “if the evidence shows that industry has not made enough progress on reducing sugar”. Similarly, there are no firm commitments on infant food labelling and marketing, or front-of-pack nutrition labelling.  

There is the confirmation of pre-existing plans to ban sales of energy drinks to children, and the re-iteration of an aim for the country to be “smoke-free” by 2030. This is an ambitious target for the government to commit to, but we will have to wait till a “later date” for the details of how this is to be achieved.

As expected, there’s a lot about the role of technology, personalised prevention, and genomics: areas where Matt Hancock is known to have a strong personal interest. This has a place in modern medicine and disease prevention, but it can’t come at the cost of getting the basics right on the wider-determinants health, which we know are the biggest drivers of ill-health and inequalities. 

So, if this is a consultation document, what should we be saying to government about prevention? 

While there’s a nod to the importance of issues such as housing, planning, and transport in the paper, it fails to provide a coherent approach to tackling these root causes. With local government facing a £3.2bn funding gap in 2019/20 and the public health grant soon to be 25% less per person than in 2014/15, it’s clear that any serious attempt to have an impact on prevention needs to be backed by reversing public health cuts at least.

Such funding increases could be made more attractive in the future by the development and launch of the much-trailed new Composite Health Index to track population health alongside GDP. This has the potential to be a game-changer if it is used to evaluate policy decisions across government departments in the way that New Zealand has started to use similar measures in its wellbeing budget. 

So, as Boris Johnson settles into number 10, the long-term battle to put prevention and health creation high up on the government agenda needs to continue, with his first budget being next on the watch list. This green paper is a very small step in the right direction, but great strides are needed before we start seeing real change.

Adam Briggs is a public health specialty registrar based at the Health Foundation and an academic visitor at the Nuffield Department of Population, University of Oxford.

Tim Elwell-Sutton is Assistant Director of Strategic Partnerships at the Health Foundation

Competing interests:

AB declares the following interests: 

• Member of the UK Faculty of Public Health and past member of the UK Health Forum, both of which have position statements supporting a soft drink tax.
• Co-applicant on the NIHR funded five-year evaluation of the UK Soft Drink Industry Levy.
• Have written various research and commissioned articles on soft drink taxes.

TES has no interests to declare.