{"id":45201,"date":"2019-07-24T17:20:24","date_gmt":"2019-07-24T16:20:24","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=45201"},"modified":"2019-08-02T10:37:29","modified_gmt":"2019-08-02T09:37:29","slug":"andrew-goddard-turning-the-green-paper-from-a-whimper-to-a-bang","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/07\/24\/andrew-goddard-turning-the-green-paper-from-a-whimper-to-a-bang\/","title":{"rendered":"Andrew Goddard: Turning the green paper from a whimper to a bang"},"content":{"rendered":"<p><span style=\"font-weight: 400\">The RCP\u2019s first reaction to the publication of <\/span><a href=\"https:\/\/www.gov.uk\/government\/consultations\/advancing-our-health-prevention-in-the-2020s\"><i><span style=\"font-weight: 400\">Advancing our health\u2014prevention in the 2020s<\/span><\/i><\/a><span style=\"font-weight: 400\"> is disappointment, both its content and the <\/span><a href=\"https:\/\/www.theguardian.com\/society\/2019\/jul\/23\/health-secretary-buries-paper-smoking-obesity-johnson\"><span style=\"font-weight: 400\">nature of its publication<\/span><\/a><span style=\"font-weight: 400\">. Making sure people stay physically and mentally well is too important to be quietly released on a Monday evening, hours before the announcement of our new prime minister.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The green paper can at best be described as a Curate\u2019s egg, good in parts. The Curate was, though, trying to be polite. The green paper correctly identifies many of the issues and talks about new technologies to tackle these. However, in effect it continues to deny the main problem<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">an urgent need to reduce health inequalities.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Unfortunately, it is nothing new. In 1977 one of my predecessors as RCP president, Sir Douglas Black, was asked by the Department of Health and Social Security to chair an expert committee into health inequality. Sir Douglas found that although overall health had improved since the introduction of the welfare state, there were widespread health inequalities due to economic inequality.<\/span><\/p>\n<p><span style=\"font-weight: 400\">That government didn\u2019t issue the report until 1980. When they did, they printed fewer than 300 copies and published it on a bank holiday Monday.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The reason why was made clear by the secretary of state, Patrick Jenkin, in his foreword to the report. He said that while the proposed expenditure may have been the right solution to the problems identified, the short term cost was simply unacceptable.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In 1987 the Health Education Council produced <\/span><i><span style=\"font-weight: 400\">The Health Divide<\/span><\/i><span style=\"font-weight: 400\">, to update the evidence and assess progress against the Black Report\u2019s recommendations. The chair of the HEC cancelled the press launch hours before it was scheduled to happen, but the panel reconvened at the Disability Alliance and held it anyway.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In 1998 the, government commissioned, <\/span><a href=\"https:\/\/www.gov.uk\/government\/publications\/independent-inquiry-into-inequalities-in-health-report\"><i><span style=\"font-weight: 400\">Acheson report<\/span><\/i><\/a><span style=\"font-weight: 400\"> found that, despite an overall downward trend in mortality from 1970\u20131990, the lower social classes experienced a more rapid decline, and that poverty affected children more than adults. It recommended increasing benefits for \u201cwomen of childbearing age, expectant mothers, young children and older people\u201d.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In 2008 the government asked Sir Michael Marmot to chair an independent review <\/span><a href=\"http:\/\/www.instituteofhealthequity.org\/resources-reports\/fair-society-healthy-lives-the-marmot-review\"><i><span style=\"font-weight: 400\">Fair Society, Healthy Lives<\/span><\/i><\/a><span style=\"font-weight: 400\">. It said that health inequalities will only be reduced if everyone has good and fair employment, the places we live and work in are healthy and sustainable, and more resources are invested in prevention.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Despite all this work, significant and growing health inequalities persist. In <\/span><a href=\"https:\/\/www.gov.uk\/government\/publications\/health-profile-for-england-2018\/chapter-5-inequalities-in-health\"><span style=\"font-weight: 400\">Health Profile for England: 2018<\/span><\/a><span style=\"font-weight: 400\">, Public Health England said there was no evidence that inequalities in life expectancy had narrowed: they had remained the same for males, and widened for females.<\/span><\/p>\n<p><span style=\"font-weight: 400\">But the starkest finding was that the gap in healthy life expectancy between the richest and poorest areas of England was around 19 years.<\/span><\/p>\n<p><span style=\"font-weight: 400\">As doctors we are committed to the belief that<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">as <\/span><a href=\"https:\/\/www.gov.uk\/government\/news\/health-secretary-launches-prevention-is-better-than-cure-vision\"><span style=\"font-weight: 400\">the health secretary\u2019s November 2018 vision<\/span><\/a><span style=\"font-weight: 400\"> said<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">prevention is better than cure. And we are reminded of it each day as we manage wards and clinics that are bursting at the seams with people, many of whose ill health could have been prevented.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Coupled with our commitment to evidence, we can\u2019t avoid the message of the data and reports of the past 40 years: socioeconomic imbalance produces inequalities in health, and the way to reduce those inequalities is to redress that imbalance. It also makes no economic sense to keep avoiding the issue: if the government had made the investment in 1980, perhaps these inequalities wouldn\u2019t be <\/span><a href=\"https:\/\/www.york.ac.uk\/news-and-events\/news\/2016\/research\/nhs-inequality-costs\/\"><span style=\"font-weight: 400\">costing the NHS billions<\/span><\/a><span style=\"font-weight: 400\"> today.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The green paper is, of course, just that<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">a starter for 10. We must use the opportunity to fill in the gaps and ensure that the message is loud and clear. At the RCP we have an advisory group on reducing inequalities in health and wellbeing that we established last year. Together with others, such as the Health Foundation and the Institute of Health Equity, we will aim to turn this whimper into a bang.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><em><strong><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/07\/andrew_goddard.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-44993\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/07\/andrew_goddard.jpg\" alt=\"\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/07\/andrew_goddard.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2019\/07\/andrew_goddard-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><\/a><\/strong><\/em><\/p>\n<p><em><strong>Andrew Goddard<\/strong>, President of the Royal College of Physicians<\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: None declared<\/em><\/p>\n<p><em><strong>Photo credit<\/strong>: Joe D Miles<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The RCP\u2019s first reaction to the publication of Advancing our health\u2014prevention in the 2020s is disappointment, both its content and the nature of its publication. Making sure people stay physically [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/07\/24\/andrew-goddard-turning-the-green-paper-from-a-whimper-to-a-bang\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":45210,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-45201","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Andrew Goddard: Turning the green paper from a whimper to a bang - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/07\/24\/andrew-goddard-turning-the-green-paper-from-a-whimper-to-a-bang\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Andrew Goddard: Turning the green paper from a whimper to a bang - The BMJ\" \/>\n<meta property=\"og:description\" content=\"The RCP\u2019s first reaction to the publication of Advancing our health\u2014prevention in the 2020s is disappointment, both its content and the nature of its publication. 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