Healthy Lives, Healthy People

Healthy Lives, Healthy People is the name of an approach to public health adopted in the United Kingdom in 2010. It transfers responsibilities for many public health activities from the national government to Local Authorities, administrative bodies responsible for policy and programs at the level of town, city, county, or other local area.

The purpose of Healthy Lives, Healthy People is to transfer decision making and programs for public health from a large, national bureaucratic organization at a significant distance from ordinary people to local governments with whom they have much closer contact. In addition, local authorities are to be provided with so-called ring-fenced financing for their public health programs that protects funds from being used for purposes other than those for which they are intended (public health programs).

Healthy Lives, Healthy People evolved out of a study conducted by a committee of health experts chaired by Sir Michael Marmot, professor of epidemiology and public health at University College London. The committee was created in 2008 by Gordon Brown, the prime minister at that time, in light of troubling statistics about the health of British citizens. Studies had shown that the British were the most obese people in Europe, the nation was losing 80,000 people a year to smoking-related diseases, 1.6 million people had been diagnosed as alcohol dependent, and a half million new cases of sexually transmitted infections were being reported annually. The committee's charge was to study the reason for these statistics and to suggest programs by which they could be reduced. The committee was also charged with investigating the nature of health inequalities in the United Kingdom, the reasons for these inequalities, and the steps that should be taken to reduce or eliminate those inequalities. The committee issued its final report, “Fair Society, Healthy Lives,” in February 2010. It became the basis of a white paper issued on November 30, 2010, titled “Healthy Lives, Healthy People.”

The second major suggestion of the white paper was to shift the focus of health treatment from the national to the local level. The Marmot report had emphasized that health issues, and preventative programs in particular, can best be dealt with by caregivers who are in physically close connection to their clients. In some circumstances the national government may and should take actions to reduce a health issue, such as when they pass laws prohibiting the use of certain types of drugs, but most health problems can best be handled by local health officers, physicians, nurses, health educators, and other health workers.

To accomplish this goal, the white paper announced the creation of a new national health authority, Public Health England. Rather than assuming a whole new set of healthcare responsibilities, Public Health England was designed to be primarily an enabling agency, providing funding and assistance to local governmental bodies (called Local Authorities). It then falls to the Local Authorities to design and implement programs in keeping with the spirit of Healthy Lives, Healthy People that are most appropriate to their own settings. To ensure that programs are actually designed and operate according to this philosophy, the white paper announced “ring-fenced” financing to Local Authorities. Ring-fencing means that the funds allocated to Local Authorities are guaranteed to be used for local health activities entirely, and are not available for any other purposes, no matter how closely related to health care those activities may appear to be.

A crucial feature of Healthy Lives, Healthy People is to improve the health care available to the poor. Over the years, the spread in the quality of health care between classes had grown until it reached its maximum level in the first decade of the twenty first century. Healthy Lives, Healthy People intended to reverse that trend by focusing on the four R's of the program: Reach out and across, by making contact with the people who need health care the most; Representative, allowing communities to develop the healthcare programs that they need, not what national government provides for everyone; Rigorous, making use of the best available scientific information about causes and treatments; and Resilient in developing programs appropriate for both current and future health needs.

All residents of the United Kingdom are to be covered by the Healthy Lives, Healthy People program.

David E. Newton, AB, MA EdD