'Healthy lives, healthy people' white paper

The coalition government's first public health white paper, Healthy lives, healthy people: our strategy for public health in England built on high-level plans outlined in Equity and excellence: liberating the NHS and responded to the Fair society, healthy lives report by Sir Michael Marmot.

A key focus was on supporting people to live healthier lives for longer and to reduce health inequalities:

'There are huge opportunities to go further and faster in tackling today's causes of premature death and illness. People living in the poorest areas will, on average, die seven years earlier than people living in richer areas and spend up to 17 more years living with poor health.'

The white paper outlined a number of non-legislative initiatives such as the public health responsibility deal (a collaborative with business and the voluntary sector to promote the reformulation of food to reduce salt, provide better labelling information and promote more socially responsible retailing).

The main structural change for public health was the transfer of health improvement functions from primary care trusts (PCTs) to local government and the creation of a new public health service – Public Health England (PHE). PHE would be part of the Department of Health and would take on the health protection functions of the Health Protection Agency (HPA).

The white paper stated:

'Local government's new role in public health presents an opportunity to address this challenge. Public health will be better integrated with areas such as social care, transport, leisure, planning and housing, keeping people connected, active, and independent and in their own homes. Neighbourhoods and houses can be better designed to support people's health, such as by creating 'lifetime homes', and by maintaining benefits such as the winter fuel allowance and free bus travel, which keep people active and reduce isolation.'

PHE would be responsible for coordinating responses to public health challenges and protecting the health of the population where a national response was required. The Health Protection Agency would be abolished and its functions incorporated by PHE.

The government committed to the ring fencing of public health funding from the overall NHS budget to ensure that it was protected from spending pressures elsewhere in the health system. Public health budgets would also be ring fenced for upper tier and unitary local authorities, with a new health premium awarded for performance against a new public health outcomes framework.

At a local level, it was envisioned that the Director of Public Health would be the principal adviser on all health matters to the local authorities and would play a key role in advocating for the public's health within the community.