Devils Advocate: The public health White Paper

The issues raised by the new public health White Paper echo many of the concerns first raised 50 years ago, says Dr Richard Preece.

Exactly 50 years ago, in an article entitled Occupational medicine and public health, Robert Kehoe wrote: “There is need for some clarification of the role of occupational medicine as a field of preventive medicine in relation to the health of the public as well as to that of the working population.”

The newly published public health White Paper, Healthy Lives, Healthy People, is a timely reminder of how little this has changed in five decades.

We have increasingly recognised the importance of the workplace as a valuable setting to improve population health – about half the UK population are in paid employment, many more are engaged on other work either at home or in education, and of the remainder, most will work (when they’re old enough) or did (when they were younger or more able).

The contribution of the workplace to public health came to the fore in 1992 with the “Health of the Nation” White Paper. Attention turned to the workplace promotion of improved general health and not just prevention of work-related illness. Somewhere in the intervening 20 years attention drifted from the workplace and investment in the public health of workers dried up.

The new White Paper draws attention firmly back to the contribution of the workplace and employers in improving public health. The White Paper is thin on detail but rich in opportunity.

The reception has been mixed. The Royal College of Physicians was “disappointed”, in contrast to the Royal College of Nursing which welcomed it and “highlighted the important role of nursing staff in supporting the health of working people”.

Mostly the media focused on “nudging” people towards better health. Nudges are most often associated with slot machine gambling. In that context they increase engagement (with the game) and encourage investment (in the machine).

They give the pretence of improving success but in reality merely increase losses. A nudge might be sufficient to engage the public, but it is unlikely to be sufficient for occupational health which needs a big kick up the backside.

In an interview with BMA News, public health minister Anne Milton suggested Christmas would come early for public health.

She is right. But the public health of workers must not be just for Christmas but for the whole year and beyond.

So what are the highlights?

  • Employers from all sectors should look to support the health and wellbeing of their staff. [s.2.5]
  • In 2011 [the Department of Health (DH)] will develop and consult on a public health workforce strategy. [s.5.9]
  • The DH will shortly publish a consultation on the proposed funding and commissioning routes for public health. [s.4.27]
  • The [Government] is also examining the incentives in the sickness absence system. [s.3.50]
  • All employers will be encouraged to contract only those [OH] services that are fully accredited. [s.3.52]
  • Central government will provide the evidence and data to raise awareness among employers of the clear case for investing in the health of their employees. [s.3.54]
  • The NHS can lead by example including improving the quality of and speeding up access to OH services. [s.3.56]

OH practitioners should have a view on workforce strategy, funding, exclusive use of accredited services, improved access, and incentives to attendance. Given the right approach OH could be a big winner here.

The White Paper lacks detail. It is up to occupational health to provide some of that detail by responding to the consultation. So take the nudge and respond to the consultation. The deadline is 8 March 2011.

Dr Richard Preece is a consultant occupational physician.


Kehoe R. Public Health Rep. 1961; 76(8): 645-650.

Stewart D. The Future of Occupational Health, British Medical Journal, January 21 1950, pp156-9.

Back to the future

It is with some amusement that I read the report The Future of Occupational Health. It was published 50 years ago, so I am sure you will all be familiar with it, but in case not, the recommendations include:

  • set up an national council on occupational health;
  • appoint regional consultants in occupational health;
  • services should be approved; and
  • a level playing field for employers.

I note that the Society of Occupational Medicine points out that “probably not more than 25% of employed persons were covered in any way by a medical service at the place of work. Even then the service provided was not always good or efficient.” The British Medical Association suggests OH is integrated into the NHS, with closer links to hospital services, and closer links to the “public health service administered by the local health authority” but warns that “experiments in methods of providing services will be necessary before plans for a comprehensive service can be made”.

This is clearly an exciting time of opportunity. We can only wonder at what will remain to be done 60 years from now.


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