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Health Impacts (Public Sector Duty)

Volume 639: debated on Wednesday 25 April 2018

Motion for leave to bring in a Bill (Standing Order No. 23)

I beg to move,

That leave be given to bring in a Bill to require public authorities to have regard to the need to consider physical and mental health impacts in the exercise of their functions; and for connected purposes.

This Bill is designed to bring a health in all policies approach to the making and delivery of all central and local government policies, and it has a simple aim: to improve the physical and mental health of our nation for generations to come.

The Roman statesman Cicero said that the health of the people shall be the supreme law. Down the centuries, when Governments have heeded his advice, they have performed great deeds: building great sewers and providing fresh water; cleaning up our food by banning contaminants; clearing slums and giving children safe spaces to play; cleansing our city air; vaccinating our children against killer diseases; banning smoking in public places; bringing in health and safety; protecting pedestrians against the dangers of traffic; introducing seatbelts; and, of course, creating our national health service, which delivers physical and mental health care at the point of need, irrespective of the ability to pay.

But we cannot rest on our laurels. New challenges and threats to our health and wellbeing arise in each generation. New responses are required, and that is what my Bill is all about. Hon. Members will have heard me speak about the mental health crisis we face in this country. That is not the only health crisis we face as a nation. We face a crisis of social care. We have a system that disproportionately focuses on treating people when they are in a crisis, already sick, rather than keeping our population well. We face an epidemic of loneliness among young as well as old. Tobacco remains a toxic killer. Too many cities and towns are blighted by substance misuse. A generation of children is facing obesity into adulthood. The technological revolution has an impact on our mental health and levels of physical activity. Cancer touches every family in Britain. Increasingly, our NHS is contending with lifestyle-related diseases.

The worst aspect of those major health challenges is the inequality in the ways they impact on people. This really is a social justice issue. Despite all the advances in our nation’s health over the centuries, poor people suffer poorer health and live shorter lives than affluent people. Income is a determinant of health—what a terrible indictment of our society.

According to the Department of Health and Social Care’s latest annual report, the health gap between rich and poor is widening. In 2010, life expectancy for men in England’s most deprived areas was 9.1 years less than for those in the richest areas. By 2015, that figure had risen to 9.2 years. The equivalent gap for women also grew, from 6.8 to 7.1 years. Poorer people are more likely to spend 20 more years in ill health than richer people. They are more likely to suffer from strokes, cancer and heart attacks. They have less chance of gaining access to a GP or a dentist. We have seen an increase in hospital admissions for malnutrition and a stalling in the improvement in life expectancy for the first time in 100 years. In modern Britain, a person’s length of life, and the number of years they spend healthy, depends on their address and income. These inequalities exist for a range of other factors too, including likelihood of suffering a road traffic accident, likelihood of suffering a house fire, likelihood of being a victim of violent crime and likelihood of suffering mental ill health. Look at the locations of our food banks. Look at the epidemic of knife crime. Look at Grenfell Tower.

Inequality is a terrible scar on our society, so what is to be done? My Bill aims to place the physical and mental health of the population at the centre of all Government activity, beyond the confines of the Department of Health and Social Care and the responsibility of local authority directors of public health, so that no policy is developed or enacted without due consideration of its impact on health and, where possible, policies are designed actively to improve our wellbeing.

That is not a new approach. I would like to highlight the work of the all-party parliamentary group on health in all policies and its chair, my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams). The World Health Organisation adopted a statement on this approach in Helsinki in 2013. It states:

“Health in All Policies is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. It improves accountability of policymakers for health impacts at all levels of policy-making. It includes an emphasis on the consequences of public policies on health systems, determinants of health and well-being.”

Health in all policies has been adopted in Wales, through the Well-being of Future Generations (Wales) Act 2015, which is designed

“to minimise any damage and increase any benefit”

from new policies. Wales joins Tasmania, Quebec and British Columbia in having statutory health impact assessments. Other countries are striving towards the same goal. Ecuador has its Plan Nacional para el buen vivir—the plan of good living. In Finland, the health in all policies approach has been part of governance for years. In Thailand, citizens have the right to request a health impact assessment if they feel that any proposal might be detrimental to their wellbeing.

Health in all policies means, for example, ensuring that the design of all buildings, estates and urban environments encourages walking, running, cycling, sharing and talking, and deters crime and vandalism. It means designing social security systems, including their assessments, that add to, rather than subtract from, people’s sense of security, which enhances their physical and mental wellbeing because they know that the system is on their side.

Health in all policies means placing duties on food and drink manufacturers, shops and takeaways concerning the ingredients in their goods, pricing and the locations where they sell them, to discourage alcohol abuse and poor diets. It means designing services for young people and teenagers, new parents, people seeking work or the recently bereaved, so that services match needs. The creation of Sure Start centres was an example of this highly innovative approach. Indeed, given that we know how important the first 1,001 days of a child’s life is, and how what happens from conception to the age are two still determines an infant’s life chances and their mental and physical health through childhood to adulthood, there is no better example of why we need a health in all policies approach in services for mums, dads and infants. This stretches way beyond childcare provision and health checks; it means looking again at patterns of work, income, benefits, parenting, education, food, housing, transport, air quality, playgrounds and many other areas of policy.

I acknowledge that we have seen some helpful steps forward in recent years, such as the introduction of a sugar tax and the banning of smoking in cars when children are present, but these are piecemeal and unco-ordinated. My Bill represents a step change. It is not just about saving money for the national health service, although the approach would save resources, which is particularly important at a time when we know that our NHS and social care are under such pressure. It is also about what the King’s Fund calls

“a cost-effective use of society’s funds that reflects the value society puts on health and other goals.”

The health in all policies duty could be placed on all public authorities, which would be further defined in the Bill to include Ministers of the Crown, Departments and local government, as outlined in schedule 19 to the Equality Act 2010. It would be backed by strong machinery within Government. It was a mistake for the coalition Government in 2012 to scrap the Cabinet Sub-Committee on Public Health, which might have served such a useful purpose, bringing together all those Departments across Government. Its remit was to enable the Secretary of State for Health to

“lead public health across central government”


“work across multiple departments to address the wider determinants of health.”

In order to work, health in all policies will require a central driver that can range across Departments and agencies, with the full authority of No. 10, bringing people together, breaking down the walls of Jericho and creating real cross-Government working. No submission would appear in any red box without a thorough assessment of its impact on our nation’s physical and mental health.

Lest some hon. Members feel that this is a licence for the nanny state, let me point to the so-called family test, supported by this Government and policed by the Cabinet Sub-Committee on Social Justice, which requires all policies to be tested against their impact on family relationships and functioning. That is just one example. Governments assess the impact of policies all the time. Surely no impact is so important as the impact on our physical and mental wellbeing. We are told that Brexit affords us an opportunity to reshape our laws and regulations. No measure could have more positive benefit than the UK adopting a robust, full-throated approach to health in all policies.

I am grateful to colleagues from both sides of the House for their support. That includes more Members than I was allowed to include in the list of sponsors, so I will quickly reference them now. They are my hon. Friends the Members for Coatbridge, Chryston and Bellshill (Hugh Gaffney), for Stoke-on-Trent North (Ruth Smeeth), for Ealing, Southall (Mr Sharma), for Birmingham, Selly Oak (Steve McCabe), for Halton (Derek Twigg), for Batley and Spen (Tracy Brabin), for Stockport (Ann Coffey) and for Weaver Vale (Mike Amesbury), my right hon. Friend the Member for Enfield North (Joan Ryan) and my hon. Friends the Members for Leeds North West (Alex Sobel), for Stoke-on-Trent Central (Gareth Snell), for Warrington North (Helen Jones), for Stockton South (Dr Williams) and for Bristol East (Kerry McCarthy).

The Bill would provide a platform for tackling the health inequalities that blight our communities and allowing more people to be fully engaged in maintaining their own health and wellbeing. It would be as solid a step forward as the restrictions on making and selling cheap gin in the 18th century, building the city sewers and delivering clean water in the 19th century, creating our NHS and the clean air Acts in the 20th century, or introducing the smoking ban in the 21st century. Health in all policies would be our legacy to future generations, and I commend the motion to the House.

Question put and agreed to.


That Luciana Berger, Debbie Abrahams, Dr Lisa Cameron, Rosie Cooper, Stella Creasy, Mr George Howarth, Diana Johnson, Norman Lamb, Johnny Mercer, Rachel Reeves, Andrew Selous and Dr Philippa Whitford present the Bill.

Luciana Berger accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 26 October, and to be printed (Bill 198).