Action plan for health could do harm, says study

The White Paper Healthy Lives, Healthy People contains proposals that have not been proven to have benefit and some may even cause harm, said the study published online in the British Medical Journal (BMJ).

Last year, Health Secretary Andrew Lansley said in his speech to the Faculty of Public Health conference: “Our new approach across public health services must meet tougher tests of evidence and evaluation.

“We must only support effective interventions that deliver proven benefits.”

But experts from the Medical Research Council, NHS Lothian and the London School of Hygiene and Tropical Medicine, questioned whether the Government was following its own advice after reviewing 51 statements in the White Paper aimed at improving the health of the population.

Eleven related to measures to increase the amount of exercise children and adults take.

While experts found some evidence to support school-based programmes to promote walking and town programmes to support cycling, they said some novel interventions to get children walking to school (such as Step2Get or Run Dem Crew) “are likely to be ineffective or have only a limited effect on population health because most people who take them up will already be physically active”.

They also pointed to “conflicting, poor quality evidence to support Olympics-based activities to increase physical activity, but systematic reviews indicate that large positive benefits are unlikely”.

Other ineffective interventions are the NHS health check to test cardiovascular risk in people aged 40 to 74 and some discount food schemes.

The health benefits of welfare reforms, such as the new “fit note” replacing sick notes, have also not been properly evaluated despite the White Paper saying these reforms would improve health.

The experts noted that some of the schemes were started under the previous government and called for all programmes to be rigorously evaluated for effectiveness.

“Large gaps in the research evidence remain, with a continuing lack of high-quality studies, particularly on the broader determinants of health, such as welfare, green space and community interventions,” they said.

“We do not believe that a lack of robust evaluations should prevent an intervention from being implemented. However, when action is taken, its effects should be rigorously evaluated.

“Given that the White Paper could result in the implementation of large numbers of interventions that lack evidence of effectiveness, their evaluation is important.

“It should be remembered that, as with medical interventions, many public health interventions have the potential to cause harm.

“In the words of the House of Commons Health Select Committee, ‘Such wanton large-scale experimentation is unethical, and needs to be superseded by a more rigorous culture of piloting, evaluating and using the results to inform policy’.”

Professor Lindsey Davies, president of the Faculty of Public Health, said: “It is vital that public health specialists are supported by the strongest possible evidence.

“Lives can be put at risk and money wasted by well-intentioned but ill-informed actions.

“That’s why it is so important that we get the new public health system – put in motion by the Healthy Lives, Healthy People White Paper - right.”

Shadow public health Minister Diane Abbott said: “Andrew Lansley promised public health plans based on evidence and evaluation.

“Instead, this study shows his public health strategy is full of untested schemes. It’s another broken promise from this Government.”

A Department of Health spokeswoman said: “The Government is committed to evidence-based policymaking in public health and to evaluating all of the programmes we implement.

“We always want to learn lessons so that we achieve the best value for taxpayers’ money.”