Living Well for Longer: A Call to Action to Reduce Avoidable Premature Mortality

Objectives

The strategy seeks to reduce avoidable premature mortality in England, improve healthy life expectancy and narrow persistent health inequalities, with the long-term ambition of reaching the five European countries with the lowest premature-mortality rates by 2020.[1][2]It focuses on preventable early deaths from cancer, circulatory disease including heart disease and stroke, respiratory disease and liver disease, while recognising links with other long-term conditions and multimorbidity.[3][1][4]

• Reduce major preventable risks, including smoking, excessive alcohol consumption, unhealthy diet and physical inactivity, and tackle inequalities in obesity, cholesterol and raised blood pressure.[5][6][2]
• Address social determinants of health, including housing, employment, environmental quality, air quality, violence, transport, fuel poverty, access to green space and active travel, which contribute to unequal premature mortality.[7][6]
• Improve prevention, early diagnosis, primary-care case management, timely referral and access to appropriate treatment, while reducing unwarranted variation in clinical outcomes and avoidable hospital deaths.[7][5][2]
• Support people with long-term conditions to have better quality of life and seek measurable progress towards preventing premature deaths at levels comparable with leading European countries.[5][4]
• Promote healthier diets by reducing salt intake to no more than 6 grams per person per day, reducing trans-fats, sugar and saturated fat, encouraging healthier food promotion, and tackling overweight and obesity.[8]
• Increase physical activity among children and adults through school sport, active travel, supportive local environments and wider participation in sport and walking.[8][9]
• Reduce alcohol-related harm, including through consideration of a minimum unit price and a stated objective to remove one billion units of alcohol sold annually by December 2015.[9]
• Improve tobacco control by preventing smoking initiation, supporting cessation, ending tobacco displays in small shops from April 2015, considering standardised packaging and targeting cessation support towards groups including pregnant women and people with mental illness.[6]
• Expand access to best available treatment, with a potential to avoid an additional 30,000 deaths annually by 2020, while building on the ambition to save a further 5,000 cancer lives each year.[2]

Implementation

Delivery relies on coordinated, long-term action across public health, healthcare, local government and wider public services rather than a short-term consultation process.[10][3]Local authorities are positioned as a major force for health improvement, the National Health Service leads on deaths amenable to healthcare intervention, and local partnerships translate national ambitions into locally relevant action.[7][4]

• Coordinate national action through the Department of Health, the NHS Commissioning Board, Public Health England and cross-government work on healthy lifestyles and wider determinants of health.[3][11]
• Enable local authorities, Clinical Commissioning Groups, providers, health and wellbeing boards, Healthwatch, voluntary and community organisations, professional bodies and academic experts to identify needs, set priorities, commission services and share effective practice.[10][4]
• Use health and wellbeing boards for local system leadership, population-needs assessment and coordination of prevention, early diagnosis and treatment, supported by local authority health-scrutiny functions.[4][11]
• Give local clinicians and Clinical Commissioning Groups discretion to design and commission services for local populations, while the NHS Commissioning Board oversees continuous improvement in treatment and care.[5][4]
• Deliver prevention through cross-government collaboration, the Responsibility Deal, national campaigns and partnerships with retailers, manufacturers, trade bodies, local authorities and voluntary organisations.[8][9]
• Implement dietary measures through food reformulation, smaller portions, lower-calorie choices, healthier-food promotion and the Change4Life ‘Be Food Smart’ campaign.[8]
• Promote activity through School Games, Change4Life School Sport clubs, active travel, green spaces and the Walking for Health initiative.[8][9]
• Use the Public Health Outcomes Framework and NHS Outcomes Framework, including NHS Outcomes Framework Domain 1 on preventing premature death, to sustain system-wide focus on mortality reduction.[7][4]
• Measure progress principally through under-75 mortality, risk-factor prevalence, outcomes across the major killer diseases, and variation between local authorities and deprivation groups.[1][12][2]
• Publish transparent and comparable local and national information, including Tobacco Control Profiles and Public Health England data on mortality, risk factors and outcomes, to enable comparison, public challenge and service improvement.[13]
• Report nationally each year through the Secretary of State for Health, Public Health England and the NHS Commissioning Board, while expecting health and wellbeing boards and local partners to set ambitions and report local progress.[11]
• Provide a ring-fenced public-health budget of £5.45 billion for local authorities over the following two years; the supplied material does not specify a wider programme budget or detailed financing plan.[4]

Monitoring & Evaluation

Monitoring centres on reducing premature mortality, using under-75 mortality as the principal national measure and aligning the Public Health Outcomes Framework with the National Health Service Outcomes Framework. Progress is intended to be transparent, comparable across places and reported nationally and locally, although the source does not provide a complete indicator specification or evaluation protocol.[3][12][7][13]

• Measure progress towards the ambition for England to become one of Europe’s best-performing countries on premature mortality through milestones, changes in major risk-factor prevalence and mortality outcomes.[4][2]
• Use Domain 1 of the NHS Outcomes Framework, focused on preventing people from dying prematurely, alongside the public health framework, the Government mandate to the NHS Commissioning Board and Public Health England principles.[4]
• Track outcomes for the five major causes of early death and examine inequalities between local authorities and deprivation groups, including variation in clinical outcomes across specialties and trusts.[1][12][7][5]
• Publish transparent local and national information on mortality, risk factors, service quality and other outcomes, including Tobacco Control Profiles and Public Health England local-authority data linked to Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies.[13]
• Enable the public and interested groups to compare local performance with similar areas and European benchmarks, and to challenge health and wellbeing boards and commissioners where improvement is needed.[13]
• Require annual national reporting by the Secretary of State for Health, Public Health England and the NHS Commissioning Board, while health and wellbeing boards and local partners set local ambitions and report local progress.[11]
• Use cited evidence and data sources covering smoking, obesity, physical inactivity, diet, cholesterol, raised blood pressure and under-75 mortality; mortality projections incorporate population trends, existing National Health Service and public-health policies, and improved diagnosis and treatment.[14]
• Recognise that the supplied material does not specify detailed reporting timetables, surveillance procedures, data-collection protocols, evaluation designs, a full indicator set or sanctions for non-performance.[12][7][5][2][11]

Costing & Financing

Financing information is limited. A ring-fenced public health budget is allocated to local authorities, and specific investments or proposed price measures are identified for selected prevention activities, but no overall programme costing, funding-gap assessment or resource-mobilisation strategy is provided.[4][8][9]

• Allocate a ring-fenced public health budget of £5.45 billion to local authorities over the following two years for health improvement.[4]
• Invest £36 million in the School Games and Change4Life School Sport clubs.[8]
• Consider a minimum alcohol unit price of 45 pence; the proposal is estimated to save 700 lives annually after ten years, but the excerpt does not provide a full cost-benefit analysis.[9]
• Recognise violence as a wider determinant of health that costs the National Health Service £2.9 billion annually.[7]
• Note that quantified figures on avoiding additional deaths, cancer survival and alcohol-unit reductions are health targets or projected outcomes rather than budgets or cost estimates.[9][2][11]
• Recognise that the source does not specify programme-level implementation costs, financing mechanisms, funding allocations beyond those identified, resource requirements, economic assumptions or quantified funding gaps.[1][12][4][6][8][11]