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

Objectives

Achieve among the lowest rates of premature mortality in Europe by reducing avoidable deaths before age 75, enabling people to live longer and spend more of their lives in good health, and narrowing persistent health inequalities.[1][2][3]The long-term ambition is for England to be among the five European countries with the lowest premature-mortality rates by 2020.[3]

• Reduce deaths from the principal major killers, including cancer, circulatory and heart disease, stroke, respiratory disease and liver disease, while addressing related long-term conditions and multimorbidity.[1][2][4]
• Prevent ill health by reducing smoking, harmful alcohol consumption, obesity, physical inactivity, poor diet, high cholesterol and raised blood pressure.[3]
• Tackle wider determinants of health and the social conditions underlying inequalities, including housing, employment, environmental quality, transport, fuel poverty, violence, access to green space and active travel.[5][6]
• Improve outcomes through coordinated prevention, earlier diagnosis, effective treatment, case management and timely referral, particularly in primary care.[5][7]
• Improve quality of life for people living with long-term conditions as well as extending life expectancy.[7]
• Reduce avoidable cancer deaths through earlier diagnosis and improved treatment, recognising the estimated potential to avoid around 10,000 cancer deaths annually if survival matched the best in Europe.[7]
• Use existing effective treatment opportunities to avoid an additional 30,000 deaths annually by 2020, alongside an existing commitment to save an additional 5,000 lives from cancer each year.[3][8]
• Increase physical activity through sport, walking, cycling, active travel and access to attractive local outdoor and green spaces.[9]
• Reduce alcohol-related harm, including through the ambition to remove one billion units of alcohol sold annually by December 2015.[9]

Implementation

Deliver a whole-system programme spanning prevention, early diagnosis and treatment, with local government, the National Health Service, Public Health England, national government, communities and voluntary-sector partners sharing responsibility for healthier lives and reduced premature mortality.[2][5][10]Local health and wellbeing boards provide system leadership by assessing needs, agreeing priorities and coordinating local action.[1][10]

• Align local and national action through the public health and National Health Service outcomes frameworks, the Government mandate to the NHS Commissioning Board, and Public Health England’s guiding principles.[1][10]
• Enable local authorities to lead health improvement and action on preventable early death, integrating responsibility for health improvement with action on wider determinants.[5][10]
• Support health and wellbeing boards, councils, Clinical Commissioning Groups, providers and Healthwatch to assess local needs, set ambitions, plan services and strengthen local partnerships.[1][10]
• Empower Clinical Commissioning Groups and local clinicians to commission services suited to local populations, improve links between primary and secondary care, and reduce variation in avoidable hospital deaths.[7][10][3]
• Use general practice and community pharmacy to provide National Health Service Health Checks, identify risk factors, deliver brief interventions, promote preventive advice and support early diagnosis.[7]
• Make every clinical contact count by supporting healthier lifestyles, strengthening primary-care diagnosis and improving access to appropriate treatment.[3]
• Coordinate cross-government action led by the Department of Health, including work with transport, culture and other public services affecting health and wellbeing.[1][9][8]
• Implement tobacco control through display restrictions, consideration of standardised packaging, campaigns such as Stoptober and evidence-based cessation support, with targeted support for groups including people with mental illness and pregnant women.[6]
• Work with food retailers and manufacturers through the Responsibility Deal to reformulate products, reduce portion sizes and reduce trans-fats, sugar and salt, while using Change4Life and digital campaigns to encourage healthier diets and activity.[11]
• Engage schools, employers, private-sector organisations and voluntary-sector partners through the School Games, Change4Life School Sport clubs and the Responsibility Deal Physical Activity Network.[11]
• Promote walking and cycling for everyday journeys, increase participation in sport, maintain initiatives such as Walking for Health, and use the Responsibility Deal with trade partners to address alcohol-related harm.[9]
• Draw on support from Public Health England, the NHS Commissioning Board, the Local Government Association, professional bodies, academic experts and voluntary and community organisations to share evidence, innovation, good practice and the public and patient voice.[10][8]
• Enable local people and interested groups to challenge commissioners and health and wellbeing boards using comparable information on local outcomes and risk factors.[12]
• Support transparency through local-authority-level data on mortality, risk factors and outcomes, a website linked to Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies, and annual reporting by Public Health England and the NHS Commissioning Board.[12][8]
• Provide local authorities with a ring-fenced public health budget of £5.45 billion over the next two years; further programme-level financing arrangements are not specified.[10]

Monitoring & Evaluation

Monitoring centres on reducing premature mortality, principally deaths before age 75, and comparing England’s performance with similar local areas and leading European countries. Shared measures in the Public Health Outcomes Framework and National Health Service Outcomes Framework are intended to align national and local action.[1][4][10][12]

• Use under-75 mortality as the principal England-level indicator of progress, alongside indicators on preventative action and the wider social determinants of health.[4][5]
• Prioritise reducing premature mortality through Domain 1 of the National Health Service Outcomes Framework, the Government mandate to the NHS Commissioning Board and Public Health England’s guiding principles.[10]
• Measure changes in major risk factors, including smoking, alcohol consumption, obesity, physical inactivity, poor diet, high cholesterol and raised blood pressure.[3]
• Publish transparent, comparable local-authority data on mortality, risk factors and related outcomes, enabling communities and interested groups to challenge health and wellbeing boards and commissioners.[12]
• Provide a website linking local premature-mortality and risk-factor data with Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies, with access to data intended to improve over the following two years.[12]
• Report annually through the Secretary of State’s Annual Report on Health Service performance, Public Health England’s annual progress reporting, and the NHS Commissioning Board’s annual reporting against its mandate objective.[8]
• Encourage health and wellbeing boards and local partners to set local ambitions and report progress.[8]
• Track specific commitments, including measurable progress towards reducing premature mortality by 2016, becoming one of Europe’s most successful countries in preventing premature deaths by 2016, and reaching the long-term ambition of being among the five European countries with the lowest premature-mortality rates by 2020.[10][3]
• Monitor selected intervention measures, including adult smoking prevalence, a target salt intake of no more than 6 grams per person per day, school participation in the School Games, and private- and voluntary-sector participation in physical-activity pledges.[6][11]

A detailed evaluation methodology, full indicator specifications, target values for most measures, surveillance protocols and reporting timetables are not specified in the supplied extracts.[4][5][10][6][11]Reference-list extracts cite the Public Health Outcomes Framework and statistical and surveillance sources, but do not add plan-specific monitoring or accountability arrangements.[13][14][15]

Costing & Financing

Explicit financial information is limited. The plan provides a ring-fenced public health budget for local authorities, identifies targeted investment in school-based physical-activity initiatives, and notes the substantial annual National Health Service cost associated with violence.[5][10][11]

• Provide a ring-fenced public health budget of £5.45 billion to local authorities over the next two years.[10]
• Invest £36 million in the School Games and Change4Life School Sport clubs.[11]
• Recognise that violence, identified as a wider determinant of health with disproportionate effects in highly deprived areas, costs the National Health Service £2.9 billion annually.[5]
• Consider a proposed minimum alcohol unit price of 45 pence through a Home Office consultation held from 29 November 2012 to 6 February 2013; this is a policy price proposal rather than a stated programme budget.[9]

No overall implementation budget, programme-level costing methodology, financing plan, funding-source breakdown, resource-mobilisation strategy, funding-gap assessment or economic assumptions are specified in the supplied extracts.[16][17][1][2][4][7][9][12][3][8][18][19][13][14][15]