Website of the Department of Health

Speech by the Rt Hon Alan Johnson MP, Secretary of State for Health, 11 February 2008: Universidade do Estado do Rio de Janeiro

Ladies and gentlemen, it’s a very great pleasure for me to be here this morning and to share with you some reflections on health and health policy.  And in particular on how the growing international dimension of health can make a difference to the way we address common problems across different countries.

Globalisation has changed the way that countries interact. Traditionally, relationships between countries have been the rather refined stuff of “foreign affairs”. 

But as the accord between Brazil and the United Kingdom illustrates, modern relationships spans a wide range of interests and issues. From education to environment, from race relations to scientific research.   These issues and many more are active areas for co-operation between our governments as well as our business and civic society.

Health is an essential part of this common agenda, as we signalled when we signed a memorandum of understanding on healthcare during the state visit of President Lula to London in 2006. 

One of my key objectives in coming to Brazil is to discuss with Dr Temporao how we advance our work together under the Memorandum of Understanding in areas like healthcare reform, primary care and tackling health inequalities.

“Health is global”

That health is a prominent part of our relationship because it is increasingly a global issue.  In a world where people and goods are in constant transit, the impact on health is profound. Infectious diseases do not respect international borders.  Healthcare professionals can readily export their skills.  Drugs are manufactured and distributed on a global scale.  Global environmental risks, like climate change - largely caused by industrialised countries – will adversely affect the health of the developing world.

Your government recognised these developments earlier than most. Brazil was one of 7 countries that signed a pioneering joint statement on the importance of taking up the challenges of global health in foreign policy. 

My government is seeking to respond to the global nature of health through a new high profile strategy for dealing with international cross-cutting health. My ministry has the lead in developing the strategy but it will be owned and implemented by all the uk ministries whose activity affects global health. Finance, trade, environment, defence, foreign affairs, and international development. 

It will help us protect the health of the UK population by working to address those health threats that may come from outside our borders.  Crucially, it will help us to promote better health across the world.

I hope that the Global Health Strategy will be a firm illustration of what  Prime Minister Gordon Brown has called “hard headed internationalism”.  Cooperating to tackle global challenges and taking the difficult decisions together.

Partnership with Brazil

As the global health statement signed by Brazil emphasises, improving global health is about partnership. Within governments, between governments.  And between governments,civil society and the private sector.  We can’t solve the problems alone.

Developing partnership is the purpose of my visit.

The UK and Brazilian governments both firmly believe in working through multilateral institutions to tackle global challenges. Where our two countries work together  we enhance  our influence and strengthen our impact.

2008 marks three significant anniversaries.

First the World Health Organisation celebrates 60 years of improving global health.  Yet huge inequalities in health outcomes between countries remain  We have a long way to go to achieve the health related Millennium Development Goals. 

I hope that Brazil and the UK can forge a strong political partnership to support and focus the WHO’s efforts to address global health inequalities; to assist countries in combatting the likely effects of climate change on health; and in ensuring that the international community is prepared to deal effectively with the next pandemic disease outbreak. Both our countries have ideas, and insights to contribute to these challenges.

There is also much to be gained from sharing how we are responding to the national challenges of health promotion and providing our citizens with high quality healthcare.

The second commemoration this year is the 60th anniversary of the National Health Service in the UK. You must excuse me being a little more parochial here. It was my party in power that created this great institution and I am immensely proud of what my Government has done to equip it properly for the 21st century.

The creation of the NHS in 1948 enshrined a vision of which we can still be proud and to which we still hold true; a universal, comprehensive health service that is free at the point of use, on the basis of clinical need rather than the ability to pay.

The challenge in 1948 was to establish this service – in the face of fierce political and professional opposition.   The challenge in the intervening years has been to provide the NHS with the appropriate resources. 

Today’s NHS has benefited from a decade of sustained investment. 

In 1997 when we returned to power in the UK, under-investment had led to a shortage of staff, declining standards and long waiting lists for treatment.

Ten years later, there are more staff, reduced waiting times, new hospitals and radically improved survival rates, particularly in cancer and cardio-vascular disease.

• We have almost trebled the health budget from £35bn in 1996 to over £90bn today
• There are around 80,000 more nurses and 35,000 more doctors
• 149 new hospitals are open, under construction or in procurement – the largest sustained hospital building programme since the NHS was foundedCancer death rates are down by 17%, saving over 60,000 lives
• In 1997 nearly a quarter of a million people waited more than 6 months to be admitted to hospital for non-urgent care. We have removed these long waiting times and the average wait is now under 6 weeks.

Next Stage Review

As the NHS celebrates its 60th birthday, we look to the future.  Having increased its capacity, we must now concentrate on improving quality, access and safety, creating a higher standard of personal service to meet the higher aspirations of the public.

Prime Minister Brown and I have launched a Review of the National Health Service to ensure that everyone involved can discuss how to build on the last ten years of investment and reform. 

This Review work is on-going, but our vision for the National Health Service is already clear:

• First a National Health Service that is personalised.  By this I mean services are tailored to the needs and wants of each individual, especially the most vulnerable.  It means that we provide access to the health services most suited to every individual at the time and place of their choice. This is particularly important for the most vulnerable citizens who have the greatest need for the health service but use it the least. To improve access to primary care, doctors’ surgeries should be open at times and in locations that suit the patient, not the practice.  But personalisation also means clinicians and individuals working closely together in partnership to improve health as well as treat illness. 
• Secondly: a National Health Service that has the highest standards of cleanliness and safety.  Too many patients currently feel insecure in English hospitals because of their fear of infection.  Healthcare acquired infections are a global problem. We’re making real progress against MRSA.  But the war against another infection, Clostridium difficile, must be intensified. As well as a series of measures aimed at clinicians and staff, we are equipping the regulator with tough new powers, backed by fines, to inspect, investigate and intervene where hospitals are failing to meet hygiene standards.
• Thirdly I want to see a National Health Service that is fair. The creation of the NHS made healthcare accessible to everyone. Just as inequalities remain between countries, they are entrenched within countries as well. For example, whilst mortality rates have reduced for all strata of society, a woman from the poorest social class in England is 19 times more likely to die in childbirth than someone from the most prosperous.  Tackling such inequalities is our priority.

The subject of inequality  brings me to the last of the three anniversaries.

The Alma Ata declaration, signed 30 years ago this September, is   rightly recognised for the central role it gives to primary health care in driving improvements. Good primary health care, within strengthened health systems is key to delivering health for all.  

But Alma Ata is also a key moment for the movement against health inequality. As point 2 of the Declaration states  “The existing gross inequality in the health status of the people, particularly between developed and developing countries as well as within countries, is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.”

As Brazil has always recognised, this has huge relevance to the poorest developing countries and the attainment of the Millennium Development Goals.

But as the Declaration makes clear, health inequalities exist, and are unacceptable, in all countries, Including countries already in the rich “club” and countries whose economic success means they are rapidly catching up.   

We feel that the key to tackling health inequalities in the UK is a balanced approach between action in our National Health Service on the social determinants of health, such as employment, housing and education.

I know it is something that you in Brazil are focusing on remorselessly. I am looking forward to hearing more about the work of the National Commission on the Social Determinants of Health while I am here.  We in the UK are looking forward to the report of the WHO Commission on the same subject.  I know that FIOCRUZ here in Brazil has made significant contributions to this, notably through the social determinants and health equity global training course.  

Lifestyle disease

So – 60 years of WHO and the NHS.  30 years of Alma Ata.   In many ways the world of 1948 is unrecognisable to us now.  Yet the persistence of inequality reminds us that we cannot be complacent about progress. But I want to close with some words about a health shift of great significance to the UK, Brazil and the world. The growing prevalence of so-called “lifestyle diseases.”

60 years ago the architects of the National Health Service were preoccupied with the major infectious disease epidemics that regularly swept the country, such as measles Since then, huge progress has been made in tackling infectious disease.

Now the challenges are different. They are more problems of greater affluence than poverty and squalor.. Heart disease, stroke, cancer and diabetes - which are often caused by obesity, tobacco and alcohol – are now the illnesses that cause long-term incapacity, and reduce quality of life. Yet they are preventable.

Obesity

In England, nearly a quarter of men and women are now clinically obese.  The trends for children suggest that the same proportion will be obese by 2050, by which time nearly 60 per cent  of the UK population will be obese or severely overweight, according to a 2 year study by some of our most eminent scientists. They spoke about modern life creating an obesogenic society. 

We have just launched a strategy designes to ensure an integrated cross government attack on obesity. The measures are designed to ensure that:

• Every child grows up eating well and enjoying being active
• The food we eat is far healthier (with a big reduction in the consumption of food high in fat, salt and sugar)
• Everyone is as active as they feel able to be; and
• People have easy access to information and advice on healthy eating and activity

Halting the obesity epidemic is principally about individual behaviour and responsibility: how people choose to live their lives, what they eat and how much physical activity they undertake. But It is about the responsibility of industry, for example, to supply foods that promote health seriously and of employers to make the health of their workforce part of their core responsibility.

But Government has a significant role to play in enabling people to make the right choices for themselves; through clear and effective information about food, exercise and wellbeing.  And in ensuring that all its policies across the piece - early years, schools, food, sport, planning, transport, as well as the health service - support people to maintain a healthy weight.

Smoking

A thirty year old man who is obese will on average lose 13 years of his life compared to a non obese smoker who will lose 16. Obesity is a relatively new problem but smoking remains the cause of millions of premature deaths.

Brazil is a leader in tobacco control. You pioneered the use of hard-hitting picture warnings on cigarettes, a precedent we will be following this year.  Brazil has also innovated in the regulation of tobacco products, establishing a state-of-the-art testing laboratory.  It has led the way in enforcement of tobacco legislation, and in using payments from the tobacco industry to fund work in tobacco control.

The noted Brazilian diplomat, Vera Costa e Silva, provided expert leadership of the WHO Tobacco Free Initiative when the Framework Convention on Tobacco Control, the world's first public health treaty, was being negotiated in 2002-03.

Smoking is the single biggest preventable cause of death in England, killing around 87,000 people each year. However, the smoking rate for all adults, which now stands at 22%, fell last year by 2%. This is in no small part due to the fact that, on 1 July 2007, the Government took the major step of banning smoking from all work and public places in England.

This measure has been shown to be highly popular, with three quarters of adults expressing their support for the new law and very little evidence of non compliance.

We also raised the age of sale for tobacco products to 18 last year. This was an effective way of communicating the serious health risks of tobacco to young people but was combined with legislation to strengthen sanctions against retailers who sell tobacco to under age people. 

The NHS provides Stop Smoking Services to give vital support to smokers to quit. Around 165,000 smokers quit between April and September 2007, an increase of 28 per cent on the same period the previous year. 

Alcohol

Preventing alcohol-related harm is also a key priority. We know that harmful drinking greatly increases the risks of heart disease, stroke, cancers and liver disease, and involvement in accidents or violent crime. Total annual healthcare costs alone related to alcohol misuse add up to £1.7 billion [3.3bn USD] per year for the National Health Service. The social impacts - on individuals, the family, public services and the economy - are wider still. 

We have been developing our relationship with the alcoholic drinks industry so that by the end of this year all alcoholic drinks labels will include the drink’s unit content and the recommended Government sensible drinking guidelines.

Closing

I am so pleased to be with you here in Brazil and I look forward to my discussions with Dr Temporao and others, to seeing and hearing how Brazil is tackling these and other health challenges. The scope for learning from this practical partnership is unlimited. 

The Ambassador has prepared a heavy schedule for me with absolutely no shirking. I have the impression that by the time my itinerary here in Rio, in Brasilia, and in Sao Paolo is complete, I will have met everyone connected with health in Brazil and perhaps lost some weight in the process.

And I hope that my visit will lay the foundations for an even stronger future relationship between our countries, through a partnership based on mutual respect and practical support to solve these enormous challenges and enhance and extend the lives of millions of our citizens.