Website of the Department of Health

John Reid, Health Secretary

A founding principle for the NHS in 1948 was that it should improve health and prevent disease, not just provide treatment for those who are ill. Sustained investment and reform in the NHS is already ensuring faster and more personalised healthcare for patients. As the health service makes rapid progress on treating illness, the need for similar progress on improving people's health comes to the fore. We are committed to ensuring that the fundamental mission of the NHS to promote physical and mental wellbeing and prevent illness is pursued effectively in the 21st century. We need to step up the action we are taking across government and throughout society to tackle the causes of ill-health and reduce inequalities. Now is the right time to refocus the NHS as a service for health, in a way that reflects the realities of the lives of people in England today.

In recent decades, the debate about the respective roles of Government, individuals, communities, industry and others in improving health has too often become bogged down in a ritual battle between two ends of a political spectrum. On the one hand, a paternalistic state is encouraged more and more to limit individual choice, constrain personal decisions and ban action which promotes unhealthy behaviour. On the other, the Government is asked to stand back, leaving people's health to whatever the hidden hand of the market and freedom of choice produces.

The extensive consultation that informed the development of Choosing health has provided the opportunity to hear about what is important to people in England today. People's concerns, and ideas based on their real lives, have helped us to develop a more down-to-earth and practical approach to public health policy that will enable everyone to move on and will begin to make a real difference.

First, people told us that they want to take responsibility for their own health. They were clear that many choices they made - such as what to eat or drink, whether to smoke, whether to have sex and what contraception to use - were very personal issues. People do not want Government, or anyone else, to make these decisions for them.

Second, what they did expect was that the Government would support them in making these choices. They wanted clear and credible information, and where they wanted to make a change and found it hard to make a healthy choice they expected to be provided with support in doing so - whether directly or through changes in the environment around them - so that it is easier to 'do the right thing'.

Choosing health sets out key principles for that support. Our starting point is informed choice. People cannot be instructed to follow a healthy lifestyle in a democratic society. Health improvement depends upon people's motivation and their willingness to act on it. The Government will provide information and practical support to get people motivated and improve emotional wellbeing and access to services so that healthy choices are easier to make.

It is a fact of life that it is easier for some people to make healthy choices than others. Existing health inequalities show that opting for a healthy lifestyle is easier for some people than others. Our aim must be for everyone to achieve greater health and mental wellbeing by making healthier choices. That means ensuring that those people in disadvantaged areas and groups have the opportunity to live healthier lives. We will work with the many other organisations involved to coordinate effort and personalise services, tailoring them to the realities of people's lives.

While we respect individuals' rights to make their own choices, we need to respond to public concern that some people's choices can cause a nuisance and have a damaging impact on other people' s health. We need to strike the right balance between allowing people to decide their own actions, while not allowing those actions to unduly inconvenience or damage the health of others.

Moreover, in the case of children there is a greater case and requirement for protection. Children need a protected environment as they learn about making lifestyle decisions that impact on their health. This is a responsibility that Government shares with parents.

These considerations, therefore, run through this White Paper: helping people to make healthier choices for themselves; protecting people's health from the actions of others; and recognising the particular needs and the importance of emotional and physical development of the young. Government cannot simply leave it up to individuals, we must work with others to provide collective support to help create an environment which promotes health. These form the basis of achieving a balance between the healthy outcomes we all want to see and the equally valued freedom to determine our own way of life that is so important in a democratic society.

Choosing health sets out a starting point for national renewal of practical and acceptable action to make a difference to the health of people in England. There is no 'magic bullet' in the strategy, because there is no quick or easy solution that is certain to work.

Some of the action set out here is substantial and will start to make a difference immediately but, in other areas, significant change will be the result of sustained action by many individuals over a number of years. This White Paper is the start, not the end of a journey. We will continue to develop ideas and action, learning from experience to help people choose health in the 21st century. It is the next step in our journey towards engaging everyone in choosing health and tackling health inequalities. We have set ambitious targets for health. By working together across society we should achieve them. The success of the strategy will be measured first in the increased number of healthy choices that individuals make, and then in the lives saved, lengthened and improved in quality.

In moving forward the public health agenda in England, we recognise that some proposals in this White Paper will have implications for other parts of the UK. We will work closely with colleagues in the devolved administrations to identify these, so that joint action can be taken where appropriate and legislative opportunities provided for the devolved administrations where new powers are created for England. In these ways we can achieve our common goal of improving the health of people throughout the UK.