If you refuse to walk under, or indeed climb, ladders then this blog is not for you.

The public health white paper is to be launched tomorrow (Tuesday).  There has been much trailing of various proposals that will likely appear in the document – from providing vouchers to school children who walk to school, to a new inclusion board to help improve the public health of marginalised communities and restrictions on cheap alcohol.

The Secretary of State for Health, Andrew Lansley, talked of a ‘ladder of intervention’ when he was interviewed about the white paper at the weekend.  In other words, the regulatory touch will be light and interventions carefully chosen.  Nonetheless it will be intriguing to see the balance the Government has decided to strike between ‘aunty nudge’ and ‘nanny state.’  The last public health white paper was in 2004 and I seem to remember it being greeted with a chorus of disapproval that Government was veering too much towards the latter.  The debate then was dominated by arguments over whether to ban smoking in public places. 

Whether intended or not, the use of the ladder metaphor by Lansley is coincidentally rather interesting given what I think will be the tone and style of tomorrow’s white paper.  Laddering is a methodology used in marketing to identify what attributes in a product appeal to the values of the consumer and attracts them to it.  I suspect that the overriding approach in the white paper will likewise be about identifying methods by which to incentivise rather than compel the right behaviour changes.  Where interventions are proposed they might well be in those areas that seem more black and white to the public – putting cigarettes into plain packgaing for instance.

However, my day job means I will necessarily search to see what the document says, if anything about public health research.  When the UK Clinical Research Collaboration (UKCRC) produced its 2006 Health Research Analysis of the 11 largest public funders in the UK it showed that only 2.5% of spend went on ‘prevention.’  When the Office for Strategic Co-ordination of Health Research (OSCHR) was set up about 18 months or so later one of its three sub-boards was focused on public health (the others were on e-health and translational research).  The public health one took longer to start and I am not clear quite where its work has got too although my understanding is that it has found the going hard.  if you want more on the research picture you might want to have a look at this analysis of public health research across the EU available on the Faculty of Public Health website.

Notwithstanding the work of this body, the need for a strategy on public health research open to scrutiny seems long overdue and it is one where the funding and expertise of medical research charities with their knowledge of patients could play a major role.  So. here’s hoping that the white paper sees public health research climb the ladder rather than snake further downwards in the order of priorities.