National Institiue for Health and Clinical Excellence

Annual Review - 2009/2010

Our guidance could prevent up to 40,000 deaths from heart disease and stroke each year, by reducing salt and saturated fat levels in our food

The health of the nation

NICE’s Centre for Public Health Excellence (CPHE) produces guidance that can be used by the NHS, schools, workplaces, local authorities and the wider public and voluntary sector to help to prevent disease and promote good health of both individuals and populations.

In 2010/11, CPHE produced guidance in a very wide range of public health areas. There were two complimentary set of recommendations aimed at increasing the uptake of HIV testing among people from black African communities and men who have sex with men.

Published in March 2011, they aim to increase the number of earlier diagnoses. The guidance recommends that health professionals should routinely offer and recommend an HIV test to all patients attending genitourinary medicine or sexual health clinics, antenatal services, TB, hepatitis and other relevant services. The aim was to normalise testing.

Advances in medicine mean that HIV is no longer necessarily the terminal disease it was 30 years ago, and can now be successfully managed with antiretroviral therapies. Therefore early diagnosis is very important. Too often people are diagnosed late, by which time the virus has already damaged their immune system. Late diagnosis is one of the biggest contributing factors to illness and death for people with HIV.

In October 2010, in collaboration with the Social Care Institute for Excellence (SCIE), guidance on the promotion of the quality of life of looked-after children and young people was published. This recommended that children's trusts should develop a corporate parenting strategy focusing on partnership work and addressing health and educational inequalities and a range of other measures to help to provide for integrated services for these children.

During the year guidance was produced on the prevention of unintentional injuries among young people under the age of fifteen in the home and on the road, and on broader strategies to prevent injuries to children. Guidance was also published on quitting smoking in pregnancy and following childbirth, skin cancer prevention and weight management before during and after pregnancy.

The misuse of alcohol and cardiovascular disease remain two of the major preventable causes of early death and high levels of sickness and disease in the population. This year guidance was published in both of these areas. The guidance on preventing harmful drinking, as well as focussing on screening and brief interventions in primary care, recommended that a minimum price for a unit of alcohol alongside other measures that would make it harder to buy alcohol, could make a significant difference to the levels of consumption among those drinking excessively.

Professor Mike Kelly, Director of Public Health at NICE, says: “Alcohol misuse is a major public health concern which kills thousands of people every year and causes a multitude of physical, behavioural and mental health problems.

“What's more it costs the NHS over £2 billion annually to treat the chronic and acute effects of alcohol - this is money that could be spent elsewhere to treat conditions that are not so easily preventable.”

The public health guidance on preventing cardiovascular disease, if implemented could save up to 40,000 deaths from heart disease and stroke each year through the reduction in levels of salt and saturated fat in our food. The guidance suggested a reduction in salt intake, aiming for a maximum intake of 6g per day per adult by 2015 and 3g daily by 2025. This action alone could result in 15,000 - 20,000 fewer deaths from heart disease and stroke every year.

The Public Health White Paper

In November 2010, in the Public Health White Paper, the government signalled that local authorities will be given major responsibility for public health for the first time since 1974, with ministers pledging a ring-fenced £4 billion budget to help tackle problems like smoking and obesity.

Much of our existing portfolio of public health guidance is relevant to these ambitions. As the new arrangements for the structures of public health are finalised, the potentially important role that NICE’s public health work can play here, will be kept under review.