The BGS welcomes the aspiration of the White Paper to move towards health promotion as a complementary strategy to disease management, but is disappointed by the focus on children and the working population, with lack of reference to older people, particularly those approaching retirement.

Older people stand to gain as much from a health promotion approach as younger people and their relative absence from this paper will prevent the government achieving its public health goals.

The BGS would hope that increased expenditure on health promotion where evidence of cost effectiveness is weak, would not be at the expense of proven interventions for health problems of older people including comprehensive geriatric assessment and rehabilitation which are evidence based.

Smoking
The Society believes cessation of smoking to be an important health promotion measure to reduce the incidence of chronic chest disease, ischaemic heart disease, cardiovascular and peripheral vascular diseases and would urge that the proposed ban on smoking in public places is implemented without exceptions, in line with other countries including Scotland and Ireland.

Exercise and dietary balance
The Society welcomes measures to tackle the problems of obesity and poor nutrition. However, there is evidence that increased exercise is beneficial at all ages and not just an issue for the young, which should be highlighted. In addition, older people may suffer from problems of under nutrition and poor dietary balance emphasising the need for greater awareness and education surrounding nutritional issues in older people. The issues may be exacerbated by concurrent disease, low incomes and social isolation.

Alcohol abuse
The Society also welcomes measures to moderate the consumption of alcohol in society. Again, this is not purely an issue for the young. In many areas, high alcohol intake throughout life has been a cultural feature leading to increasing evidence of liver disease and mental health problems among older people, exacerbated in the post retirement period.

Mental health
The Society is concerned that mental health is insufficiently represented in the White Paper. There is an emphasis on work related stress, but levels of stress, depression and anxiety among spouses and carers of people with chronic disease are very high and often under-recognised. Vulnerable older people living alone suffer from the same difficulties.

Resources in health care
The Society welcomes the recognition of the impact of inequalities in the White Paper. There is a lack of equity in health care resourcing which is particularly evident in services for vulnerable and older people, but also inequity of access due to disability or disengagement. Current concerns over the value of pensions and financial security may exacerbate these issues and the Society would urge that attention be paid to these areas.

Multiple co-morbidities
The Society acknowledges the important role of community matrons (advanced nurse practitioners) in health promotion and chronic disease management. However, the role of these professionals seems to be disease specific and may not address the multiple co-morbidities special to older people. The role of health trainers appears unevaluated at this point.