Select Committee on Home Affairs Memoranda


Submitted by the Health Development Agency (HDA)


  1.  The Health Development Agency (HDA) welcomes the opportunity to submit the following evidence to the Home Affairs Select Committee. The HDA is a Special Health Authority, working to improve the health of people and communities in England, in particular, to reduce health inequalities. In partnership with others, it gathers evidence of what works, advises on standards and develops the skills of all those working to improve people's health. The role of the HDA is different from that of its predecessor, the Health Education Authority, whose primary purpose was education of the public on health issues, including drugs. The Health Education Authority was cited in Tackling Drugs to Build a Better Britain (1998) as one of the mechanisms for supporting the delivery of the national drugs strategy.

  1.1  As part of its wider remit for developing the evidence base for public health, the HDA is currently collating and assessing published and unpublished reviews of the evidence base for drug education and prevention, particularly in relation to reducing health inequalities. This work will be completed by May 2002 and complements an international collaborative project (Brown and Hosman, 2001), which is currently reviewing the international evidence base for drug education and prevention.

  1.2  The Health Development Agency's response will focus on the following points:

  1.2.1  The evidence base for the Government's drugs policy

  1.2.2  The contribution of the Government's drugs policy to health improvement and tackling health inequalities.

  1.2.3  Public health systems to support drug education and prevention and the capacity and capability of the public health workforce to deliver the Government's drugs policy.

The evidence base for the Government's drugs policy

  2.1  At present the evidence base for policies on drugs does not meet established quality standards for scientific evidence. In this respect drugs policies in England, Scotland, Wales and Northern Ireland are no different from those in Europe, North America and internationally.

  2.2  Most initiatives and innovations in the drug education and prevention field are not evidence-based and have not been subject to evidence-based evaluation. Initial findings from the HDA's review show that there are very few systematic reviews of drug education and prevention activity. In other words, there are very few peer-reviewed journal articles, which employ a rigorous methodology to compare different types of drug education and prevention interventions and their outcomes. Even when we cast the net wide to include published literature reviews, meta-analyses or syntheses, the body of evidence for effective drug education and prevention with vulnerable groups in the UK is small.

  2.3  There is an understandable time lag between completion of research studies, acceptance in peer-reviews journals and, therefore, any resulting published systematic reviews. Recognising this time lag, the HDA will also be trawling databases to identify and assess "grey" literature, such as reports of evaluations on drug education and prevention interventions in the UK, to identify interventions that look "promising".

  2.4  In developing other evidence bases, including those for tobacco, alcohol, teenage pregnancy and sexual health, the HDA is able to examine relationships between effectiveness in these areas and the implications for drug education and prevention.

The contribution of the Government's drugs policy to health improvement and tackling health inequalities

  3.1  We do not know if drug use is more prevalent amongst vulnerable groups because very few studies have been broken down in terms of social class and other indicators of vulnerability. But there is a body of knowledge that those who are "worst off" are more vulnerable to the negative effects of drug use. One of the most effective ways of reducing inequalities is by tackling child poverty, and the Government's drugs policy emphasises supporting the most vulnerable groups of young people. Apart from local Drug Action Teams, the main bodies and projects, which have tried to link research with practice in relation to effective drug education and prevention with vulnerable groups include the following:

  3.1.1  The University of Central Lancashire's Ethnicity and Health Unit of the Faculty of Health;

  3.1.2  The Home Office Drug Prevention Advisory Service's Vulnerable Groups Consortia;

  3.1.3  The Department of Health's additional Health Action Zones funding for addressing drug education and prevention needs of vulnerable groups and its related evaluation and dissemination of good practice project, based at Bradford Health Authority;

  3.1.4  The independent voluntary organisation, DrugScope's "Right Approach. Quality standards in drug education (1999)" and DrugScope's LocateNet database, which maps UK young people's drug prevention projects and any resulting evaluation;

  3.1.5  The National Healthy School Standard, which contributes to reducing drug-related school exclusions, as well as other education and health issues;

  3.1.6  The Department for Education and Skills' (DfES) Connexions Service, which provides personal advisers for all young people, including vulnerable young people, between the ages of 13 and 17;

  3.1.7  UK Anti-Drugs Co-ordination Unit and DfES programme to support young people who have graduated from drug treatment programmes into training and employment;

  3.1.8  The National Children's Bureau Drug Education Forum's "Drug Education for Children and Young People in Public Care" project.

  3.2  All these initiatives, plus the many promising interventions commissioned and delivered at a regional and local level, have helped to fill some of the gaps in the knowledge base with regard to vulnerable groups. Some, but not all, of these initiatives have been a direct result of the Government's drugs policy.

Public health systems to support drug education and prevention and the capacity and capability of the public health workforce to deliver the Government's drug policy.

  4.1  The Government's drugs policy relies on good partnership working between key stakeholders, including young people, at a local and neighbourhood level, particularly when tackling drug-related crime. The proposed restructuring of the NHS (Shifting the Balance of Power Within the NHS, 2001) will provide opportunities for greater ownership of the agenda for drug prevention and tackling health inequalities. Regional Directors of Health and Social Care will have a responsibility for supporting health and social services activity at a local level, in particular, by ensuring strong links with the agendas of other government departments. Primary Care Trusts and Care Trusts will provide support to Drug Action Teams and, by supporting newly emerging Local Strategic Partnerships, will ensure that drug prevention priorities are, included in, and supported by, local community strategies and Health Improvement and Modernisation Plans. Inevitably, changing landscapes for the public health workforce can reduce their ability, in the short term, to contribute effectively to the government's drugs policy. This can exacerbate existing difficulties in recruitment and retention of suitably trained or experienced workers to deliver some of the programmes highlighted in the government's drugs policy.

  4.2  In conclusion, the HDA will ensure that the evidence base for drug prevention and tackling health inequalities is accessible to a wide range of stakeholders. The evidence base will inform guidance for commissioners of drug prevention services. However, the shift towards evidence-based practice should not have the effect of stifling innovation. Innovation is a vital part of a dynamic and evolving evidence base particularly in relation to tackling health inequalities and the wider determinants of health.

September 2001


  Acheson, D (1998). Independent Inquiry into Inequalities in Health Report. London: The Stationery Office.

  Brown, C and Hosman, C (2001). International Classification of Prevention Trials. Society for Prevention Research (work in progress).

  DH (2001). Shifting the Balance of Power in the NHS. London: The Department of Health.

  DH (2001). Tackling Health Inequalities. Consultation on a plan for delivery. London: Department of Health.

  DfES (2000). Connexions. The best start in life for every young person. London: DfES.

  DfES/DH (1999). National Healthy School Standard. Guidance. London: DfES

  DrugScope (1999). The right approach: quality standards in drug education. London. DrugScope.

  Meyrick, J., Burke, S., and Speller, V (2001). Public Health Skills Audit 2001. Short Report. London: Health Development Agency.

  Health Development Agency (2000). Health Improvement Programmes (HimPs) 1999-2000. Conclusions and recommendations of the Health Development Agency's National Review. London: Health Development Agency.

  Tackling Drugs to Build a Better Britain (1998) Government White Paper. London: The Stationery Office.

  White, D and Pitts, M (1998). "Educating young people about drugs: a systematic review", in Addiction, 93(10), 1475-1487.

September 2001

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Prepared 20 December 2001