In our modem pluralist society, the lifestyle approach to sexual health reflects our wish to recognise that conventional approaches to morality are no longer adequate and that informed choice is an essential underpinning of sexual health. However, the ability to make an informed choice is affected by many facets of our lives.
Behavioural, emotional, social and political factors all impact on an individual's ability to take control of and enjoy their sexuality, and to protect and celebrate their sexual health with knowledge and confidence.
In recent years, the main thrust of public health policy in sexual health has been towards raising awareness about HIV/Aids and the establishment of services to treat and care for people who have contracted HIV. Less attention has been paid to other aspects, particularly inequalities in the ability to exercise choice and autonomy, the integration of sexual health into generic health and social policies and practice, and to the sexual health needs of socially excluded groups.
While specialised services are frequently clear and focused in their approach, there is often confusion and ambivalence about the potential contribution of non-specialists to the promotion of sexual health. Locating sexual health firmly within the new public health agenda opens up the possibility of a new approach to enhancing human health and well-being by promoting the healing and creative power of sexuality.
We need a definition of sexual health that reflects sexuality as positive and life-enhancing, and an awareness of the social, economic and political forces that impact on sexual health for individuals and communities. The Family Planning Association's definition of sexual health is "the capacity and freedom to enjoy and express sexuality without exploitation, oppression, physical or mental harm".
If we examine how the population's sexual health measures up to this definition, we find that there is a wealth of qualitative and quantitative evidence which indicates that sexual health is poor.
Inequalities exist, such as a higher age of consent for gay men, which has reduced their freedom to protect their sexual health. The relationship between teenage pregnancy, low socio-economic status and low educational achievement illustrates the disadvantaged position of particular groups of young women. And the needs of boys and men are not adequately recognised, so they are rarely met by sexual health services.
Indicators of sexual health show a worrying position: approximately one- fifth of all pregnancies end in abortion; there were 446,000 cases of sexual infections diagnosed in genito-urinary medicine clinics in 1997, an overall increase of 5 per cent; a sixth of couples seek assistance for infertility. These figures demonstrate the current deficit in sexual health and the urgent need for action.
There must be a coherent national approach to sexual health as a primary component of human health overall. We need the Government to ensure that its new sexual health strategy employs an integrated approach, to avoid the issue being marginalised because of a narrow, problem-led focus.
It should include a number of key objectives: encouraging openness, knowledge and understanding about sex; ensuring that all young people receive effective education about sex and relationships; and reducing inequalities by prioritising interventions for groups with poorer sexual health.
In addition to the overall strategy and the integration of sexual health into mainstream services, social inequalities need to be tackled in culturally sensitive specialist services. This has important consequences for the ethos and values of local services.
Sexual health is central to well-being and has a major impact on physical and mental health. The current problem-led approach limits the effectiveness of policies to meet the needs of all the population. We need a new approach, a new strategy that places sexual health firmly within the public health agenda and, in so doing, celebrates sex and relationships as key components of a happy and successful society.