The primary threat to life in the UK

By Tom Keeley

2 in 5 British people over weight, increasing to 3 in 5 by 2020. Type 2 diabetes rising year-on-year. The most alcoholic nation in Europe. A generation that will die before their parents. These are statistics that have been repeated to the point of futility. The myth, that modern medicine will increase our length of life, regardless of how we live that life, endures.

The fact remains however, that poor public health is the primary threat to life in the UK; it will claim more British years of life than crime, terrorism, and war combined. This should haunt Labour health ministers and MPs of the last 14 years – it happened on our watch.

The Public Health White Paper, published at the start of this month, is attempting to address a problem as big and important as any this government will face. It is therefore disappointing that we have a paper high on political rhetoric, low on workable solutions and with a dangerous undertone of the “Big Society”.

Political rhetoric

The paper claims that centralisation has failed. Central government should no longer act to improve the health of the people. Where this reasoning comes from is unclear. History is a bad justification for the present, but it should be noted that the 1875 public health act, the seat belt law, our drink driving laws and the smoking ban are all centrally conceived directives, which have saved lives.

This present case for central government is two-fold. The evidence and knowledge base in public health is growing, but still slim. Unlike in education and medicine, there is not an abundance of highly qualified experts capable of implementing well directed policy at a local level. Secondly, many of the threats to health are nationwide and need national solutions. Multinational fast food chains, the availability of low cost alcohol, tobacco and almost non-existent national physical activity, are not problems that can be addressed by local community action.

This should be an area where government, following the advice of experts, intervenes to improve people’s lives. Where it ensures that wealth, race, class, locality or education are not determinants of health. An area where no part of society is left behind. Workable solutions. This white paper is not totally void of strengths; it does contain some highpoints. A ring-fenced public health budget, the creation of Public Health England and the forwarding of walking to school schemes, are all initiatives that should have been adopted in the early years of the Labour government.

However, the positives are slim pickings, in a massively misjudged proposal. The focus of the reforms is on gently persuading people into better health. Intervention will be limited to providing information and, at most, positively incentivising choice. There is little evidence that such an approach works. The disincentivisation and restriction of choice, of which the smoking ban is a prime example, will not be used.

The conservatives argue that the last two options are the actions of a “nannying”, intervening and paternal state. They may be right. However, they should consider this: we now live in a society where it is easier to be overweight, inactive and unhealthy, than it is to be of normal weight, active and healthy. This becomes even more difficult if you are poor, uneducated and non-white. A sedentary, fast food lifestyle is the easier and cheaper choice. And, as just about every study of human behaviour shows (sociology, psychology, economics, history), humans normally take the easier, cheaper choice. The healthy choice needs to be the easy choice, and this does not happen without intervention.

A workable solution should to be across the spectrum, at all levels, inter-departmental and immediate.

The Big Society

The “Responsibility Deal” is the Big Society in public health: the coming together of industry, community and government to collectively work for the betterment of the public’s health. The five biggest UK supermarkets will be represented, as will Unilever (manufacturer of Pot Noodles and Walls ice cream), the Wine and Spirits Trade association (pressure group) and Diageo (spirit and beer producer). From the little information available it appears that the Chief Executives of many of these companies, will chair their committees; committees responsible for health in this country. It makes this author want to jump out the nearest window.

While industry does need to be brought into this process, their involvement is now dominant, pervasive and enduring. Profit margins will dictate policy. What the results will be is anyone’s guess. But, as a first indication consider this: traffic light food labelling has been a hate of the food industry since introduced. It allows for the informed choice of healthy options. It reduces the profits of food companies. It will now be dropped, as an early concession to industry.

Many of the government’s plans have not been announced in this white paper, they are to follow in smaller reports. The devil will be in the detail. Opposition to these proposals for public health will not be easy. It is an ill understood area, where the position of “it is simply about personal responsibility” plays well for the Tories. However, it is also a position that will lead to massive pressure on the NHS and the early death of hundreds of thousands of British people.