There is still controversy about the plain packaging of cigarettes, and unit pricing of alcohol, but it seems clear that both measures will be introduced eventually throughout the UK.  But there has been relatively little political discussion of public health since the last election.

Andrew Lansley claimed he wanted to be responsible for public health, and would leave the NHS to run itself.  “Tactics will be switched from nannying and legislation to nudges and persuasion”, it was claimed.  There was a lot of talk about Change For Life, which was to be funded by industry, and a promise that the public health programme would  ‘improve the health of the poorest fastest.’  But there wasn’t much sign of real activity, and since the Faculty of Public Health withdrew from the Government’s responsibility deal the Government’s Public Health strategy looks a bit thin.

So the way looks clear for a Labour alternative strategy. One more solidly based on a collective, rather than an individual approach.

The central issue is, however, the most difficult.  Health inequality is primarily an expression of economic inequality.  The last Labour Government seemed to think that it was a problem for the NHS to deal with.  Of course there are things the NHS could improve in the way in which services for poorer people  are organised, but that is not the central problem.  Economic inequality has increased, is increasing, and should be reduced.  Most of the benefit of economic growth in the UK over the last 30 years has gone to the very rich, and so has most of the improvement in health.  This inequality drives all the others.  There isn’t much that can be done about it at a local level.  And there doesn’t seem to be much evidence that the Labour Party is prepared to tackle the problem.  It’s too difficult.

Economic inequlity UKMoving the responsibility for Public Health out of the NHS into local government is something the SHA welcomes – though the shortage of money is a problem, at least local councils have more control of the things that make people ill – especially housing and transport – than the NHS.  But we need to think about measures that don’t cost a lot of money which means looking at legislation, rather than individual solutions.

We may need to think of a more European approach to some of these issues.

The commercial development of e-cigarettes is a new development, and it’s not yet clear what its effects will be.  There are not a lot of obvious new measures to be considered in this area, but raising the age at which people can buy cigarettes may be worse considering.

There is a sensible argument that moving alcohol consumption back to licensed premises and away from homes would be a helpful move.  Measures which make the promotion of alcohol less attractive for retailers are certainly worth considering. For example if there were restrictions on the hours during which alcohol could be sold or displayed then we wouldn’t see so many piles of cheap lager on offer in supermarkets.

Obesity is in every way the growing problem, and its not easy for politicians. Interfering with eating habits is seen as unacceptably intrusive.  And manufacturers are right to say that obesity is not primarily the result of consuming more sugar.  The problem is that most people don’t use so much energy. There are fewer jobs which require much physical effort, and fewer people routinely use a lot of physical exertion.  The problem really is cars and television. The solution is getting people to walk or cycle.

But in the mean time perhaps we need to confront the food and drink manufacturers.  If we reclassified sugar as being fuel, rather than food, it would attract VAT and excise duty.


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  1. A Member says:

    Maybe I’m missing something but E-cigarettes are an adjunct to quitting smoking. They are a nicotine substitute (like NHS-prescribed nicotine gum) combined with a tactile substitute. How on Earth can anybody seriously suggest they are a health risk? There are no carcinogens & the vapour is totally harmless. There is absolutely no evidence that these harm anybody, and if they help people stop smoking, they can only be a good thing.

    By contrast, Sarin (GB) is a potent agent, which inhibits neuromuscular transmission, resulting in life-threatening respiratory paralysis. Without immediate intubation & ventilation, it is rapidly lethal. Its deployment was intended to cause mass fatalities & instill fear in survivors. The Syrian use of Sarin, in the attack near Damascus, on its own population, resulted in 1,429 civilian deaths, including 426 children.This constitutes genocide.

    Sarin is classed as a weapon of mass destruction in UN Resolution 687. Production and stockpiling of Sarin was outlawed by the Chemical Weapons Convention of 1993 where it is classified as a Schedule 1 substance.

    Today, it was confirmed that, between 2004-2010, New Labour licensed UK firms to export sodium fluoride to Syria. Intelligence confirmed that the regime was using these supplies to manufacture Sarin. Syria had refused to sign the Organisation for the Prohibition of Chemical Weapons (OPCW) accords, forbidding manufacture of weaponised agents.
    CBRNe agents are “real” weapons of mass destruction. New Labour had intelligence reports that the Syrian regime was manufacturing these agents, yet continued to license UK firms to supply essential precursors. Blair and Straw were complicit in Assads’ regime developing this capability. Capability + intent (and it’s widely recognised that he was a brutal dictator) = threat.

    The use of WMDs against civilian populations results in death, disability, disease, population displacement & destitution. Martin should try working in a refugee camp, where epidemics such as measles, cholera, dysentery, diphtheria & meningitis combine with food scarcity, inadequate water, sanitation and hygeine to result in humanitarian emergencies. These are slightly more real public health threats than E-cigarettes. For some bizarre reason, Martin focuses on E-cigarettes, whilst ignoring genocide.

    I find it excruciating that the SHA has now become an arm of New Labour, where we turn a blind eye & deaf ear to crimes against humanity because it might embarrass Martins’ friends in New Labour.

    If we are going to talk about public health, can we widen it to addressing preventable suffering in Syria rather than just banging on about the bloated beurocratic UK public health industry, which has failed millions? The best way to prevent suffering in Syria is to take out Assads’ WMD & work with Russia and China to effect a peaceful regime change.. The best way to prevent governments using WMDs is to prevent nations manufacturing WMDs, tactically destroying stockpiles & intervening to bring perpetrators (and their accomplices) to justice. International governments have a responsibility to act promptly to prevent further deaths. Intervention requires military action & humanitarian intervention.

  2. Martin Rathfelder says:

    How am I responsible for the SHA turning a blind eye & deaf ear to crimes against humanity?

  3. Martin Yuille says:

    You write “moving the responsibility for Public Health out of the NHS into local government is something the SHA welcomes”.

    I think SHA has not got this quite right. Yes, local government is an important partner in improving public health since it is well placed to deal with some environmental issues (housing, transport, primary and secondary education, town planning) that impact on public health. But the key word here is “partner”.

    NHS organisations and local governments need to work together to address the challenge of improving public health. They both have a responsibility. The Coalition’s recognition that local government has a responsibility is therefore welcome (even if funding is wholly inadequate).

    But there is far more to do than that if we are to improve public health effectively. We need partnerships for public health – bringing together the population, health professionals (in primary and secondary care and in local government), health researchers (in universities for example) and the various agents for local and regional economic development and growth.

    The Coalition has also improved on Labour’s efforts to bring health professionals and researchers together: Labour introduced five “academic health science centres” (with no dedicated funding). The Coalition has introduced England-wide “academic health science networks” (with limited funding).

    But all this still falls far short of the partnership that will be required actually to improve public health – especially where the health stats are the worst.

    The key partner that needs to be engaged is the most amorphous: the population. This need is widely recognised, but most efforts to address this need are formalistic (let’s have a website; let’s have a patient rep on our committee) and transitory (no sustained financing). As a consequence, those members of the population who most need to be empowered in improving their own health and their communities’ health are least empowered.

    Some of us are conscious of this need and, with limited resources, are making efforts to address it. SHA would do well to look at these efforts and draw on them so as to make policy recommendations that would give bite to a future Labour-led government.

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