Start Well, Live Better is the Faculty of Public Health’s manifesto for improving the public’s health during the next parliament. A child born today is very much more likely to live to be 100 than at any time in the past so we see our manifesto as a charter for the health and the future of those who can’t yet vote.

Whoever forms the next government, we want them to take up our demands: to give every child a good start in life; to introduce good laws to prevent bad health and save lives; to help people live healthier lives and to take national action to prevent global problems.

The good laws we call for are standardised cigarette packs, a minimum unit price for alcohol, a sugar tax, controls on the marketing of high sugar, high fat, high salt foods to children and a national 20mph speed limit in built-up areas. We believe that national government action is necessary to enable health to improve and it should not have to wait until everything else has been tried.

Local government is shackled in its efforts to tackle the obesity epidemic and control alcohol-related violence and ill health, because governments have failed to implement good laws to help the sector. There is long history of local action preceding national legislation for the public’s health in this country. The first Public Health Act of 1848 came in only a year after the first wave of cholera but it was still six years after Chadwick’s sanitary report. It would then be 27 years before the second Public Health Act gave real and coherent powers to require clean water and sanitation, reduce shoddy housing and require the appointment of a medical officer and sanitary inspector. Many councils, notably Liverpool, Leicester and the London boroughs, were on the case 30 years before that 1875 Public Health Act and had implemented local nuisance control laws of their own. More recently, Liverpool’s threat to implement a public smoking ban in 2004, and Greater Manchester’s high-profile proposal to introduce a minimum unit price on alcohol in 2010 gave stimulus to national policy debate. On the smoking ban, some might say the government was shaken or shamed into action. The prime minister supported Manchester on the minimum unit price but failed to follow up. Many types of council are now looking at local minimum unit price policies.

Traditionally national politicians seem to exhaust all other possibilities before having recourse to law making. The 20-year waits for seatbelt legislation and for the public smoking ban hide a catalogue of premature death and disability which should have been a cause of national shame. The illusory defence of individual freedoms and individual responsibilities has deflected blame from politicians who have failed to protect and improve the public’s health.

Politicians, to their credit, have finally moved to standardise cigarette packs. Buoyed by this, a minimum unit price for alcohol should follow in the first 100 days of the next parliament. A tax on sugar-sweetened drinks would reduce the number of obese adults by 180,000. Controls on the marketing of processed food to children would arrest the continuing rise of obesity in year 11 children and adults. These changes would give councils a fighting chance in obesity prevention and reduction through active transport policies and healthy town planning and through weight management services. For any local authority, there will be more child death audits involving road accidents than there are other children’s safeguarding issues; 20mph residential zones can be done by local authorities, so why aren’t they?

We need a national standard through law. Cicero put it best: “The health of the people is the highest law.” We quote it freely and it appears in our manifesto. His words engraved are on a plaque above a health centre built by Southwark LBC in 1937 under the last Poor Law, and should be ingrained in every policy and every action taken by councils.

The Faculty of Public Health believes councils are fighting with one hand tied behind their backs on public health. Protecting the public’s health should be a partnership; good national laws should complement the local action councils are taking to secure a better future for all our citizens.

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  1. 8 April 2015
    Dear Mr Middleton
    Your article here certainly makes a very telling point – that of Chadwick and the sanitary laws.
    Where is Chadwick now though? We are now being told that rubbish collections might only happen once every 4 weeks. And yet public health could be in jeopardy if streets are filled with overflowing rubbish bins.
    What is the answer please?
    Why did our weekly rubbish collections disappear? Surely that is a number one priority to ensure that our waste disposal is done on a frequent basis.
    Thank you very much for this essential piece.
    Rosemary Cantwell

  2. Robert Jones says:

    Possibly if I had children I might subscribe more enthusiastically to this rather corporate view of public health, and yet while it is the responsibility of local authorities of one kind or other (eg, water companies, since we’ve turned the clock back to the 19th century and privatized utilities) to ensure that the drains are in good order, that water is not contaminated, that rubbish is removed from the streets, I don’t believe responsibility should extend much farther than that.

    There are laws, too many I believe, which restrict what people can do for their own good, but it’s the ‘for their own good’ element I find troubling. We are entitled to do horrible, dangerous, smelly things if we wish; to eat full fat sugar-laden excrescences if we choose. We should also be entitled to live in sanitary, dry, safe housing – but no such right enforcing this exists in public health law or anywhere else.

    When public health concerns itself over-much with people’s personal habits, while ignoring the unhealthy environment in which many live, it assumes the Lady Bountiful aspect characterized by the lady of the manor visiting the peasantry in their noisome cottages while bestowing improving tracts and Christian consolation. Public health requirements should apply to public bodies, not to the nasty habits of the great unwashed – which are entirely their business. There is too much of the pulpit in this piece – although I’ve read much worse: the defence of individual freedom is NOT “illusory”: without it, we have nothing.

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