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.
Moving 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.