Everybody interested in public health will welcome the fact that, after a period of dithering, the health secretary Andrew Lansley has announced he is going ahead with Labour’s ban on shops displaying tobacco and will consult on plain unbranded packs. But the idea (hinted at in this Guardian leader) that government can only take action on public health issues when public opinion has already begun to change is the counsel of despair.
The tobacco epidemic is certainly on the wane. But this has not happened out of the blue. It is a combination of media whistleblowers about “big tobacco”; decades of determined campaigning by the medical profession; the hard work of campaigners such as Ash and decisive government action. Tobacco control was one of the last Labour government’s public health successes. We introduced the smoking ban in pubs and enclosed spaces, ended sports sponsorship and billboard advertising, raised the legal age of purchasing cigarettes and put graphic warnings on cigarette packs. We often had to push on with these policies against industry and public opinion. But nobody now would reverse any of it (except cigarette manufacturers).
Firm action was needed on tobacco because it causes the most preventable deaths. But other public health issues like nutrition and diet are clearly linked to acute health problems like hypertension, diabetes, strokes and cancer. Cancer Research UK has made it clear that so-called “lifestyle” issues are important in preventing the disease.
And health inequalities in Britain remain quite shameful for one of the wealthiest countries in the world. For example, in London the life expectancy of local people falls by one year with each station along the Jubilee line between Westminster and Canning Town, and in Glasgow there is a divide of 28 years in life expectancy between the richest and poorest areas. But this health inequality, as the House of Commons public accounts committee sets out in its recent report, is largely caused by public health issues.
When people’s lives are at stake, it is not good enough to say that government action on public health issues will be determined by holding up a wet finger to the breezes of public opinion to see which way the wind is blowing. More is demanded from a responsible government.
Public health does not have the glamour of hospital-based medicine. George Clooney will not be appearing in an exciting prime-time television series about public health officers any time soon. Vested interests are quick to paint any action on public health as the “nanny state”, as Lansley touts the importance of personal responsibility. But the great public health causes of the 19th century, clean water and a proper sewerage system, succeeded because of municipal action.
Education, moral suasion, investigative journalism, diligent lobbying and people exercising personal responsibility all have a part to pay in fighting the public health problems that condemn so many of our fellow citizens to an early death. But government has to be part of the change it wants to see.
Junk food is ubiquitous and the middle classes do like their wine. More important, the global forces that benefit from these phenomena are massively powerful. But, if politicians are only willing to go as far on public health as the pollsters tell them that swing voters are prepared to go, then thousands will die unnecessarily every year. On some issues government has always had to lead. Public health is one of them.
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