Simon Cooke is Deputy Leader of Bradford Council Conservative Group and blogs at The View from Cullingworth.
As Conservatives, we believe people are individuals able to make their own choices – good or bad. But a strong society looks after those whose choices get them into a mess. We spend money on drying out drunks, helping drug addicts get clean, running stop smoking clinics and supporting people who want to lose weight. We also mend the torn ligaments of Sunday morning footballers and patch up the head injuries of people who fall off horses. What we don’t believe is that, because these activities are a cost to society, we should stop people from making the choice to do them.
So we should be concerned about the ideology of Public Health England. The professional leadership in public health doesn’t share the Conservative belief in choice and personal responsibility. They see it as their job to use the power of the state to stop people from having those choices.
The core of this is the Faculty of Public Health definition:
“The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society.”
This definition isn’t the traditional understanding of public health as removing or reducing environmental risks to health – dealing with things like clean water, fresh air and contagious diseases. The Faculty of Public Health – led by John Ashton, a prominent member of the Socialist Health Association – interprets its definition by viewing the ‘organised efforts of society’ as state intervention in lifestyle choices.
The time has come for Conservatives to reject this left wing definition of public health and to argue for a focus on environmental factors that involuntarily affect the health of the population. Rather than, as we saw with the recent NHS Five Year Forward View, headlines about how we’re all too fat and drink too much, we should be looking for headlines that talk of reducing the harm caused by environmental factors outside the scope of personal choice.
These are genuine public health issues where people are ill, live shorter lives because of things in their environment they can’t control not because they’ve made the personal choice to smoke, drink or eat a lousy diet.
Some 75 per cent of NHS spending goes on treating people aged over 65 – at a recent Bradford Health & Wellbeing Board someone quipped that it is pretty close to a ‘national old-peoples’ health service’. If public health interventions are, in part, intended to get us more bang for our health pound, we should intervene in those environmental factors most likely affect the health of old people. The next biggest users of the NHS are children and, just as with older people, we need to consider the most likely environmental contributors to child ill-health.
There should be seven priorities for a Conservative approach to public health:
- Responding to contagious disease. This covers not just high profile events such as Ebola but diseases that have become endemic again such as tuberculosis and measles. Partly this is about vaccination campaigns but it is also about a focus on high risk groups like new immigrants, drug-users and children
- Air quality. It is clear that a significant factor in asthma, respiratory disease and even lung cancers is urban air quality and especially the role of diesel particulates. The encouragement of diesel engines for reasons of economy and reduced carbon emissions has done little to help here.
- Cold homes. The government has invested in warmer homes but there is still a problem with poor heating as well as with fuel poverty, especially for the elderly. We need to look again at policies to promote warmer homes and at the cost of domestic heating.
- Road traffic accidents. The UK has a tremendous record in promoting safe roads and this is something we all benefit from. However, road accidents are still one of the most common causes of death in younger people.
- Trips and falls. When older people go into hospital they typically stay in longer than do younger folk. One of the common reasons for such hospitalisation is tripping and falling – broken bones and bruises heal more slowly in the old and can trigger other health conditions. Making homes safer and improving access to places outside the home contribute to reducing the risk of falling, and the cost of hospital treatment
- Loneliness. Lots of research tells us that loneliness is a real killer and we have a growing population who live alone. Promoting social engagement and interaction especially for people who find it hard to get out and about should be a central part of public health policy.
- Education and information. People should know the risks and this means providing the information needed to make an informed choice. But we need to get away from the shrill headlines – which are often misleading – about those risks and to be more measured in what we say about personal choices.
None of this means we should stop funding drug and alcohol programmes, sexual health clinics or smoking cessation. But it does mean that we should redefine public health and move away from the dominant ideology of nannying fussbucketry with its plain packaging, minimum pricing and soda taxes and towards one that focuses on environmental factors rather than personal choices.