You may be forgiven, given recent media focus, for thinking that most healthcare takes place in hospitals. Or that it is the NHS that makes the greatest difference to our health. In reality the most significant impacts are made through really good quality public health. Think about the changes that resulted from improved sanitation, smoking legislation and seatbelts in cars.
Labour’s new public health policy ‘Protecting Children, Empowering All’ was launched yesterday. Andy Burnham and Luciana Berger have been set a tough challenge: how to use public health policy – traditionally an area where Labour can bring radical change to health and health inequalities – without any extra spend.
Burnham and Berger are also restrained by the need not to spook the electorate by redistributing wealth. Given the significant link between poor health and poverty this would be the most effective way of finding extra healthy years for those living in the poorest parts of the country who die seven years younger than the rest of us.
But this is not the time for controversial announcements. The policies outlined are a natural evolution from where Labour left off in 2010, albeit in a new era where public health has returned to its rightful place in the heart of local authorities.
The most significant detail is hidden in the small print. Local directors of public health have a £2.8bn annual budget that they try to use to leverage spend across local government. Their effectiveness can be determined by their level of seniority, and Labour wants boost their influence.
There are positive plans described to reduce unhealthy food, cigarette and alcohol consumption, and to increase physical activity. I spent the summer cycling the route of the Tour de France so it will not be a revelation that I welcome the idea that every child will be given the chance to learn to ride a bike.
The twin strategies are to legislate to protect children, but to have a more light-touch approach to adults. This helps avoid the ‘nanny state’ charge but proposals could have been more transformative to make a real difference to the causes of the causes of ill health: poverty and unemployment, social isolation and a lack of power in the hands of communities.
No opportunity is missed to lambast the government’s lack of progress on plain packaging for cigarettes or the failed ‘responsibility deal’ with big sugar and big alcohol – rightly blaming this on vested interests. I hope that ‘supporting people to make healthy choices’ will include harnessing the technology revolution to try to counter the power of those trying to sell us things that are bad for our health.
A future Labour government will get us to talk more about sex in schools, and will increase the threshold for advertising junk food to children. It will not be taxing sugar and saturated fats, and there is no mention of how smoking in pregnancy could become a thing of the past. The principle of ‘proportionate universalism’ espoused by 2008 Marmot review of health inequalities is reaffirmed and there is a positive emphasis on communities and ‘empowerment’.
The test of any good policy is how it will relate to the lives of people that I provide care for in Stockton-on-Tees. There is a lot here that will work: simplifying the alcohol ‘units’ system, a focus on intervening in the ‘early years’ and more opportunities for adults to live a more healthy and active lifestyle.
Creating a fairer society would undoubtedly have more impact on public health than most of the policies suggested, but ‘Protecting Children, Empowering All’ is a logical progression and a masterclass in public health in a time of austerity.
Paul Williams is a general practitioner in Stockton-on-Tees. He tweets @paulwms
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