Well… it has been a bit silent on the blog here recently, mainly because I have been feeling, as I said to some of my online friends somewhere: “writer’s blocked, sunlight-deprived and winter-torpid”.
So winter-torpid, indeed, that I have been shamefully slow responding to comments on the last post.
[Incidentally, the last blogpost was, I discovered to my surprise, the 100th one since Dr Aust's Spleen opened for business. True].
One commenter I finally got around to replying to this week was “David Cruise (no relation, honest)”, who was commenting on my incredulity at the idea that the Govt was proposing inviting the fast food giants to be part of the strategy-setting group for tackling obesity. (And, indeed, the booze conglomerates to be part of the similar set-up for tackling heavy drinking, though I didn’t put that in the original post).
“I’m not sure what the ruckus about this story really is about. If it were a campaign of road safety nobody would bat an eyelid if Volvo, Mercedes, Nissan etc. were participating.”
My reply to this is here, should you be interested. But David’s comment did make me have a think about whether I was getting over-exercised about this.
On the whole, though, I don’t think so.
Partly this is because other people in a position to speak with some authority about it seemed, and seem to be saying the same.
“[Sir Ian] said he was very concerned by the emphasis on voluntary partnerships with industry. A member of the alcohol responsibility deal network, Gilmore said he had decided to co-operate, but he doubted whether there could be
“a meaningful convergence between the interests of industry and public health since the priority of the drinks industry was to make money for shareholders while public health demanded a cut in consumption”. …” (italics added)
A White Paper… White as in “fresh look”? Or as in “bogroll”?
One notable development, since the original Guardian article I was writing about was published, is that we now have an actual White Paper on Public Health, released at the start of this week, setting out the Government’s ideas.
So has this allayed the fears of people like Sir Ian? And undercut the cynicism of people like me?
I have to say that seems doubtful.
The headline messages of the White Paper (or perhaps the ones the Govt has been keenest to promote) are that public health and health promotion budgets and responsibility will be devolved down to local authorities. and that the money will be ringfenced.
Less prominently featured were that overall there would be less money for public health, the “responsibility deal partnerships” (as before), and the clear steer that legislation (for instance, to curb sales of cheap booze) would be a last resort – or “vanishingly unlikely under this government”, if you prefer.
“The Royal College of Physicians, which has always provided strong leadership on public health, said it welcomed a ringfenced budget and the attempt “to bring to the field a much-needed strategic focus and coherence”. But, said its president, Sir Richard Thompson, “the RCP is disappointed by the lack of detail, especially around how to deal with the threats posed by alcohol misuse, obesity and smoking. We wait keenly to see if the promised subsequent strategies will fill in the gaps”.
Which, translated, means, I think: “we are deeply unconvinced, to put it mildly”.
The Guardian goes on:
“[Thompson] warned that it took six years for the last government to realise that voluntary agreements with industry would not necessarily deliver on public health.
“On a whole raft of issues it has been clearly demonstrated that a laissez-faire attitude does not work, either in terms of promoting responsible behaviour among the manufacturers and retailers of potentially harmful products, or in creating an environment that would allow individuals to make healthier choices,” he said.
An example of the latter would be, perhaps, the “Traffic Light” food labelling scheme. This kind of “red light” system was supported by real studies, preferred by consumers in tests, and universally backed by the public health people, the charities that are concerned with the health consequences of things like obesity and diabetes, and the UK Food Standards Agency. However, it was deeply unpopular with the food industry, and was ultimately killed off by the European Union, an act widely understood to have come after determined lobbying from the industry.
In this context, and given the traditional closeness between big business and the Tory party, Gilmore’s and Thompson’s coded but fairly clear meanings do not inspire one with confidence.
A less carefully phrased take on the White Paper can be found in a recent blog by Andy Cowper, the shoot-from-the-lip editor of the online magazine Health Policy Insight.
This public health White Paper takes the piss more thoroughly than a phalanx of urinals.
Is there a contest in the DH [Department of Health] for silliest policy of the year?
Its foreword states, “Britain is now the most obese nation in Europe. We have among the worst rates of sexually transmitted infections recorded, a relatively large population of problem drug users and rising levels of harm from alcohol. Smoking alone claims over 80,000 lives every year. Experts estimate that tackling poor mental health could reduce our overall disease burden by nearly a quarter. Health inequalities between rich and poor have been getting progressively worse. We still live in a country where the wealthy can expect to live longer than the poor.
“The dilemma for government is this: it is simply not possible to promote healthier lifestyles through Whitehall diktat and nannying about the way people should live. Recent years have proved that one size-fits-all solutions are no good when public health challenges vary from one neighbourhood to the next. But we cannot sit back while, in spite of all this, so many people are suffering such severe lifestyle-driven ill health and such acute health inequalities.
“We need a new approach that empowers individuals to make healthy choices and gives communities the tools to address their own, particular needs. The plans set out in this White Paper put local communities at the heart of public health. We will end central control and give local government the freedom, responsibility and funding to innovate and develop their own ways of improving public health in their area. There will be real financial incentives to reward their progress on improving health and reducing health inequalities, and greater transparency so people can see the results they achieve.”
Umm. There is a problem with this, which is that other than the stats on ‘Our Unhealthier Nation’ (to coin a phrase), it’s talking, in civil-service-speak, round objects.
A few examples of the more egregious bits of crap:
“…it is simply not possible to promote healthier lifestyles through Whitehall diktat and nannying about the way people should live”. Blatant horseshit. Public health measures that made undeniable and significant impacts include: seatbelt laws, drink-driving laws, the smoking ban. Public health is not solely about using the tax system and legislation to ban things, but both are vital tools in the arsenal.
McDonalds, KFC and Pepsi (or whoever) are not going to do things that meaningfully threaten their core business: the vending of youth-branded convenience, high-energy or high-fat products. It is Pollyanna-ish optimism to think otherwise.”
More in the same vein here. It is a bracing read.
And, having read it, I don’t think satire is getting off the ventilator any time soon. Unless the lure of a Big Mac and large fries becomes too great.
PS As I was (finally) getting this ready to post, I heard the re-run of The Now Show on Radio 4, and was interested to hear the team offering their own take on Health Minister Andrew Lansley’s public health ideas. On the plus side, they have found something to satirise. On the minus side – at least for public health – they seem to see things rather the same way I do. You can listen to the programme here (for the next 7 days; the relevant bit is at 13 min 40 sec in).