The events of the last couple of weeks have brought it into sharp focus: public health is being ruined by politicians who don’t understand the nature of evidence or how inequalities manifest or need addressing.
This is the shape of public health 2013;
– a government who have decided that they will delay making a decision about plain packs for cigarettes so that they can wait for Australian data. Anna Soubry, health minister, won’t say when the government will decide, saying “how long is a piece of string?” There is evidence that plain packs are likely to have a decent effect on stopping children from starting smoking; currently 200,000 start every year. In terms of harms, the biggest effect will be to the income of tobacco companies. I note the Conservative party’s election co-ordinator has also been alleged to chair a meeting of the tobacco industry to discuss how to block plain packs.
– a government who have been reported to be dropping plans for minimum alcohol pricing. It will now be going ‘on hold’. We have over a million alcohol-related admissions to hospital per year and almost 200,000 admissions where the primary problem was the consumption of alcohol. There is copious evidence that minimum pricing can help limit damage caused by alcohol. Remember all the fuss about overstretched A+E departments? Here’s a good way forward. So why aren’t we taking this up?
Whose interests are our political leaders acting in? Oh, look, it seems that Lynton Crosby has also represented alcohol firms.
– The plans to ditch publicly available ONS data, including that on smoking and alcohol, because of funding cuts. These numbers are crucial; how do we know what the effects are of policy, where the burden of risk lies, or where we need to direct resources? If you wanted not to know how damaging policy is on people’s health, this is a good way to do it.
– on obesity, which is a cross-class issue, Anna Soubry is relying on a voluntary code to ensure that customers got fair information about the nutritional values of what we bought; this has been rejected by Cadbury and Coke. Allowing industry to write their own guidelines and trying to persuade them into doing it has been going on for a decade. Fast food merchants sponsored the Olympics. This is a nonsense.
Instead of fair laws which are capable of protecting everyone, our politicians have decided that instead individuals must be responsible for themselves. This would be fair enough were we all born equal. Instead, geography is at least partly destiny.
Then there are the effects of the recession on inequalities and mental illness . What’s happening there? Locally, people are waiting 3 or 4 months for evidence based cognitive based therapy. The Citizens Advice Bureau, a free source of financial advice, has had funding cut. Smoking and deaths due to alcohol are class related. If we want to do something useful for people who live the shortest lives in the UK, we have plenty of evidence based options.
So what is the government doing for public health? Where are the resources going? At least some are going into the electioneering favourite, ‘health checks’.
Free NHS Health Checks. So instead of relying on fair law to protect everyone, we are now ‘relying’ on people over 45 attending for NHS health checks. Except for a few problems; we have no evidence that these health checks will cause fewer people to die of preventable diseases. We know that the tests being offered, such as blood pressure, will cause overtreatment (people being prescribed medication which they cannot benefit from and can only be harmed from). We also know that treatment for mild hypertension isn’t beneficial. We know that screening for type 2 diabetes doesn’t reduce death rates. But an awful lot of leaflets have been printed and GPs will be contacted for people to discuss their results – meaning less or later appointments for people who are actually ill.
The extent to which the NHS ‘social good’ has been corrupted by politics and conflicts of interest; NHS SOS is brilliant on explaining how. So much talk of needing more data from our public health ministers on fair public health law, but so little when it came to the Health Act. The NHS has been betrayed.
So what are we doing? We are spending money on non evidence based checks that will likely – like most other screening tests – be most attended by people at lowest risk of earlier death. We have opportunities to protect most people by law, but our politicians are measuring string while doctors are writing death certificates. John Ashton, head of the Faculty of Public Health has spoken up for the need for decent law on minimum alcohol pricing, as has vice president John Middleton. We need to replace these disasters a summer of evidence for the NHS, with everyone that cares about our common good to be standing up with him.