The summer of death for public health

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’.

healthcheck 2

healthcheck nhs

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.

7 Responses to “The summer of death for public health”

  1. Guy Chapman July 15, 2013 at 1:00 am #

    What depresses me most is hearing the tobacco industry’s long since busted argument that advertising and packaging is about brand-switching, repeated as fact. I really do feel as if we have been transported back in time to the 1980s and that the tiny amount of evidence based policy the Labour Party used to deflect the Daily Mail has been entirely discarded in favour of naked vote-chasing and smells pandering to the apparently crucial delusional right wing bigoted cretin lobby.

  2. Urban Svensson July 15, 2013 at 7:08 am #

    I totally agree, work with OSH where employer and union focus often is On traditional general health checks instead of work place safety and environment where smoke and alcohol as well as malnutritional habits are of more importance than men’s S/P-PSA-value!
    Then we shouldn’t forget the harm of sedentary life style where employees never take a walk or bicycle ride! Bare then i mind that the working population is the healthiest!!

  3. Mary Hawking July 15, 2013 at 9:14 am #

    There does seem to be a disconnection between aspirations such as a requirement for CCGs to decrease deaths before age 75 by 2.3% within this financial year (part of preformance management/quality premiums for CCGs) and removal of national level public health organisations, powers and initiatives outside the remit of PH England, linked with absolute refusal to take public health measures the government previously supported – but now appears to refusing to implement.
    Are they saying that although they previously accepted that there was evidence for the beneficial effects of introducing plain packaging for tobacco products and minimum pricing for alcohol, they no longer believe the evidence they previously accepted – without giving any reasons for this U-turn?
    Or is this an acknowledgement that evidence is irrelevent to this government (not saying they are unique – just in slightly precarious power) – and public health policy is not, and for politicians possibly shouldn’t be, Evidence Based – and is this especially if there are financial implications elsewhere in the equations?

  4. Miles Dolphin (@MileDolphins) July 15, 2013 at 9:40 am #

    Whilst the title is right, it appears that the content uses a slightly distorted version of the English language. The word “evidence” seems to be being used in a way that I don’t understand, instead of being used as “proven fact”, it is being used as “ideological theories”.
    To date there is no data at all as to whether plain packs will have any effect at all on the rate of take up by youth. Only Australia has this at the moment and no figures have yet come to light. To call the theories that led to the Australian experiment “evidence” is misleading to say the least. The studies that suggest this policy are, to date, only theoretical ones, and remain invalid as evidence that the policy will work. To be sure, they suggest that it might work, but I would suspect that a minimum pack size of 25 and a price bump would work better, and end up a lot cheaper to implement.

    To be honest, when I was smoking, I didn’t look at the packs at all, just the prices.

    I have no objection in principle to plain packs for tobacco or minimum pricing for alcohol, I do object to the waste of resources that may be incurred by either imposing these theories before they have been proven by testing, or by legal costs from challenges by IP owners.

  5. Malcolm Case August 20, 2013 at 8:56 pm #

    I was diagnosed with Type 2 Diabetes only as a result of a Health Check – without that check I wouldn’t have known I had diabetes, and would probably have continued with a less than healthy lifestyle

  6. margaretadmin August 20, 2013 at 10:26 pm #

    Dear Malcolm
    thanks for replying.
    The problem is that trials have not shown a benefit to offering screening to the population for type 2 diabetes.
    The problem is not that type 2 diabetes can’t be found by screening – it can – but it doesn’t work in terms of not being able to offer an intervention that makes a difference.
    The trials suggest that whenever you were diagnosed – now or the future – would make no difference to your lifespan.
    The fact that you say your lifestyle could have been improved prior to the diagnosis – to me that’s where the difference can be made whether or not you were diagnosed with diabetes – for example, policy that promotes cycling and public transport, policy that promotes fair law on smoking food and tobacco.


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