Feature

Needled by the pointless ‘drugs csar’

Labour’s public health strategy is like a breath of fresh air, says Geof Rayner – apart from one small point

A new minister for public health,’ said the Labour manifesto ‘will attack the root causes of public health, and so improve lives and save the NHS money.’ This was a lovely promise which rather jarred with the insipid ‘no uncosted policies’ format of Labour’s general election campaign.

But then, if you start with low expectations, things can only get better. Like many, I suspended judgement on what a Blair government might do. Meetings with Labour front bench people, and the shadow public health minister last year, were not inspiring. Nice, listening people, but not much direction.

Two conferences in July made me rub my eyes. First, public health minister Tessa Jowell (incidentally, the revival of this post was first suggested in the Public Health Alliance report Beyond Acheson in 1989) delivered a speech which was universally recognised to be excellent — so much so that at least two people I came across claimed authorship.

What made something good even better was the fact that Jowell was flanked by colleagues from the departments of education and employment and environment, clear demonstration of the fact that Labour had listened to advice on the need for a public health approach to be taken right across the government.

What also heartened me was the co-operative nature of Labour’s vision. There was to be a place for local authorities, voluntary organisations, private groups, and community organisations: ‘The community and local action...can bring together people and agencies, facilitating action and providing support based on knowledge and needs.’ Improving health meant action right down to where people live, focusing on those who suffer the greatest health problems.

To suggest that this group, the poorest quarter of our population, were ignored by the last government might be to suggest a legacy of benign neglect. That neglect was never benign. With the new Labour minister, dealing with poverty is up in front.

Jowell set out a five-point strategy including: working across Whitehall, the production of a coherent strategy with clear targets, strengthening of the NHS in public health, good public information, and policies designed to tackle inequality.

Perhaps the difficulties weren’t really thoroughly acknowledged. Current health inequalities are rooted in the rising market inequalities of the past two or three decades. We wait to hear at what level the minimum wage will be set; equally important is a review of welfare benefits and pensions. Sadly, I think that the government might use the excuse of globalisation as an explanation for the fact that these are things governments can do little about.

One proposal did jar. The ‘Drugs Csar’ idea is a discredited piece of Americana we could do without. And the US is the last place in the world from which to borrow drug prevention policies. We can recall Blair’s ‘tough on drugs, tough on the causes of drugs’ (or something like that). It would be nice to hear — and for the government to listen — to people on the ground, including people with drug problems, about the causes of drug misuse, before we jump too quickly to ‘solutions’. Drugs are not ultimately a police issue, they’re a people issue. And if the Drugs Csar is such a good idea, why not an Alcohol Csar or even a Poverty Csar? And what about a cars-parked-half-way-across-the-pavement Csar? Remember Richard Branson’s feeble attempt to be Mrs Thatcher’s ‘Litter Csar’? The point is that there are multiple factors, cultural, economic, local and national, behind the rise of drugs misuse, which calls for a multi-pronged approach. We need to inspire everyone, not just someone who is inspired.

The smoking summit pointed towards the right way to do things. More ministers were present — eight — including the uncharacteristically quiet Tony Banks (the Sports Csar?). The ubiquitous Mr Branson was there too, with the promise to replace tobacco sponsorship of Formula 1. What was proposed was a ‘multi-pronged attack’, to be formulated following broad consultation — a Green Paper later this year – drawing on ample lessons from abroad (people were there from Canada, Finland and Norway). And, in the spirit of the New Public Health, a non-discriminatory approach to smokers. Smokers are only drug users using a legal delivery mechanism, so what’s the difference?

Tessa Jowell is getting a lot of advice from many different quarters, and her task is to sift out the best of it. My pennyworth is that we need a National Public Health Commission and local joint teams, whether these are relaunched Healthy Alliances or not. We need a framework of Healthy Public Policy, a long-term strategy to turn around the economy, employment, transport, agriculture and so on, to emphasise environmental sustainability, effective investment, and quality of life. This goes beyond health impact statements, which are essentially reactive. Nevertheless, at least there has been good start and some of the right tasks have been identified.