Feature

Time for Labour to deliver: public health

Labour’s first term was strong on public health and environmental rhetoric, but weak on action. Now it has another chance to be bold – so John Nicholson and Charles Secrett set out what’s on the agenda

So what should the new government do about public health? Before the election – at the UK Public Health Association’s annual public health forum – delegates hammered out a new manifesto for public health. A debate on the issue urged coordinated government thinking and action at the top across the UK, not simply in England. Delegates envisaged all-encompassing plans and interdepartmental cooperation to achieve this aim, rather than expecting local bodies to join up the plethora of initiatives passed down from on high.

The DIY manifesto included fluoridation and universal benefits. It emphasised the importance of advocacy and community involvement, and enhanced democracy within the governance of health. It gave health a prominence that went beyond the remits of the NHS alone. It redistributed wealth. And it legalised cannabis.

The UKPHA is committed to gaining the real involvement of its members in its own policy development and encourages all political parties to do likewise. That is why we produced our own manifesto, or prospectus, developed in consultation with our members. We urge the new government to adopt its main principles and put them into practice over the next five years.

The UKPHA recognises that major improvements in health have occurred over the past century. Most infectious diseases in the developed world have been brought under control. Life expectancy has been dramatically extended and infant mortality rates continue to fall. But these improvements mask substantial variations between social classes, genders and ethnic groups. It also worth noting that UK health trends compare poorly with those of other rich nations.

Such variations in health were attributed to geographic peculiarities by previous governments or even dubbed ‘inexplicable’. Thankfully, it is now possible once again to talk about inequality, since this is the underlying causes of the differences.

The UKPHA also recognises new health threats, emerging from many different sources. They are the consequence of the damage we are causing to the world’s ecosystems through unsustainable economic and population growth; the lack of investment in the public health and environmental health infrastructure; the global spread of new diseases and threats often prompted by human action; and of the failure to provide all the world’s people with basic access to the means of sustaining life and health.

It is equally important to be able to say that health is more than the sum of crude statistics on sickness and disease. A healthy society is one that promotes a positive view of health, mental and physical well-being, and that establishes effective, accessible and dignified arrangements for health and social care.

In response, the UKPHA makes three demands: combat health inequalities, promote sustainable health policy, and challenge anti-health forces.

• Health inequalities People living in poorer communities die younger and experience poorer physical and mental health throughout life than those in more affluent communities. The growing health gap between rich and poor is bad for everyone, promoting insecurity, inefficiency and waste. To put it bluntly, a fairer society is a healthier society.

The UKPHA has – successfully – advocated national targets for tackling inequalities. Having won the argument, we believe it is vital that the government takes action to meet the targets and monitors the results.

• Sustainable developent This is intimately linked to public health. The best managed societies promote equitable environmental principles, apply these across industry, transport and other sectors, and regularly appraise the impact.

The UKPHA argues that public health and sustainable development must be complementary national priorities. Policy development in all government departments must take account of the implications for both health and sustainability.

• Anti-health forces In this area the UK is, sadly, a world leader. Our arms and tobacco industries render measurable harm not only in our own country, but also – even more so – overseas. Our use of depleted uranium in Iraq and the Balkans is now rivalled by the willingness to back US president George Bush’s son of Star Wars.

Our food and drinks industry promotes unhealthy consumption, frequently targeted at children or the most vulnerable, which undermines government efforts to advocate healthy diets through health promotion initiatives. Our society produces harmful attitudes towards people with disabilities, mental health problems or those simply seeking refuge from torture and persecution abroad.

The UKPHA recognises that challenging harmful production or consumption poses difficulties. Some industries, for example, provide employment or sponsor education; efforts to control them may be portrayed as attacks on freedom of choice. But if the government is to support those for whom there is often no real choice, it must regulate the anti-health forces – and their profit drive – in the interests of protecting all of us.

It is a question of power. The freedom of the people, through our elected governments, to promote public health must be at least equal to the freedom of multinationals, through unregulated market forces, to promote ill health.

These are the local and global challenges that the UKPHA is setting for our new government. We welcome support in promoting our goals – and meeting them.