Despite a barrage of criticism from the right wing commentariat, the Government, wishes for us to smoke and drink less, to adopt better diets and to live in more secure, healthier homes.
A jolly good thing too, says Will Hatchett! But is there enough public infrastructure left in the UK to help make a difference?
With optimism thin on the ground, it’s no wonder people are excited about Oasis reforming. Anyone who is now in their late 30s, or older, will remember the last time that an old, tired government in the UK was replaced overnight in a seismic demographic, cultural and political shift.
Tony Blair’s smile when he arrived in Number 10 matched the bright colours and catchy, patriotic jingles of Britpop. For a while, he basked in the radiance of Cool Britannia. It was a great time to work in the environmental health discipline of local government, because the Blair government refreshed policy areas that had withered from neglect in the sterile, market-ruled politics of the previous two decades.
New Labour promised upstream, generously-funded health intervention. It appointed the UK’s first public health minister, Tessa Jowell. It created a Health Development Agency and a health-focused Food Standards Agency, and turned its sights on the deadly triad of smoking, poor diet and alcohol, in a programme of ‘lifestyle politics’.
Labour’s radical approach to health was vigorously opposed by right-wing commentators. Their views reflected those of a famous editorial in the Times, opposing the 1848 Public Health Act. It stated: ‘We prefer to take our chance with cholera than be bullied into health. There is nothing a man hates so much as being cleansed against his will, or having his floors swept, his walls whitewashed, his pet dung heaps cleared away, or his thatch forced to give way to slate, all at thecommand of a sort of sanitary bombaliff.’
These anti-health campaigners, often allies of the tobacco industry, adopted a term that had been used by Margaret Thatcher, to lampoon measures designed to level up the life chances of the least well off, i.e. the non-rich, ‘the nanny state’.
Well, the nanny state is back, or so The Daily Telegraph and Daily Mail would have us believe. It’s the latest example of the UK’s traditional oscillation, in government, between interventionism and libertarianism – Labour and Conservative.
We are unhealthier
The statistics on health have worsened since 1997, when New Labour took office. Life expectancy is no longer increasing; there is an epidemic of child and adult obesity linked to junk food consumption and lack of exercise. Housing in the UK kills old people in the winter because it’s too cold. A child in a housing association property in Rochdale died in 2020 because his house was infested with mould.
The causes of these ‘crises’ are entitrely avoidable. As a society, we could eat better food, exercise more, smoke and drink less and ensure safer and more affordable housing – of course we could. These lifestyle changes would save money for the state on health interventions in our lives.
Keir Starmer, with his subsidised spectacles and Taylor Swift tickets, is no Tony Blair. The Oasis brothers won’t be dropping into Downing Street any time soon. But his government has re-occupied the interventionist territory of Tony Blair and Gordon Brown. On housing, Labour’s Renters’ Rights Bill promises to ban no-fault evictions and to improve private rented housing. Health-wise, tobacco is, again, public health enemy number one.
A proposal to outlaw smoking in pub gardens has the Mail and Telegraph boiling with indignation. And nanny has confiscated the keys to the tuckshop: a pre-watershed ban on TV advertising for junk food is proposed from next October, alongside banning the sale of high-caffeine energy drinks for under-16s. Disposable vapes are also in Labour’s sights.
Anticipating a second term, more strategically, Labour has indicated that NHS reform should include structural change aligning more funding to upstream interventions designed to prevent people from becoming sick.
Yes, we have been here before. Remember the Acheson report of 1998 on tackling the determinants of health? Sadly by its second term in 2001, New Labour had lost momentum on shifting the focus of health funding towards tackling the social and environmental determinants of ill-health. It reverted to what all governments do – pouring more money into the leaky bucket of the NHS while holes are banged in with six-inch nails.
Post-Grenfell landscape
The landscape has changed since New Labour. Since the crash of 2008, politics have been all about crisis and firefighting. The Food Standards Agency, set up in 2000, made a strong start on promoting healthy eating and reigning in ‘big food’. But it was soon tamed and ‘de-politicised’. Now it’s a managerialist body. The Conservatives removed the NHS’s public health function in the privatisation-friendly Health and Social Care Act of 2012 and failed to transfer budget savings to local government.
One of the casualties of the Covid pandemic was Public Health England, a flagbearer for ‘lifestyle politics’. Set up to replace it, the UK Health Security Agency has a microbiological focus, and the Office for Health Improvement and Disparities is an invisible body that gathers statistics. Civil servants prefer public health to be passive, not active.
However, the Grenfell Fire of 2017 was a wake-up call. It showed us that maniacal, ideologically driven deregulation kills people.
Housing is political. Food is political, Smoking, drinking and vaping are political. Environmental health practitioners (EHPs) who work for local government ensuring safe food and workplaces, clean air and healthy rented housing, are not political, nor should they be – they are public servants. But their skill-sets, for example, in coercing food businesses and pub owners into behaviour that is in the public interest and in reigning in bad landlords through a well-tested blend of education and coercion, have a century-long record of effectiveness.
In the 1990s and early 2000s, the historically well-resourced environmental health services of local councils became active in areas as diverse as tackling food deserts and improving sexual health. Two chief medical officers of the period – the senior health officials working in government – Sir Donald Acheson and Sir Keneth Calman, were the last CMOs to view local government professionals as part of the public health workforce. There's not much left now of the civil society that still existed when the Coalition took office in 2010.
It’s hard to remember now but, in the Britpop era, EHPs visited shopping centres and housing estates dressed as vegetables or pieces of fruit – or giant cigarettes. They were active champions of the smoke-free laws of 2007 and played a major role in their enforcement.
The fact that EHPs, with their specific and well-honed skills in contact tracing for infectious illness, were initially ignored and sidelined during the Covid pandemic is a testament to our dysfunctional political system, the short memories of politicians and the unerring ability of the civil service to douse down innovation and revert to bean counting.
Other worlds are possible
Dare I say this: the time has come for the UK to revisit the almost forgotten Black, Acheson and Marmot reports and to address the causes of ill health – poor national diet, insecure over-expensive housing and generally unhealthy lifestyles. EHPs can and should be part of changing this unhealthy status quo. They have been before, and although their teams have been reduced to skeleton status by cuts to frontline services, they could be again. The motto of the Chartered Institute of Environmental Health, Amicus Humani Generis, translates as ‘Friend of the Human Race’.
The Punch and Judy politics of the political tribes, with their non-evidential basis and simplistic, headline-favouring slogans, are entertaining and make good copy. That’s one reason we still have them. But they are ineffectual. A downstream treatment-after-the-damage-is-done model dominates health and social care as it inevitably will under a political system that is based on five-year electoral cycles and ministerial musical chairs.
Such a system will always be defended by the well-paid flag-wavers of libertarianism and its corollaries, lower taxes and ‘small government’. How dare a ruling party think that it might be in office for more than five years – long enough to make a difference – and that things could be done differently! More nails! More buckets!
In truth, the noisy, wannabe influencers of GB News and newspapers owned by billionaire offshore-based press barons, are largely talking to each other in print and online, while claiming that they are denied a voice by mere ‘experts’ and the ‘legacy media’.
EHPs are, or should be, the primary health champions within local government. In many cases, directors of public health, at several tiers of seniority above them, are barely aware of their existence. I’m not calling for EHPs to become more involved in political debate – those in managerial roles, quite rightly, are not allowed to. I’d just like them to be given their rightful role in fixing broken Britain (and Northern Ireland). It can happen. As the situationists used to say, ‘other worlds are possible’.
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