Earlier this month Andrew Lansley told the UK Faculty of Public Health's annual conference how the 223 partners in his so-called responsibility deal, most of them industry bodies, were "all making collective pledges about public health" including efforts to reduce calorie consumption, increase fruit and vegetable consumption, lower alcohol options and provide smoking cessation support in the workplace. The health secretary gave the impression of a man who really believed that, taken together, all these contributions – such as Unilever helping staff with healthy cooking, physical activity and kicking the cigarette habit – will make a big contribution to tackling the huge public health problems so closely allied to our dysfunctional relationship with food, booze and tobacco, and which threaten to engulf the NHS.
In the 16 days since then, some 6,000 more Britons have been diagnosed as diabetic, while a further 10,000 have joined the 5.5 million who are already obese. The cost of these epidemics will be measured not just in expensive healthcare but in misery, disability, pain, dependence and death. Terrible problems require bold, imaginative, determined solutions. Is Lansley's prescription – nudging people towards healthier behaviour and relying on food and drink industry "partners" to do their bit – really sufficient?
On Tuesday, a House of Lords report said nudging was unlikely to work. And the British Medical Association's recent annual conference added its doubts to those already expressed by medical charities and groups of specialist doctors about the responsibility deal. "I have grave concern about whether the government – in supporting nudge theory, voluntary approaches and the ladder of interventions – is too averse to regulatory action and central action where appropriate," said John Chisholm, a London GP.
For all Lansley's talk – both in opposition and in government – about a radical new approach to public health, it is Wales and Scotland that are doing adventurous things. Wales may ban smoking in cars with child passengers. Alex Salmond's Holyrood administration, emboldened by its recent landslide election victory, is still pressing ahead with plans to introduce a minimum price per unit for alcohol. There is considerable support from the royal colleges of physicians and paediatrics and the UK Faculty of Public Health for bringing in one or both measures in England. But, under the coalition government, the voices of these influential organisations is not heard. Is Lansley ignoring their counsel because regulation is a philosophical no-no to this government?
His other oft-repeated public health pledge in opposition was to encourage greater personal responsibility as a form of preventive medicine. But little is heard these days of that promise. More than a year of government has brought no substance, no details, no initiatives and no detail of any sort. Why are there not, for example, Department of Health-funded pilots of teams of health visitors, dieticians and psychologists working together intensively with individuals or families to help them to start leading the healthier lives many would surely prefer? That would constitute integrated care and preventive health – and might just work.
Changing people's behaviour requires much more than deals with supermarket giants, healthy food discount vouchers and pleas for more willpower in people's lifestyle choices. The environment around us must change, opportunities for us to over-indulge must be reduced, new campaigns must warn us in graphic terms about the likely impact of our behaviour, and the cost, quality, availability and marketing of potentially lethal products should be subject to stringent new controls. Over to you, minister.
