Public Health – ‘This Government has put ‘Dracula in charge of the blood bank!’ says Public Health Professor.
Public Health is the part of medicine concerned with the health of populations rather than the individual. It covers matters such as vaccinations, smoking bans, screening and health promotion. It is enormously important and cost effective. Improvements in sanitation in 19th century doubled life expectancy. Much of the increase in life expectancy from about 65 in the 1960’s to 80 now is a result of a decrease in smoking not expensive technology [smoking kills half of those who smoke]. Anti- smoking legislation has undoubtedly been helpful. The major public health challenges in the last 200 years concerned infectious diseases such as cholera, TB and more lately HIV epidemics. The major public health challenges of the 21st century are ‘non communicable diseases’. These are heart disease, strokes, cancers, type 2 diabetes and lung problems. Obesity, smoking, alcohol and lack of exercise are major contributors to these.
In the last 2 weeks the following headlines have appeared in newspapers
‘Sugary Drinks Affect Genes Regulating Weight Gain!’
Three new studies published in the United States last weekend reaffirm a link between sweet soda and fruit drinks to an epidemic of obesity.
‘Diabetes threatens to bankrupt NHS!’
‘I like my coke and crisps’ says new health minister –Jeremy Hunt
Public Health measures such as bans on large bottles and portions of sugary drinks in New York, trans fats [a very harmful type of fat] in the USA and countries in Europe have been implemented to try and counter increasing obesity levels. The ‘fat’ tax has recently been introduced in Denmark on foods containing a high level of saturated fat.
The present British Government has said it does not wish to legislate. Its slogan is ‘nudging not nannying’. It has introduced major changes to public health, separating it from the NHS and has set up the Public Health Board. Companies such as Mc Donalds and Pepsi have been given places on the Public Health Board and the Government wants to encourage the food industry (rather than to legislate) to introduce voluntary cuts to fats, sugar, and salt levels. This has caused dismay in the medical profession. Simon Capewell, a prominent public health professor, described this policy of such companies having power over health policy as ‘putting Dracula in charge of the blood bank.’ Which? (the consumer magazine) reported early this year that very little change has been achieved because of the vested interest the food industry has in promoting unhealthy products. The Government has finally changed its mind on minimum alcohol pricing but is otherwise resistant to interfere with the rights of individuals to follow unhealthy practices.
The argument of upholding the autonomy of the individual against those encouraging healthier habits is centuries old as can be seen from an editorial in the Times 1854. The first Public Health board had just been dismissed, cholera was rife, the ‘Great Stink’ had forced the abandonment of the Houses of Parliament. However The Times rejoiced when sanitary reformers were defeated in their attempts to clean up cities and have human excrement removed as this extract shows.
The Board of Health has fallen. We prefer to take our chance of cholera than be bullied into health. ……There is nothing a man hates as much as being cleaned against his will, or having his floors swept, his walls white washed, his pet dung heaps cleared away, all at the command of a sanitary bumbaliff’
The Times 1st Aug 1854
It was thought then that people had the ‘right to be unsanitary’ but the germ theory of disease and the cholera epidemics convinced doctors that their autonomy had to be overruled because of the public health consequences. Perhaps in another hundred years or so people will be just as incredulous at the idea that cancer causing cigarettes were sold and sugar sweetened drinks were promoted and marketed as we are now at the thought that people opposed the removal of human sewage in 1854.
‘Rights versus Responsibility’ is still an issue debated frequently today, the unhealthy habits of other people affect us all – from second hand smoke, consequences of alcoholism to the costs of obesity for the NHS.