I’ve often wondered amid the plethora of health messages pushed to us why The Powers That Be never seem to call for smokers to switch to roll-ups instead. They are surely less carcinogenic than manufactured cigarettes and must represent a half-way house for those struggling to quit the demon weed. A long journey starts with small steps.
Improving public health, to mix metaphors, is one of those classic oil tanker issues. Making any change in trends takes an age to deliver and requires consistent movement in a new, more virtuous direction. As local authorities prepare to take responsibility for public health from the NHS next April the question arises: can councils do better?
Of course many are already playing a role, not least through sharing directors of public health with the NHS. But next April is a chance to turn a page, to raise the profile of the problem and really turn improving public health into a key frontline issue.
It isn’t at the moment, I would argue. Public health resides in that cloistered world of highfalutin’ strategies, spreadsheets and measle maps. Of course we have to analyse the problems; but the challenge is being bolder in getting something done about them.
The depressing reality about health inequalities is that the pattern has barely shifted during the years of plenty. Research by the health thinktank the King’s Fund shows that between 2003-08 the number of adults engaged in three or four of the riskiest common lifestyle behaviours: smoking, consuming excess alcohol, eating a poor diet and having a sedentary lifestyle - fell from 33 per cent to 25 per cent.
A welcome fall, however this is set against the backdrop of fifteen years’ worth of continuous economic growth, increasing wages and rising public spending through the late 90s and noughties which has nevertheless still left most cities and towns with life expectancy gaps that stretch to a decade and more.
Now, with years’ worth of austerity ahead of us, there is even less prospect of making a ‘paradigm shift.’ With reports that one in five mothers routinely goes without a daily meal to feed her children, entreaties to eat better quality food are highly unlikely to receive a more successful hearing than they have done hitherto.
There is a need for a new approach, one that actively, directly engages those communities at the bottom of the right league tables and the top of the wrong ones. Not in the usual preachy and remote way, but by lowering the municipal drawbridge and going out to talk to them, investing in outreach initiatives and appealing to intelligent self-interest. Once people take ownership of health issues as they affect them and their family, something might change. Getting them to do so is the key. Simply broadcasting headline messages is not the way to make that happen; the approach needs to become bespoke.
The NHS is great at many things, but it is lousy at campaigning. Unfortunately, this is an effective, cost-effective way of making a difference to public health. This doesn’t mean tweeting into a black hole, or posting Facebook messages full of gobbledegook public health-speak. It means delivering a more nuanced message to a more segmented audience. If the public health problem is multi-faceted, then the message needs to be as well. There has not been much of that approach so far, with repetitive chants of ‘eat five a day’ seemingly the best we can do.
But the public sector can only do so much. This has been true under the NHS’ stewardship and remains the case as councils gear-up to take the lead. It is up to communities and individuals affected to step forward and share the burden of improving their own health - a genuine opportunity for a ‘big society’ approach. But that will only happen if councils signal a new approach that combines genuine partnership working and effective campaigning.
Are they up to the task?
Kevin Meagher is a political blogger and was a special adviser to the last Labour government