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Public Health (England)

I cannot comment as I have no direct knowledge of that, but I will deal with the issue of school meals later. Progress in public health is actually quite hard to monitor. If a drugs education programme works or if there are benefits from healthy eating or physical exercise, it is not easy to see them in a straightforward way—unlike with the administration of a medicine to a patient. Another factor is that much of what can be done turns out to be totemic and slightly cosmetic. I have certainly sat in school dining rooms where there are pictures of big green apples—and watched the children tuck into pizza and chips. Progress is also complicated because it requires a fair degree of partnership. In order for it work, we have to work with leisure services, schools and the adult world of the workplace. A realistic problem touched on here is that funding can be quite erratic and intermittent in the world of public health. I warm to some extent to the Conservative suggestion that we need clearly earmarked funds, but I also respond positively to the Minister’s suggestion that we need to target funds very effectively. I agree that what we do in public health is not simply a matter of health spending. Another problem in public health—we have to be fair and acknowledge it—is that we are sometimes working against other very strong and powerful social forces: commercial advertising, for example, and media influences. Young people pay more attention to Heat magazine than to directives from the Department of Health, and we should acknowledge that there can be a positive side to that. A lot of very good health messages come out via the media. There are both good and bad aspects of the media, but one of the principal and most basic problems is that all the Government can do in connection with public health is advise, facilitate, enable and encourage. They cannot actually coerce or proscribe. Essentially, the Government are trying to carry out the very difficult job of influencing lifestyle. They can present the public with an idea of the good life or the healthy life, but in a pluralistic society, that will always be debatable. That is relevant to debates on drugs, sexual behaviour and alcohol use, where some of the unhealthy options are seen as a legitimate choice. The Government can be accused, if they weigh in heavily, of being bossy or of being a nanny state. Even if they do not insist on a Korean-type national exercise scheme, they still come in for a certain amount of criticism. Plato, for example, favoured a very Spartan regime, coupled with no medical care whatever, but that is not the sort of approach that any Government these days—or for the foreseeable future—could recommend. I have no problem with the suggestion that good health is a precondition of a good life, and everybody knows broadly what good health amounts to. That is a fairly evident conclusion that the whole House would share. I have absolutely no problem either with the state removing hindrances to good health. I firmly supported the smoking ban in public places, not simply because it got rid of—or will get rid of—passive smoking, but because it removes hindrances in the way of people who want to give up smoking. It helps to minimise the social occasions when people light up, although they are trying very hard to give up a habit that is doing them no good. We should be fairly unrepentant about that. My mother is a twin. Her sister died 20 years ago, whereas my mother is alive, well and not troubling the NHS to any great extent. What is the difference between the two? One smoked; the other did not. Given that stark fact, one would think that there was every incentive for a Government to persuade people not to smoke at all, as well as not to blow smoke in other directions. Notwithstanding the enormous benefits that will come with the smoking ban, the reality is that we still have to take the public with us. Public health works if we take the public with us. Messages therefore have to be attractive as well as cautionary. Healthy eating programmes in schools have sometimes led to a dip in school meal consumption, with children simply getting their food elsewhere. It is possible, however, to over-stress the contribution of school meals to childhood obesity. I cannot recall a time when school meals were anything other than pretty fattening, from an adult point of view. Taking people with us is especially important in recognising that good public health requires good mental health. That means combating over-stressed lifestyles and unnecessary emotional trauma. Good mental health supports good physical health, and vice versa, but it is far harder for any Government to create the conditions for the latter, or to find agreement on what the latter actually amounts to. It is often said that the national health service should live up to its name rather than being a national sickness service, but there is more to it than simply putting up posters about eating oranges. That simplifies the objectives of public health, which include full physical and mental well-being. Public health needs all the friends that it can get. It needs a whole-Government approach, a local government approach, a local community approach and a family approach. It also needs a commitment to a good, sustainable and wisely structured society.