Where does the states responsibility for peoples health start and end? Should you be allowed to harm your health as a basic human right? Its a large can of worms.
When we kicked off our recent Public Health Heroes Twitter campaign the first message I got back was from @LBusson (above) and it simply said FFS #HealthNazis! Rather than being upset or annoyed I was intrigued why a reference to Sir Richard Doll the foremost epidemiologist of the 20th century should create such a reaction. Unfortunately a polite message back to @LBusson didn’t get a reply, I can only imagine that Sir Williams pioneering work that demonstrated a relationship between lung cancer and smoking, as well as other detrimental health outcomes associated with asbestos, alcohol and radiation was the subject of some concern for my commenter. Recent guidance from NICE which aims at stopping hospital patients and staff smoking outside hospital buildings is just one new initiative that I’m sure has added to that discontent. Personally when I arrive at a certain NHS Hospital where I do some voluntary work the sight of patients on drips being wheeled outside for a quick cigarette has always seemed crazy but to some people it is seen as a way of easing suffering. We could argue that one for a long time so maybe we need to spread the argument into all areas where lifestyle activities that harm health are concerned.
In 30 years in Environmental Health that was my life, be it enforcing food hygiene, health and safety or environmental protection legislation. If the argument that the state should have no input into health is carried to its logical conclusion I and my colleagues were wasting our time. A large amount of legislation has its roots in Public Health whether we like it or not. The words ‘nanny state’ are often used when things go too far in some peoples eyes and in a small number of cases they may have a point. The problem is though if we removed all state interventions into health related activities we would surely slide into anarchy. If Sir Richard Doll hadn’t carried out his research many more thousands of workers would have died as a result of exposure to asbestos at work as they wouldn’t have been aware of the risk of a substance that was called a ‘boon to modern life‘ in the 1920’s. The same argument can be used for anything from radioactivity to passive smoking.
Perhaps the line is between having the information and putting it to use for the public good. To even start that argument we need to discuss what is for the public good and there we will begin to include economics. During a recent radio debate there was a confusing argument that tried to compare the costs of obesity, smoking, and alcohol presumably with a view to ranking them in some kind of economics league table. Ash tell us the total cost to society of smoking is £13.74 billion and that revenue from taxes associated with tobacco runs at £12.1 billion. I was never great at maths but that seems a straightforward way to save £1.64 million to me. Unfortunately things are not that simple as thats only economics what about the human cost? Public Health England tell us obesity costs society £49 billion while the Alcohol Concern estimates costs to society of £6 billion from alcohol but are we really going to stop dealing with any of these issues purely based on those figures?
One of the ideas of living in a society is to enable its members to benefit in ways that would not otherwise be possible on an individual basis. In my final years in Local Government I had a few interesting conversations with PR colleagues who persisted in sending out customer questionnaires that asked residents to state what they considered to be the prominent issues in their area. My argument was that only a few will mention anything that relates to services like Environmental Health because as part of a civilised society the vast majority of people take for granted they can eat out without being poisoned, breathe clean air, and that they won’t be killed in an accident at work. The problem for society presented by people like @LBusson is how do you treat those that wish to operate outside its confines?
Jigsaw 