Whither public health policy: conspiracy or cock-up?

Whither public health policy: conspiracy or cock-up? Whilst Public Health England has been busy releasing useful tools to help local areas benchmark their performance against others, Whitehall has been largely quiet on the public health policy front (with the exception of the Secretary of State’s welcome focus on reducing premature mortality). 

All that changed last week, first with the news that the Office for National Statistics (ONS) had proposed to drop the critical statistics on smoking and drinking that help researchers and policy wonks evaluate whether government public health policy is delivering. This was swiftly followed by the kicking into the long grass of a decision on plain packaging for tobacco, and rumours of the end for minimum unit pricing for alcohol. Whilst tobacco and alcohol got the headlines, the former is just as worrying; it hardly supports transparency and smacks of short-termism at the centre of government.

The response to this potential triple whammy has been furious, with potentially far reaching consequences. Sarah Wollaston, the influential Conservative backbench MP and GP, tweeted ‘R.I.P. public health. A day of shame for government; the only winners being big tobacco, big alcohol and big undertakers’ and castigated the government in The Guardian. The Faculty of Public Health have responded by withdrawing from the Responsibility Deal. Questions have been raised about Number 10’s links to the tobacco industry, and even the government’s own chief advisers are starting to be rattled. The arms-length body, Public Health England, pointedly included support for minimum unit pricing in last week’s Chief Executive’s round-up letter and has tweeted its support for plain packaging for cigarettes.

Behind the headlines, it is hard to tell whether these are signs of a change in tack in policy, the undue influence of lobbyists, or a cock-up. Whichever it is, it is a triumph of poor communication and the sign of little visible cross-government coherence to public health policy. By its very nature – from improving sanitation to reducing health behaviours and keeping people in employment – public health policy is an issue for the whole of government and therefore relies on the right and the left-hand of central government working together, not against each other. As an illustration of that, in the same week as this potential triple whammy, we saw Jay Rayner in the Observer, praising the Education Secretary for his ‘socialist’ approach to school foods. 

In the early days of the Coalition, we welcomed the introduction of the sub-Committee on Public Health as a potentially powerful mechanism to make sure that all big cross-government decisions, from welfare reform to alcohol pricing, were co-ordinated, consistent and underpinned by good quality and transparent health impact assessment . We, like many others, were disappointed when the sub-Committee was abolished. Its removal, and the lack of anything to replace it, is one reason the government got itself into last week’s mess on public health.

It is important to remind ourselves – at least at the time of writing – that no final decisions have been made on any of these issues. Plain packaging for cigarettes may still be introduced, albeit with no timeline, and we have yet to see the prospects for minimum unit pricing receding fast. All those interested in transparent information to help hold this and future governments to account could still have the opportunity to save important public health statistics by responding to any ONS consultation. Perhaps the government needs to set up a cross-government Committee on Public Health to help it sort this lot out? The King's Fund