A proper public health emergency puts 'Public Health' into perspective

Government and 'public health' activists take note.

When the current crisis is over it is clear there will have to be a serious re-evaluation of our bloated 'public health' industry and the role it plays in tackling genuine public health scares.

Rae Maile, an investment analyst at the investment bank Panmure Gordon, hit the nail on the head when he wrote, 'A proper public health emergency puts 'Public Health' into perspective':

The 'public health' industry has spent years lecturing people about lifestyle choices more than anything else, and questions have been raised by the response to COVID. Some elements have been seen to be the wrong side of the debate when arguing that PMI's Greek affiliate, Papastratos, should not have donated 50 ventilators to the local health service. It is too much to hope that lifestyle nannying goes away, but it might perhaps moderate.

I have written many times about Public Health England and its obsession with smoking in particular, but the problem goes much deeper than PHE and its well-remunerated army of mandarins.

The 'public health' industry has ignored what should be its real role for years if not decades. Instead of focussing on infectious diseases or illnesses caused by deficient hygiene, sanitation and water supply, campaigners – most of them living comfortable middle-class lives – have fought an increasingly nasty war on habits and behaviours that have little to do with public health.

Part of the reason for this is that, in the West at least, most of the major diseases of the past, like tuberculosis, have been consigned largely to history.

Many other common illnesses that were once potentially fatal have also been eradicated or reduced to a minor inconvenience in large parts of the world because of vaccines or antibiotics such as penicillin.

As a result of this, perhaps, the 'public health' industry appears to have taken its eye off the ball. Not even viruses such as ebola and SARS (which had relatively little impact in the West) could shake their belief that the great public health battles of the 19th and 20th centuries had been won.

Today that confidence looks a bit misplaced and while it's too early for an inquest it's worth noting that since the introduction of the Clean Air Act 1956 – which was in response to London's Great Smog of 1952 – 'public health' has increasingly focussed on private rather than public health.

Two factors could be jobs and money. Governments, by and large, aren't going to employ thousands of people or throw millions of pounds at problems that appear to have been solved.

New issues had to be found and smoking was an obvious target. The concept of passive smoking was enormous because now it could be argued that smoking was not just about individual choice, it was a public health issue – in particular, the health of non-smokers 'forced' to breathe other people's tobacco smoke.

It didn't stop there, though. 'Public health' now covers obesity and drinking even though the idea of secondhand eating and drinking have yet to catch on. (That said, it’s only a matter of time.)

Which brings us back to COVID-19.

It's no coincidence that neither the World Health Organisation (on a global scale) nor Public Health England (at domestic level) have provided much leadership on tackling the current crisis.

The WHO stands accused of turning a blind eye to what was happening in China while PHE, as I explained yesterday, responded to an attack on its competence by neatly deflecting the media's attention back in the direction of smoking.

I'm speculating, but the reason bodies such as the World Health Organisation and Public Health England have been unable to react in a convincing fashion to the coronavirus crisis is because neither organisation is fit for purpose – that is, capable of responding to a genuine public health emergency.

I could go on but I won't, for now. All I'll add is that the day of reckoning is fast approaching for a 'public health' industry that lost sight of its primary function a long, long time ago.

PS. I've just remembered that in September 2011 the World Health Organisation launched a 'Decade of Action for Road Safety’ campaign "to raise awareness of dangers on the road".

I wrote about it here – Now WHO turns on drivers.

People die in road accidents, it's true, but is road safety a public health issue in the accepted meaning of the term?

Either way it's another example of the WHO losing focus on what should arguably be its primary purpose - fighting illness and disease over which the general public has little or no control.

Comments

[Misty]

Much as I mentioned in an earlier comment, one thing that I do believe will occur as a result of the Covid-19 crisis is that everyone, including Governments, will, out of necessity, have to take a long, hard look at their priorities. Primarily, this will be as a result of the financial backlash which will inevitably result from people losing their jobs, businesses losing trade or closing, and Governments faced with the double-whammy of much-promised financial support to individuals and businesses, together with the greatly reduced tax-take from the aforementioned ex-employees and ex-businesses.

So surely (let’s hope!) quangos such as Public Health England must now come to be seen as the expensive luxuries that they have in reality always been. I think I’m right in saying it was David Cameron who created this – his famed “Nudge Unit” – out of thin air during his tenure as PM, and I’ve always believed this was a political move rather than one which was actually required for health reasons, to take the nasty business of finger-wagging and hectoring out of the hands of doctors and other medical professionals doing the vital job of actually treating sick people, because those professionals had become aware that the obligation to perform this add-on work was (a) distracting them from doing their real jobs, (b) damaging their relationships with their patients and (c) destroying public trust in, and respect for, the whole profession.

Now, it’s one thing creating a separate body to take on all these nasty, unpopular jobs and to relieve the medical profession of tasks they don’t want to do when times are good and the economy is relatively bouncy, but when times are less good and the economy is as flat as a pancake – as it looks set to be for some years to come after this – such bodies can surely only be seen as decadent indulgencies. As a politically-motivated body, after all, PHE doesn’t actually do or produce anything of real value, being primarily a propaganda machine that does little other than pump out TV and radio campaigns exhorting everyone to toe the line (their line, naturally!), and statistics usually designed to “prove” how “successful” those same campaigns have been! As far as I can see, PHE is largely a body which effectively therefore exists almost purely to justify its own existence and nothing more! If there is (or was ever) an intention for it to do anything else – anything useful, that is – then it has, quite simply, not done it! It doesn’t produce medicines; it doesn’t fund vital medical research; it doesn’t develop or support new treatments; it has failed roundly to apply itself effectively to a single genuine health emergency on the rare occasions when one has landed on its doorstep (including this one); it doesn’t even stick plasters on children’s grazed knees, for goodness sake!

It’s a talking shop and a word-machine and nothing more. Pretty much everything it does could easily be split amongst various of the other existing public services, such as the ONS, or not done at all and few people except PHE themselves would even notice. How many people, for example – even smokers – would have noticed that this was the first year that they didn’t run a New Year stop-smoking campaign if you yourself, Simon, hadn’t mentioned it in your blog? That’s how ineffective PHE are in real terms – it takes the spokesperson of an organisation which is diametrically opposed to many of its policies to bring something it’s not doing to the attention of the people it’s supposed to be targetting! Now that’s ineffectiveness at - err - its most ineffective!

The Government finally saw sense and withdrew funding from many of the local anti-smoking “charities,” simply because their work was already being done by the NHS perfectly adequately and there was no point in paying for the same thing twice – they should now do the same to PHE (and so many of the other publicly-funded quangos who have been quietly siphoning taxpayer money away from the important, real, public services that we all thought we were paying our taxes for). But as the “luxury body” created for the benefit of the one public service which has been under most pressure during this current crisis – the NHS – it should surely be the first to be axed when the chips come down, economically speaking, and the funds re-allocated to the NHS which, even after Covid-19 is a distant memory for the public, will still desperately need it. PHE is simply a failed experiment and a huge waste of money which, to be frank, the country can no longer afford.

[Pat Nurse]

I hope you are right Misty but my fear is that the crisis may make politicians even more nasty about smoking and smokers.

The easiest way for them to virtue signal on lung health, relieving financial pressures or burdens on the NHS, and doing what public health experts like Chris Witty (now an almighty saint) want, means the easiest, quickest and all encompassing way of showing support is to figuritively beat up smokers and smoking, berate anyone who does not treat their body as a temple, and show support for good health by banning smokers from everywhere even evicting them from their own homes if necessary.

Personally, I find it strange that in the decade that public smoking has been banned, old diseases are coming back and new ones are becoming like plagues. Maybe there is something to nicotine offering some public protection against these diseases we thought we had seen the last of generations ago.

I hope for fairness, honesty, and an end to hate campaigning propaganda after this crisis but I fear the propagandists will exploit it and turn it against us with the public and politicians baying for the blood of someone to blame for all this. Smokers are easy targets and the obvious choice.