Thursday, 3 January 2013

It's not public health, it's none of the council's business

 In recent days the fussbuckets have been out in force. Hardly a day passes without another proposal to judge people by their lifestyle choices. There is nothing that can’t be justified by reference to ‘health’ or ‘well-being’ especially when the proposals is accompanied by reference to ‘how much it costs the NHS’ or ‘society’.

Part of the context for this outpouring of nannying fussbucketry is that ‘overall responsibility’ for public health (i.e. some of the budgets for public health activities) transfers to local councils in April this year – hence the publication and fuss about a report from the LGIU and Westminster Council. 

Well sort of transfers – let me explain.

The recent health legislation does transfer the public health budgets to top tier local authorities (that’s counties, mets, unitaries and London boroughs). However, these budgets are ringfenced – we can’t snaffle them and use the money to provide more of better adult social care or keep libraries open. And, just as importantly, the committee that oversees this budget – called a Health & Well-being Board – is a joint body of the NHS and the local authority. Membership is defined in the statute and has to include both council officers (the Director of Public Health, for example) and councillors. Full council cannot direct or control this body nor can the council’s executive so to say that councils are taking responsibility for public health is something of a misrepresentation. The budget will sit with the council – just as the schools budget does – but the decision-making rests right where it does now with unelected officials.

Oddly enough the report from the Local Government Information Unit (LGIU) doesn’t mention any of this. Instead it focuses on all the exciting things that can now be done – including making fat people go to the gym:

Westminster council and the Local Government Information Unit say new technologies such as smart cards could be used to track claimants' use of leisure centres, allowing local authorities to dock housing and council benefit payments from those who refuse to carry out exercise prescribed by their GP.

Or rather – as is clear here – fat, poor people. 

This proposal comes of the back of the proposal to have a welfare card so folk on benefits don’t do anything naughty like buy booze, fags or mucky videos. A couple of stern Tory MPs – Alec Shelbrooke and Kris Hopkins – have wagged their fingers at us in support of this proposal.

It is all part of directing the poor towards a more purposeful life and away from those sinful pastimes – drinking, smoking, bad telly and sex – that are, these moral paragons would have us believe, the cause of their problems.

These fine men are speaking to that single mum on the estate. Stop making these unhealthy choices they say and, hey presto, your life will be transformed, folk’ll be at your door offering you a job, food will miraculously appear on the table and a man will arrive who thinks you’re something other than a convenient slot for his sexual organ. And the kids will stop snivelling too.

Or maybe our pals in Westminster are thinking about the ex-offender in a bedsit. The message is that going to the gym, cutting out the whisky and scrapping the roll-ups will change everything. Suddenly the employer will look at him and choose to ignore the rap sheet, the ex-wife will let him see the kids and people will stop asking him to do a little running around for cash, ‘no risk mate’!

Perhaps they're thinking of the retired builder. Not much cash but enough to maintain his beer gut, provide for some cheap cigars and perhaps a few bets at the weekend. For sure, stopping these bad habits will help - the bad back will go away, the hearing will magically restore and the pains up the arms from years of using power tools will be so much better!
This approach to public health – lecturing people about their lifestyle choices while ignoring why they made those choices in the first place – is a dead end. It might make a few middle class do-gooders feel better, for those Tory MPs it’s a chance to burnish their ‘tough-on-welfare-scroungers’ credentials and for councillors in Westminster is furthers their desire to kill the things that make London a great city.

But it isn’t a decent public health strategy. That would focus on things that actually are public health concerns – air quality, road safety, immunisation, access to healthcare provision, warm homes, cheaper fuel, safe food and clean streets. Personal lifestyle choices – eating drinking, smoking, sex – are just that, personal concerns. By all means make sure people know the risks but that’s where our responsibility ends. These choices are nothing to do with public health.

Making someone’s life less pleasant because you disapprove of their lifestyle is an act of ghastly authoritarianism not health care. Yet this is seemingly the only concern of so-called ‘public health’.

Well, my dear councils, it isn’t public health – it’s none of your business at all.


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