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Katy Cooper's Blog
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A logic problem?
27th Aug 2008
I’ve just got back from a talk by Andrew Lansley (click here for an article about it in The Guardian), the Conservative shadow health secretary in the UK, on the Tory plans for public health after the next election ... working on the assumption, of course, that they win! I’d been beginning to wonder – along with many in this country – where the differences lie between Tories and Labour: are they really morphing into one another in their desperate scrabbling for the hallowed ‘middle ground’?
On this morning’s showing, there are still significant differences. In fact, I’m still trying to get my head around what seemed to me to be a logical gap in the thinking that was presented. Much of what he said was entirely uncontroversial, indeed sensible. The Tories are planning to separate out public health funding from health funding more generally – thereby preventing the ongoing issue that public health budgets tend to be the first to be cut and money siphoned off elsewhere. Apparently, since 1997 (when Labour came to power) public health staffing has decreased by 5% in the UK, as NHS staffing has increased by 25%. He spoke of the importance of involving industry in the solutions, of local empowerment, of providing a way for SMEs to access occupational health (wellness) for their employees.
Importantly, he also spoke eloquently about the impact of social inequalities on health – poverty, unemployment, social breakdown in cities.
However, he then turned to the language of public health (notably obesity). He claims that the Foresight report has made a fundamental error in terminology – namely that, by blaming the ‘obesogenic environment’ for the rise in obesity, it removes any responsibility that might otherwise accrue to the individual. In other words, I always have an excuse: it’s not my fault.
What I didn’t – and don’t – understand is how the two halves of his talk can be consistent. On the one hand, public health is all to do with overcoming poverty. On the other hand, the individual has to take responsibility and not blame the circumstances in which they live.
What was lacking, to me, was how to square the circle. To do that, don’t you first have to get rid of the poverty and other inequalities that affect health, and only then can you say that the individual is fully responsible?
Of course, I’m not suggesting that this is never about the individual. It’s my fault I’m overweight, for example: I don’t get enough exercise, though I could afford to go to a gym, ride my bike more, or reach my 10,000 steps a day; I eat too much, given how little exercise I take; and I probably drink more than is good for my weight, never mind my liver. I take responsibility for this – I kick myself on a daily basis, and I’ll join a gym next week...
But what if I couldn’t afford to eat fresh food and take exercise, and I’d got addicted to nicotine when I was still a child? These are the people who haven’t been empowered to take responsibility, and I would be unhappy to see them accused of using ‘excuses’ based on the social circumstances in which they live, given that they have no power to change that (obesogenic) environment.
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