The dirty dozen

We are now a third of the way through the decade (where did the time go, etc.?) so let's take a breather and chart the progress of 'public health' against its own manifesto.

In January 2010, the UK Faculty of Public Health and the Royal Society for Public Health published a twelve point plan showing what political action they craved and the dates by which they wanted it. Much of the campaigning and 'research' of the last three years has been designed to meet these targets. Only two of them are related to healthcare. A few of them are trivial. The rest involve the type of lifestyle regulation which the quasi-medical profession finds so appealing. We'll take each of them in turn...

1. A minimum price of 50p per unit of alcohol sold. When? By 2011.

Enormous effort has gone into this one, including sock puppet campaigning by the Department of Health and appalling junk science. Alas, the policy has little support in cabinet and it has been criticised across the political spectrum for being regressive and anti-competitive. It is also almost certainly illegal under EU law and now seems to have been ditched. The nanny statists will keep on trying, however, so expect to hear more about it, especially if Labour wins the 2015 election.

2. No junk food advertising in pre-watershed television. When? By 2011.

This is basic slippery-slope stuff. They got the government to ban 'junk food' ads during children's programmes several years ago but—surprise, surprise—that wasn't enough for them. Some dubious research came out last year claiming that the chiiiiiiiiiildren were seeing more of these ads than they had before the ban. Unintended consequences or junk science? I don't know, but the government has so far resisted the food faddists on this one. If they ever succeed, you can expect a total television ban to be the 'next logical step' as per tobacco.

3. Ban smoking in cars with children. When? By 2011.

The blurb for this part of the manifesto says: "Evidence shows that air inside a car can be 23 times more toxic than a home environment in the context of passive smoke." This notorious clanger (which I first wrote about in 2010) helped to undermine the BMA's campaign to push this policy through in 2011. It is based on a well-debunked myth and the Meddling Association later issued a retraction.

Tellingly, the BMA's 2011 campaign was for a ban on smoking in cars even if no other person was present. This was a pretty clear indication that passive smoking was not really the issue and that it was never really about teh kidz. The real purpose was to set a precedent for prohibiting smoking in private environments (next stop, the home). Subsequent attempts to revive the campaign have reintroduced the 'think of the children' element. It is likely that some politician or other will see this as an easy way to make a name for themselves in the near future.

4. Chlamydia screening for university and college freshers. When? By 2013.

This one relates to healthcare and therefore isn't of much interest to the professors of sociology and English literature who dominate 'public health'. If you haven't noticed much of a campaign for this policy, it's because there hasn't really been one. Any student can get tested for Chlamydia for free, as they could in 2010. The blurb for this part of manifesto vaguely alludes to "targeting students on entry to university or college" but does not go into specifics.

5. 20 mph limit in built up areas. When? By 2011.

This is a favourite of the Green Party and there are a bunch of 'civil society' groups who are pushing the EU to legislate a 20mph/30kmph limit in urban areas. It is just the kind of policy Eurocrats love so I wouldn't write it off, although the UK Faculty's 2011 deadline was hopelessly unrealistic.

20 mph is a ridiculously low limit in most urban settings and the UK Faculty acknowledges that most drivers would find it intolerable. That is the whole point. They say that they expect it to "discourage people from using polluting cars because of the “frustration” of having to drive slowly." The Greens love it for the same reason.

6. A dedicated school nurse for every secondary school. When? By 2012.

"An RCN survey in 2009 reported that 64% of school nurses consider their workload too heavy," says the UK Faculty. It would be interesting to compare that figure with surveys of people in other occupations. Most people moan about having too much work to do, as far as I can see, especially in the public sector. Still, this is the only other healthcare-related item on the list and it is not a bad idea if it is necessary and cost-effective (which is highly questionable). In any case, this part of the manifesto has not had much effort put into it, probably because it doesn't involve banning things.

7. 25% increase in cycle lanes and cycle racks by 2015. When? By 2015.

The UK Faculty mentioned this expensive but not entirely unreasonable idea again in August 2010, but since then nothing. The cost makes it unappealing to politicians and the lack of a prohibition element makes it unappealing to the aforementioned sociology lecturers. There have been a few local initiatives, but the 25% target is unlikely to be met.

8. Compulsory and standardised front-of-pack labelling for all pre-packaged food. When? By 2011.

Specifically, this refers to the traffic light labelling system that is so beloved of nanny statists. The problem with this system is that is is rather arbitrary and it implies that certain foods, rather than certain diets, are inherently unhealthy. It won't take long for consumers to notice that the tastiest foods have a red light on them and start using the system in quite the opposite way that is intended (those unintended consequences again). Nevertheless, it allows public health folk to dictate how packaging looks—and we know how much they like that—and so there has been a concerted effort to legislate.

However, as with minimum pricing, there are EU legal implications which make legislation troublesome so the government has instead strong-armed the supermarkets into using the traffic light system "voluntarily". Public health mandarins celebrated, but naturally still found time to moan...

Prof Alan Maryon-Davis, an expert in health promotion from King's College London and a former president of the UK Faculty of Public Health, said: "This is welcome news - at long last... This is a triumph for public health and common sense - but just goes to show how the voluntary approach can be so much slower than government regulation."

The scheme will come into effect later this year. Inevitably, left-wing MEPs want Brussels to bring in EU-wide legislation.

9. Olympic legacy to include commitment to expand and upgrade school sports facilities and playing fields across the UK. When? By 2012.

School playing fields have continued to be sold off.

10. Introduce presumed consent for organ donation. When? By 2012.

They could increase the number of people who have organ donor cards by making it easier for people to get them, but that would take a bit of work and imagination so the answer—as ever—is to legislate. The public is divided on the issue of the state owning your body after you die and there is no sign of the British government passing a presumed consent law any time soon, but the Welsh Assembly will be pushing ahead with the controversial legislation in 2015.

11. Free school meals for all children under 16. When? By 2014.

There's no such thing as a free lunch. What this policy does is force people who don't have children at school to feed those who do. And since most children don't need free school meals at all, this policy serves no purpose other than to make children the custodians of an ever-growing state. It is an example of medical socialism, which explains why hard left groups such as CPAG and sock puppet charities such as the Children's Food Trust are so keen on it. It does not seem likely to become government policy in the near future.

12. Stop the use of transfats. When? By 2011.

There was never much hydrogenated vegetable oil in the British diet to begin with and the government's much maligned voluntary code "commits businesses to remove artificial trans fats from the few remaining products that still contain them by the end of 2011." As such, the UK Faculty can claim a win, albeit one which is unlikely to have any tangible effect on health.


And finally...

So far, very few of the dozen targets set out at the start of the decade have been met, nor look likely to be met. In the main, that is a jolly good thing since most of them are pointless at best and repellant at worst. We can be sure that the campaigns for the most reprehensible of these objectives will continue for years to come.

What is most interesting about this list is what is not on it. You'll note that plain packaging of tobacco—which they now claim to be an urgent public health priority—does not feature at all. That is because it was barely on the radar at the start of 2010 and it only moved up the pecking order because a few extremists in Australia persuaded the gullible Gillard government that it was worth pursuing.

Similarly, there is no mention of a fizzy drink tax. Indeed, there is nothing specifically about sugar and certainly nothing about banning large sodas. The sugar panic has rocketted up the policy agenda thanks to a dodgy Youtube video and a camera-hogging crank. For a movement that claims to base its policies on years of rigorous evidence, it is strangely opportunistic. It will be interesting to see which hare-brained ideas have suddenly taken hold when we review their progress in another three years.