Monday 23 December 2019

A decade of 'public health' achievements

The Royal Society of Public Health has published its list of the top 20 'public health' achievements of the 21st century. Only three or four of them actually involve public health and the most important of them (HPV vaccination) only comes in at sixth.

It is estimated that the HPV vaccine will prevent over 100,000 cases of cancer in Britain in the next forty years, but according to the RSPH it is less important than the sugar tax. That tells you everything you need to know about the way this husk of a movement was taken over by puritans and anti-capitalist loony tunes.

Their top five are:

1. The 2007 smoking ban
The Guardian says the ban 'has been credited with causing a fall of more than 20% in heart attacks and other cardiac conditions in the first 10 years'. This is a reference to some pitiful nonsense from Public Health England. The main achievement of the smoking ban was to close thousands of pubs.

2. Sugar tax
The RSPH says that the sugar levy 'has so far encouraged product reformulation' and this, apparently, makes it a greater public health achievement than the Teenage Pregnancy Strategy and childhood flu vaccine. Low and zero sugar drinks made up more than half the market before the tax came in. The main effect of the tax was to remove several popular brands from the shelves, resulting in discontent from consumers who would have been quite happy to pay a bit more, and fewer sales for the companies that were dumb enough to play ball.

AG Barr's share price ends the year 30 per cent lower than it was at the start. There has been no impact on obesity.

3. Marmot review
A transparently political tract masquerading as health research.

4. Sure Start centres
Left-wingers have a strange preoccupation with these.

5. Minimum unit pricing in Scotland
It is, at the very best, too early to say whether this has had any positive impact, although it has certainly cost Scottish drinkers many millions of pounds. The RSPH nevertheless describes it as a 'a high profile example of a fiscal intervention that is effective in improving health outcomes'.

As the decade nears its end, it's worth looking back at what the 'public health' lobby set out to achieve in the 2010s. It is nearly ten years since the RSPH and Faculty of Public Health published their '12 Steps to Better Public Health', a list of priorities for the decade ahead. Depending on how you define it, around half of the proposals can be considered to be 'nanny state'.

The full list was as follows:
  1. A minimum price of 50p per unit of alcohol sold (achieved in Scotland, with Wales soon to follow)
  2. No junk food advertising in pre-watershed television (in the Childhood Obesity Plan but not introduced)
  3. Ban smoking in cars with children (became law in England in 2015)
  4. Chlamydia screening for university and college freshers
  5. 20 mph limit in built up areas (achieved in a few places, but if the experience of Brighton is anything to go by, it is rarely enforced or obeyed).
  6. A dedicated school nurse for every secondary school
  7. 25% increase in cycle lanes and cycle racks by 2015
  8. Compulsory and standardised front-of-pack labelling for all pre-packaged food (not compulsory and cannot be compulsory until we leave the EU. A voluntary agreement with the evil food industry covers most products, however.)
  9. Olympic legacy to include commitment to expand and upgrade school sports facilities and playing fields across the UK
  10. Introduce presumed consent for organ donation (happened first in Wales and backfired, is due to start in England next spring)
  11. Free school meals for all children under 16
  12. Stop the use of transfats (no mandatory restrictions, but the stuff isn't used much anyway)

The interesting thing about this list isn't how few of the objectives were achieved but how many objectives were achieved that weren't on the list. Where is the sugar tax, for example, which RSPH now claims is one of the greatest 'public health' wins of the century? Where is the ban on the sale of energy drinks to minors that is now on the cards? Where is plain packaging for tobacco?

The fact is that the sugar tax and plain packaging seemed too mad to be politically possible at the start of 2010. It is not that the 'public health' lobby had not considered these policies; soda taxes had been much discussed in the USA and the idea of plain packaging first surfaced in the 1990s. It is that they hadn't found a health minister dumb enough to take them seriously.

That soon changed when Nicola Roxon got behind plain packaging in Australia and Denmark introduced its ill fated fat tax. Once they had evidence that somebody somewhere was prepared to treat these policies as serious proposals, they dropped everything and diverted their efforts towards lobbying for them. They were not important enough to be mentioned at the start of the decade. The try-anything, ban-anything activists of the 'public health' racket made them priorities because a win is a win and who cares about the consequences?

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