Leading Article: The peoples' road to hell is paved with government advice

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The Independent Culture
NO ONE should deny that public health, on the widest definition, is more important to the quality of people's lives than anything that happens in the busy wards of NHS hospitals. Because it is newsworthy, and looks exciting on television, pioneering surgery gets most of the attention. Or, as in Bristol recently, most of the blame.

But such procedures can save, or mar, the lives of only tiny numbers. The way people live can make a much bigger difference. Historically, the classic example is tuberculosis. Deaths from the disease began to fall long before anyone knew anything about the bacillus that gave rise to it. There was better nutrition, less overcrowding. It helped, also, that some dairy farms took up Pasteur's invention of heating milk before selling it - though, at that stage, more with the intention of stopping it going sour than of preventing infection.

Yesterday's White Paper, Saving Lives: Our Healthier Nation, mostly treads in established public health footsteps: by changing lives, you can save them. The idea is to try to level up the death and illness rates between the worst-off and the better-off. People will have access to better information. The language, as always with New Labour, has changed more than the realities have. After the constant complaints levelled at the Tories' former Health Secretary, Virginia Bottomley, there is an insistence that the aim is not "preaching" or "nannying". Rather, it is a "partnership" between state and people. But, in spite of the disclaimers, there is still an air of nannying about the White Paper. Of course, nannying is cheaper than nurses.

Determinists, like the authors of the famous 1980 Black report on inequalities in health, might say that almost all the discrepancies relate to the wages people get (or don't get), the houses they live in, and the schooling they receive. But, within those parameters, individuals do make choices. The new proposals could help some individuals to make them more wisely. It is as well, however, to be aware of the limits.

The rocket-eating classes may walk through the poorer streets of our cities, horrified at the junk-food, couch-potato obesity that is beginning to be a classic sign of poverty here, as it has long been in the US. They may raise their eyebrows at all the young women smoking (social taboos shift, but they never go away). But, for decades, the public health message about smoking, for example, could hardly have been more insistent. The fiscal back-up has been ferocious. It has mainly hit the poor, for whom a pack of cigarettes takes up far more, proportionately, of their income; yet it is, disproportionately, the poor who smoke. This may disappoint the nannies, but it is well to remember that once the warnings have been sounded, people have a right to go to hell their own way.

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