Health: A shot in the arm for campaign trail needs

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The Independent Online
It is more than 20 years since the Government recognised that health could not be guaranteed by a health service. Diet and smoking, as well as Government policy in areas such as employment, housing and education had a greater impact than anything the NHS could achieve.

Over the past two decades repeated attempts have been made to improve public health and the difficulty of doing so is reflected in the uncanny resemblance between yesterday's Green Paper and those of the past.

In 1976, the then Department of Health and Social Security published Prevention and Health: Everybody's Business which highlighted what individuals could do to protect themselves from what were then known as "diseases of affluence" - heart disease and cancer.

It was followed by health campaigns in the Eighties, such as Look after your Heart launched by the Health Education Council, which today would be regarded as nannying. The Health of the Nation strategy launched by the Tory government in 1992 marked the most sophisticated development of this approach.

Its key weakness was its failure to acknowledge the link between ill health and poverty. But although yesterday's Green Paper makes that link it is notably cautious about how far the health gap between the rich and the poor can be narrowed.

Caution is advisable. The lesson of the past 20 years is that improvements in public health, while desirable, are extraordinarily hard to achieve. Some campaigns, such as on drug-taking and Aids, in the Eighties, have made matters worse.

Julian Le Grand, professor of health policy at the London School of Economics, said: "Given that public health is such a difficult and diffuse area and given our ignorance about what works and what doesn't I think the most we can hope for is small incremental steps. The only things we know work are locally targeted programmes."

- Jeremy Laurance