Clean bill of health

The man in charge of Britain's health inspectors welcomes the appointment of a public minister - but with reservations. Paul Gosling reports

The creation of a public health minister has been given a cautious welcome by the body that represents environmental health officers in local government. But the Government has been warned that it must prevent public health issues being dominated by health professionals and scientists with a too narrow agenda.

Mick Cooke, chief executive of the Chartered Institute of Environmental Health, says: "Environmental health is far broader than public health, and a ministry of environmental health would be far better. This would not have a medical connotation but a social connotation, and give an implied view that there are people who are not medical practitioners who can participate to embrace social and economic issues.

"Providing a focus for public health is very important, but we would want to look very carefully to make sure it was not looking too narrowly, and that it wasn't replicating the chief medical officer. We want to see how his role fits in."

Mr Cooke hopes that Tessa Jowell, the new public health minister, will quickly review the effects of the deregulation programme introduced by the last government. He believes this gave a green light to bad producers and retailers to worry less about food safety, and that it caused confusion among councils' enforcement staff about whether their job is to protect the public or to protect the food industry.

Although the new minister is placed within the Department of Health, it is essential that environmental health officers still work for councils, argues Mr Cooke. "There are clearly some strategic issues around Health of the Nation that need to be dealt with on a central and a regional level, but the delivery of environmental health services is the bedrock of local government. Next year is the 150th celebration of the Public Health Act of 1848 which established medical officers, inspectors of nuisances, where local government really started, looking at local problems which needed local solutions.

"I am not attracted at all by the concept of any environmental health services being provided by a national department," Mr Cooke says. He believes that the inadequacies of the Meat Hygiene Service, which took over meat inspection from environmental health officers two years ago, show why a similar solution should not be sought for environmental health functions.

Costs doubled and responsiveness decreased, yet inspection of carcasses became less critical under pressure for greater productivity, with the role of meat inspectors compromised by conflicts of interest within the sponsoring department, the Ministry of Agriculture, Fisheries and Food. "That is a good model of why things shouldn't be done like that," suggests Mr Cooke.

The new Government's agenda must focus on consumers' concerns rather than producers' interests - emphasising the producer's responsibility to provide healthy food - and adopt a precautionary approach to public health, believes Mr Cooke. He argues that the risk-taking inherent in the production of genetically engineered food, and the use of genetically modified organisms, is unacceptable. "Clearly we are taking a risk, and there are interesting scientific views saying this is a risk not worth taking, yet we are already moving down that road," he says.

These are matters which the Institute hopes will be urgently examined by the new Food Standards Agency, which it enthusiastically welcomes. The expected framework of the Agency is in line with the Institute's own proposals, and Mr Cooke believes it could make a major impact in improving food safety.

The Institute is delighted that food standards will no longer be the preserve of the Ministry of Agriculture, Fisheries and Food. "The responsibility for both consumers and producers created conflicts - episodes before BSE, of salmonella in chicken eggs, of listeria, are examples of that 'corruption' of principle which has been mainly manifested by the lack of transparency," Mr Cooke says. "There were many occasions when people were able to hide behind the cloak of commercial confidentiality when the interests of businesses were deemed far more important than the interests of the public.

"What is important is that there is a clear contribution from ordinary people. One would hate any agency, whether it is responsible to the Department of Health or if it were independent, to be dominated by scientists.

"Everybody always talks about science providing an answer. Well, science has not provided an answer, and scientists are very poor communicators. You need other skills because people don't necessarily believe scientists.

"The Agency has to have a big contribution from the consumer, and you need to bring in people with interests other than those of food production and government ministers," suggests Mr Cooke. He adds that the Agency should be willing to look at the effect of diet on health. "More people die as a consequence of salt in food [causing strokes] than they do from food poisoning."

Above all, the new Agency must remember the past, and not just look at the most recent public health problem. Mr Cooke points out that the same causes of contamination of cooked meat by raw meat that is blamed for the Lanarkshire e-coli outbreak was also responsible for the spread of typhoid in 1964.

Hopefully, the lessons we learn now will remain learnt n

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