To what extent should the state intervene to make us healthier? Of all the thorny questions whirling around government, this is one of the most urgent and yet in some ways least resolved.
In advance of his lecture on this theme in Nottingham yesterday, Mr Blair spent two days meeting readers of local newspapers, a panel organised by a regional television company, and health professionals at two separate gatherings. On specific issues nearly all of them wanted him to intervene more. Why was the smoking ban not implemented with greater urgency? Why is the Government not doing more to prevent excessive drinking?
Yet when people are asked in general terms about the state, they tend to be dismissive. We don't want those politicians telling us what to do is a common refrain. Some newspapers are more confused in their outlook. Most days of the week, headlines scream about the rise in obesity and alcohol abuse under the Labour government. But when the Government shows signs of responding, the newspapers fume about the nanny state.
As Mr Blair made clear at the start of the lecture, there is one unavoidable connection between the state and unhealthy lifestyles. If levels of drinking and obesity continue to remain high, the NHS will not be able to cope. The direct connection highlights the conundrum. The Government is responsible for funding the NHS, and yet at the same time cannot be responsible directly if someone decides to get drunk most nights of the week, becoming an inevitable burden on the NHS. Even the hyperactive John Reid could not prevent particular individuals from drinking, although he would probably have a go: "Tonight Mr Reid will be in Southend to make sure that Burt Thung and his friends stick to two pints each."
The connection between the state and the individual goes well beyond the economics of the NHS. As Mr Blair has astutely recognised, health and lifestyle issues have become one of the great obsessions of our time. Newspapers devote pages to the topic. The shelves creak with magazines aimed at making us feel and look good. On some ill-defined level, politicians are blamed if we do not have the bodies of an athlete. Yet they have not found a positive way of addressing the new fashion for health and lifestyle issues.
During Mr Blair's visit to Nottingham, the questions flowed ceaselessly on diets, smoking, weight loss, nutrition. The questioners were not being politely restrained in failing to bring up the plight of John Prescott, sleaze or prime ministerial departure dates, the issues that grip Westminster, especially once we journalists have had a drink or two. Like the rest of the country, they are more bothered about their health, their children's health and what the Government can do about it.
Such are the intense contradictions, the Government can intervene only subtly, seemingly responding to a national mood while seeking to shape it. In relation to the smoking ban in public places, it was too cautious. The national mood was ready for the Government to act. In a revealing phrase, Mr Blair has spoken of being "given permission" by the public to impose the ban. The persistent allegations of arrogance against the Government are wholly misplaced. Sometimes it is not arrogant enough. Ministers were in a position to act earlier and more decisively than they dared to do.
As part of the preparation for yesterday's speech, Downing Street gathered evidence from a range of health professionals. Their views are published on the Downing Street website. Some of them argued that there is "permission" now to act in relation to alcohol as well. With good cause, Downing Street aides pose a challenging response: What do they suggest should be banned? Tackling alcohol abuse, and indeed obesity, are more problematic than challenging smokers.
Sensibly, in relation to responsible advertising by the breweries and food labelling by the supermarkets, Mr Blair seeks a voluntary deal, but warns that the state will act if the companies fail to deliver. One Downing Street aide describes this proposal neatly as voluntary compulsion, a new third way.
Yesterday's lecture had a broader political purpose. In relation to public health, Mr Blair calls for an enabling state, one that empowers and informs while working with others to help people to lead healthy lives. In the first part of the lecture he argued that the notion of the enabling state extended well beyond the issue of public health.
The series of lectures, of which this was the latest, is a formidable political exercise, an attempt as far as it is possible to have a dialogue with a range of people, many of them critical of the Government. It is grown-up politics.
Such is the fashion to dismiss all prime ministerial activity, few have commented on the degree to which Mr Blair has revolutionised, in a positive way, the way a political leader engages with voters. So rarely did Mrs Thatcher discuss matters with critically informed voters that her one public dissenter became a national celebrity. A voter, Diana Gould, dared to challenge her over the sinking of the Belgrano and was virtually offered her own chat show the next day. John Major met critics fleetingly when he stood on his soap box in general election campaigns and that was more or less it.
Constantly Mr Blair engages with critics, listens and responds. Before the last lecture Downing Street published detailed criticisms of its crime policies from a sociologist. Some in the media lifted the criticisms without even mentioning that Downing Street was the source. It is still adapting to grown-up politics.
My impression from observing him closely in Nottingham is that Mr Blair is as energetic as he was in 1994 when he became a youthful leader. On the two days in the city he broke off to make calls on the Middle East crisis and took part in four events on the role of the state. Yet in spite of the hyperactivity I sense a different mood. He seems no longer defiant about serving most of a full term, and has been known recently to reflect on the challenges that Gordon Brown will face when he takes over. I am told that privately he admits all the noise about sleaze is damaging and predicts with a self-awareness that defies the current caricature that when he goes the noise about "trust" will go too. Instead, Mr Brown will face other challenges.
Of these the role of the state will, in Mr Blair's view, be central. He senses that the next election will not be the familiar contest between Labour's necessary investment and the proposed sweeping cuts of the Conservatives. Instead it will be more about the purpose of government, a more challenging issue. Yesterday's lecture was not just about the health of the nation, but the future health of the Labour Party too. Mr Blair is not fighting the next election, but he knows what the main battleground will be.Reuse content