Leading Article: Bad habits can be changed

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The Independent Online
THE Government's White Paper The Health of the Nation drips with targets, good intentions and glimpses of the obvious. It is none the worse for that, since it establishes public health as a major policy issue and sets out clear targets for improvements. These come with a welter of suggestions as to how they might be achieved, and an apparent commitment to persuade those involved to take the necessary action. The range of potential agencies is wide, from the NHS and local authorities to employers and the food industry. Much will depend on how firmly that resolve is maintained, and on the Government's readiness to provide funds when justified.

There is no magic in setting targets, be they ambitious or already on their way to being met by existing trends. But targets do provide a yardstick against which success or failure can be measured - and a rod with which the Government's critics can beat its back. The chosen fields are those that might be expected - heart disease and strokes, cancer, sexual disease and accidents - with the less predictable addition of mental illness, an affliction much less amenable to social policy and public education.

The most interesting issue raised by the White Paper is summarily treated within it: the link between poverty and poor health. The paper concedes that 'in general, people in manual occupational groups . . . have higher rates of illness and death than those in non-manual groups . . . the reasons for these variations are by no means fully understood. They are likely to be the result of a complex interplay of genetic, biological, social, environmental, cultural and behavioural factors.' Given the undoubted importance of this 'complex interplay' and of individual elements within it, the White Paper is surely wrong to write them off in a few paragraphs.

At the opposite pole stand those, such as Robin Cook, Labour's health spokesman, who see the reduction of poverty as the key to better health. Carried to its logical conclusion, their argument would require massive social engineering and a wholesale levelling up of incomes to achieve a healthy nation. Its lack of economic realism aside, their case is also fundamentally patronising towards the poor. It implies that the poor are so trapped in poverty and their culture that they cannot understand what is good or bad for them and their children.

It is doubtless true that those who read only the Sun and watch soap operas and quiz shows on TV rather than documentaries may emerge with a very low level of information about health matters. They may not know that boiled potatoes are better for you than chips, and that pulses are not only cheap but very nutritious. They may not care, or they may have no energy for cooking. Equally, in certain vocations - nursing, unsuitably, is said to be one - cigarettes are a form of emotional currency, as alcohol is for many. For others, it will be sickly sweet biscuits and sugar-laden tea. But these patterns of behaviour are not immutably fixed.

The Government's campaign against drinking and driving has shown how effective a determined and repeated propaganda effort can be in changing public attitudes. The White Paper will have to be backed by equally stark warnings if those in all economic groups who abuse their bodies in a multitude of ways are to change their habits.