Sunday, 6 January 2013

Nanny has a role to play

An interesting debate last night between left and the hard libertarian Conservative Party right last night which shows you the divergent opinions on health within our towns.

This is very important for residents because public health and the responsibility for scrutiny is the preserve of Medway Council and the Health and Adult Social Care Overview & Scrutiny committee. This committee is Tory-led and policy formulating so it is important that the views of Conservatives and their supporters on health are exposed. In Kent County Council also the Health Overview & Scrutiny committee is Tory dominated.

The two issues my libertarian colleagues were expressing surrounded the concept of state intervention in promoting health by banning or management of substances which can cause harm; and the treatment of health issues which arise from potentially such excess.

The Conservative argument expressed is the state has no place at all in banning, legislating or promoting healthy activities which could curtail the freedom of those who make us unhealthy, and that as a result it is for the individual to make a rational decision with all the facts. As a result; if you were to get unhealthy, you should have to pay - at the hospital - to cure yourself because the state should not treat you equally to those who have not made the same 'lifestyle choice'

Assuming of course the libertarian argument that freedom requires access to all the information and facts which in reality never happens because people misunderstand fact which is presented in different ways, and that these people are willingly choosing to make themselves unhealthy, the issue then arises does the state have a wider role to play at all to ensure we live healthier lives? 

They would say no. 

This is where I part company in that people dont make decisions based on objective parameters, and are heavily influenced by emotion and the environment around them, which means individuals dont necessarily make the right choices for their future. 

How many documentaries on those with Liver disease have I watched where the patient regrets the decision and would not want to go back again? 

I have always, and do consistently believe, the state has a role to play in promoting healthy lifestyles and eating and should be seeking to promote education of health choices. In addition it should seek to restrict, 'ban' or manage social health outcomes if issues are leading to wider public harm. Obesity and alcholism are two such areas where state intervention is needed because the problem, like with other addictive behaviours, will not cure itself without education and intervention.

The libertarians start from a blank canvass but it is worth reminding ourselves how 'nanny' state has intervened in the past to set the context for why it is not a slippery slope towards state control but reasoned policy to safeguard people. 

It seems strange now, but back in the 1930s the issue of milk pasteurisation was controversial with 2,000 deaths a year from bovine TB, mainly due to people drinking raw milk. At the time many experts  recommended milk be pasteurised - heated to kill bacteria - but the libertarian right opposed this as state inteference in lifestypes. Only in 1949 did a bill finally come before parliament with campaigning MP Dr Edith Summerskill saying: "Pasteurisation has been prevented by ignorance, prejudice and selfishness."

The statistics show she was right. Nowadays the infection of humans with bovine TB is virtually unheard of. Since the pasteurisation of milk - and indeed before then - a series of public health measures have helped to prevent disease and ill-health. Of course the introduction of Pasteurisation would have led to additional cost on milk production and would have led to some losing business or becoming less profitable; but today the standard is set and progress made.

Air pollution was brought under regulatory control in 1956 with the Clean Air Act following the death of 4,000 people in the London smog of four years earlier. And the 1960s and 1970s saw a series of measures, including drink driving and seat-belt laws, to curb the number of deaths on the road. Of course the introduction of Clean Air laws led to red tape on industry which led to decline in profits but the result today is a healthier society and air we can breath.

The introduction of a seat belt regulation for all drivers in the 1990s was met with hostility from libertarians yet its use has saved lives and actually not fundamentally undermined our rights. The introduction of a smoking ban in public places; which many libertarians still hack over; resulted in a small decline in attendance in some bars but improved the working environment for employees in pubs - who didnt smoke - do not have to breath fumes from those that do. Many look back it now and wonder how we all survived in smoke filled bars and how our clothes stank at the end of the night... alas hindsight. 

Taking away the carcinogenic and major health issues around smoking which are not in dispute - countless studies prove it causes cancer, heart problems and other issues - but we still have some libertarians campaigning to stop plain packaging which has been introduced in Australia. It is only a matter of time given the statistics on smoking are stubborn.

The Scottish government is also introducing minimum alcohol pricing and it is welcome to note some Supermarkets are restricting alcohol sales. The scourge of heavily reduced drink subsidies which were tightened up under Labour and the fact people are not binge drinking to a closing time has reduced the problem of late night rowdyness... though more needs to be done. We have seen a reduction in alcohol consumption in young people from 18-24 for the first time in decades with Labour legislation but the legacy of alcohol remains; especially in my ward which has the highest rate of alcohol related admissions into Medway hospitals.

At every point society has come upon a major social health problem - and obesity by the way is the latest 21st century problem - their has been one of two responses. We either put our heads in the sand and allow the problem to worsen or we can learn from history and engage with the issue head on through legislative action. I say we learn from history.

Dr Chris Spencer Jones, the former chairman of the British Medical Association's public health committee, said: "Public health measures can have a huge impact and at times have played a more important role than medical breakthroughs.

"The UK has often not been the first to introduce these, but we have been good at implementation and that has saved many thousands of lives."

My guiding principle is that government should intervene if an individual's or organisation's actions are harming others which is why intervention on high alcohol drinks and a curtailment of fast food chains are necessary; be that licensing hours, use of trans-fats or indeed super-sized portions or just to copious advertising that goes through doors in my ward and in Medway.

There is of couse a happy medium to be had on the above; Frosties at breakfast is an example of high sugary food but other examples could be better highlighted. The free mega-sized chocolate bar at WHS Smith when you buy a paper etc..

Where I differ further from my Conservative friends however is on dealing with health care as a consequence of the above perceived 'lifestyle' choices.

Dr Phillip Lee MP and his surrogates have positioned that people should be forced to pay for health care if their 'lifestyle' (and how this is defined in law would interest) was a contributory or main cause to their health problem. Dr Lee suggests that people then have to pay - by credit / debit or cash - at the hospital for treatment; perhaps on drugs or a treatment regime. 

The problem with this libertarian position is that where is the limit defined. Many cancers could be caused by lifestyle choices in addition to genetic predisposition to a particular cancer; do we charge those with skin cancer because they tanned too much twenty years before diagnosis. Do we charge for statins for a gentleman who is overweight and has been admitted with an emergency heart attack? Do we charge for those from the sub-continent who do not present obesity in the same way as Caucasian patients; and thus are more pre-disposed to Diabetes? Does an adult who has been fat since childhook (because of parental choices on diet and a lack of education by schools) not deserve the same treatment? Does someone who has found out she has an unplanned pregnancy have to pay? 

These are all clear points where 'lifestyle' hits reality hits individual grey lines; no person is the same but assumptions can be made which may be wrong; Tories should be considering this before rushing to the press including those with medical backgrounds who should know better 

And more importantly who makes the above judgement to charge; are doctors forced to make economic decisions whilst examining patients. Do NHS bean-counters obesessed with rationining have the final clinical choice on those who are unable to afford health care or drugs?

The problem with this libertarian view is that, like most of their rabid arguments, they dont stand up to scrutiny. Clinical decisions by doctors on the frontline should not be based around economic judgments and the ability to pay; or indeed even making judgments on lifestyle which could turn out to br wrong through misdiagnosis or early misjudgement by junior doctors. 

And going to the opposite extreme - because Tory MPs are an inconsistent bunch are they not - we have another Conservative MP, Alec Shelbrooke, taking state intervention a step too far by targeting those on welfare with ID cards so that they cant spend any money on anything other then what the state gives permission for; taking the argument of state intervention to another level he has callously mixed the issue of cost of benefits to the government with that of reducing perceived undesirable behaviours. A truly dangerous position for a mainstream politician to take. It would be totally unenforceable; watch out for HM Government white vans trying to stop people getting hold of pound sterling ...

On childhood obesity - where remember the parent makes the choices in many cases on diet - Medway does have a problem; the above table highlights the issue we have in our towns and you can read more about it here

I believe that national and local government does need to be more proactive in managing health which is why I support the move to look at whether we cant change the licences of fast food chains near schools; in the same way the Council has the ability to change the licences for alcohol sales in our pubs for the social good. 

Obviously the above can not be isolation which is why we need to encourage personal responsibility an fitness and work on school sports initiatives. 

We also need to accept that with the rise of computers people are becoming more sedentary which means ensuring nutritional guidance is advertised on all products is absolutely key. 

People need to be educated on healthy eating but having 15 fast food restaurants stuffing pizza and kebab shop leaflets into peoples letter boxes in my ward is in my mind contributing to health problems; I think its time we legislated on it to stop the waste in paper and something which actually irks our residents.

Local government has a major part to play with government; we have seen this throughout history and whilst being sensible and reasonable it isnt always the case that the state restricting and banning things is negative.

p.s. In case you are wondering I have never supported a ban on fast food outlets near schools without firm evidence which does not exist. I do think stronger licensing should be looked at.

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