Andrew Lansley MP, the Shadow Health Secretary, was our guest at a power lunch in Westminster this week. His topic was "Public Health – Personal or Public Responsibility?" 'Public health' used to mean environmental health, of course – sanitation, clean water, that kind of thing – but now its usage has changed. When politicians talk about public health these days they are normally referring to obesity, smoking, and 'lifestyle diseases' in general. It makes libertarians like me feel a little queasy, but I suppose it's inevitable when you have a national health service and rapidly rising costs.
The general Tory approach to public health was outlined by Lansley in a speech this summer, and is usually summed up as "no excuses, no nannying". The idea being that if you educate people and give them all the necessary information, they can really take responsibility for their own choices. I get the impression to Tories are committed to activism and 'engagement' in this area, but don't want to interfere too much with people's lives.
One obvious problem, however, is that the NHS is a sickness service, and not a health service. Will the NHS really be able to do something – i.e. promote health – which is so alien to its culture and ingrained bureaucracy? Probably not, in my view, so it's not surprising the Tories aim to separate 'public health', where they see a major role for government activity, from the day-to-day running of the health service, where they want to rely more on professional autonomy balanced by consumer choice and provider competition.
I'm still not convinced by the whole 'public health' agenda though. Yes, so-called 'lifestyle diseases' (triggered by eating too much, smoking too much, drinking too much, and so on) are a major burden on the NHS and, by extension, the taxpayer. But I'd much prefer the government to just leave us alone, cut our taxes, and got us pay directly for our own healthcare. If people bore the financial consequences of their unhealthy lifestyles, perhaps they would make more sensible decisions. Otherwise, we'll forever be fixing problems caused by too much government with even more government.