The Great Public Health Debate
Thursday, 28 June 2007
If, as many of the speakers at this year's conference have stated, climate change is the public health issue of the 21st century, does the answer lie in centrally-imposed legislation or individual action, the panel at the Great public health debate session were asked.
‘You can't leave it to the individuals because the automatic human reaction is ‘my little bit doesn't make any difference'' said Liberal Democrat Shadow Health Spokesperson Sandra Gidley. It was essential to look at incentivising behaviour and addressing things like the public transport infrastructure, rather than expecting people to do everything themselves.
It was not an either/or situation, said King's Fund Chief Executive Niall Dickson. ‘It has to be both. Entire nations were also capable of saying that their little bit didn't matter, he said, which was equally dangerous. Levers would need to be applied at local, national and international level, he stressed, along with more investment in technology.
State intervention and individual responsibility should go hand in hand, said Shadow Health Minister Andrew Morrison MP, and a key thing would be to work through the fiscal system so that there was less direct taxation and more green taxes. There should also be binding annual targets for emissions, he said, as it was unacceptable to have them ‘stretching out into the future.'
Even if we all did the right things now we were already on the climate change curve, said Faculty of Public Health President Alan Maryon Davis, so it was essential to work hard on adaptation and managing the problem now. An essential thing was to introduce tougher penalties for local authorities on recycling, he said.
Management of healthcare
On the question of whether management of healthcare organisation should be controlled by local government, Alan Maryon Davis said it was clear that ‘locally elected people should be able to commission healthcare services at local level'.
‘When spending such huge amounts of public money, someone has to be accountable but having politicians completely in charge could lead to the kind of short termism that we want to avoid in public health,' said Sandra Gidley. We should be looking at models like the police authority, she said, and bring together all kinds of people, including patients. ‘We can't have unelected, unaccountable mandarins in charge.'
The Conservatives were in favour of having an arms' length board in charge, said Andrew Morrison, and devolving power in the health service away from politicians. ‘It's superficially attractive to put (health) into local government,' said Niall Dickson, ‘but one of the most sensible health policies the Tories have produced so far is ‘no more reorganisation.'' But this didn't mean things couldn't be tweaked he said, and one of the key things that could be done was beefing up scrutiny committees.
Considering long-term health outcomes
Finally, the panellists were asked what it would take to bring about health policy decisions based in health outcomes rather than the outcome of the next general election. ‘Probably some kind of crisis,' said Alan Maryon Davis.
‘Public health outcomes are very long-term' said Sandra Gidley. ‘We seem to have lost good old fashioned political leadership. Politicians should have more courage to say ‘we're doing this because it's the right thing to do. You won't see the benefits just yet but we're investing in your childrens' future.''
Andrew Morrison said he agreed with Wanless that public health must be a priority, because the temptation was to direct money to short term, target-rich things in the acute sector. ‘Short termism is a national disease,' agreed Niall Dickson, but he hoped we could a better, more nuanced political debate around health, he said. ‘And there are signs that this is beginning to happen,' he said.