by Professor John Ashton, President of the Faculty of Public Health
What is the best way to advocate and improve public health policy? Quietly and diplomatically, or through loud and public protest? Or is there room for both approaches?
These are some of the questions that are part of the discussion that led to the Faculty of Public Health’s (FPH) recent decision to withdraw from the government’s Responsibility Deals, a group drawn from industry, local authorities and the public health community.
The aim of the responsibility deal was to provide a quicker means of improving public health policy than bringing new legislation before parliament. The logic was that a ‘carrot not stick’ approach would lead to faster progress than forcing companies to meet new legal requirements. Participating organisations signed up to pledges on public health issues such as physical activity, taking a billion units of alcohol out of circulation or reducing calories in food.
FPH had representatives on the alcohol, food, physical activity and health at work networks until July 2013. We owe a debt of thanks to those FPH representatives who gave up their time to challenge decision-making and question the logic of the direction public health policy was taking. We can be sure that their input has helped mitigate some of the worst excesses of a commercial need to put the value of shares ahead of public health.
FPH’s decision to join the responsibility deal was controversial and much debated throughout the past two years. There are many people within the public health community who disagreed with our participation. Others felt it was better to be at the table, than to leave the debate unchallenged by public health expertise.
Given how public health policy has developed in recent years, the available options for effective advocacy have sometimes seemed like the moment in the film Argo when CIA officer Jack O’ Donnell has to admit that the ludicrous-sounding plan to rescue American hostages in Tehran, by pretending they are the crew of a sci-fi fantasy movie, is the ‘best bad idea’ he has.
Unlike the fictional and public world of a Hollywood film, much of public health advocacy goes on in a less public fashion. It has become clear that government public health policy has fallen victim to a concerted and shameful campaign of lobbying by sections of the tobacco and drinks industry who are putting profits before health and public safety.
The balance of gains and losses of participating in the responsibility deals shifted recently when the Government made it clear that a minimum unit price for alcohol and standardised packs for cigarettes would not be introduced.
In light of this, we withdrew from all of the Responsibility Deal groups. Using legislation to bring in measures like minimum unit pricing would have been quicker than a ‘softly softly’ approach. There is also no way of knowing if the responsibility deals have been truly effective because it is unlikely the key pledges will be evaluated.
For example, there is no case for saying that the Billion Unit Pledge for alcohol is a success because any gains from people drinking lower alcohol beer have been cancelled out by the increase in people drinking wine and spirits. On these two measures alone, the Responsibility Deals have not achieved their original purpose.
FPH has worked with governments of all political persuasions since it was first founded over 40 years ago. We want to continue to work with Government to improve people’s health. We know that the best way to improve everyone’s health is by working in partnership and we remain committed to doing so. However, we, like other NGOs with limited resources for the important work we do, need to make sure we use our influence and expertise in the most effective way possible. We look forward to continuing our advocacy work and will keep you updated on how it progresses.