Better Health For All

I first read George Orwell’s 1984 when I was fifteen and it terrified me. Never had I experienced such an acute realisation of the importance of human freedoms and civil rights. This never left me during my first career working for ‘the state’ as a psychiatric nurse within the National Health Service, and it has become ever more salient during my current career working for ‘the state’ in public health.

Public health is first and foremost a belief that a better world is available to us through planning, organising, collaboration and action. A world with less disease, fewer premature deaths, and greater equity in the achievement of human flourishing and wellbeing.

It goes without saying that all potential actions can provoke debate and the voicing of concerns. Such concerns can be sincere or cynical, and it is helpful to be able to differentiate them in order to inform one’s best response.

This is where FPH’s Special Interest Group (SIG) on public health ethics comes into its own. Having secured the invaluable involvement of professional philosophers, ethicists and legal scholars, the SIG works to strengthen our understanding of relevant issues in political philosophy, ethics and law, and how to deploy these in our everyday practice. Leading the case for change requires engagement with such issues, as much as it requires engagement with the empirical epidemiological and healthcare evidence base.

Of particular relevance here is the recent report on the Nanny State Debate authored by Professor John Coggon Hon MFPH, Professor of Law at the University of Bristol. This resource, in which Professor Coggon generously makes the breadth and depth of his scholarship accessible to the public health workforce, provides the key facts one needs to know to be able to classify voiced concerns of ‘nanny statism’ and respond appropriately.

People can have heartfelt concerns about human autonomy and proposed restrictions on freedom of choice. I relate to this in light of my early experience of reading Orwell. Professor Coggon’s report reassures me that it is entirely appropriate to recognise and acknowledges these concerns. Dialogue is worthwhile, making use of empirical evidence to set out the issues and the benefits of action, while other relevant values can be introduced for consideration alongside freedom, such as fairness, equality, and solidarity. In this way, progress can be made.

Alternatively, vested interests whether financial or power-based or both, can cynically seek to prevent action to protect or improve population health. I suspect we will each have had our own experience of this in one form or another. Professor Coggon clarifies how claims of ‘nanny statism’ can be deployed to shut down debate and block action. Direct attempts to engage and persuade, through evidence and appeals to justice, are unlikely to be effective. As public health professionals we need to know how to craft public responses to constructively maintain debate and momentum for action.

In summary, I found The Nanny State Debate to be concise but hugely thought-provoking, and a valuable addition to my public health ‘toolkit’.

At a time of ecological crisis, growing inequalities, and stalling life expectancy we need evidence-based and values-based planning, organising, collaboration and action more than ever before. As a practitioner on the public health front line may I commend Professor Coggon’s report to you, and urge you to read it and put it in to action.

Written by Christopher Littlejohn FFPH, Deputy Director of Public Health, NHS Grampian.