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by David Pencheon, FPH member

This blog is part of a series of posts to promote discussion and debate around the priorities in Start Well, Live Better: FPH’s manifesto for the 2015 General Election.

"Never in human history has the health and welfare of so many people (already living and yet to be born) depended on so few people who know so much and are doing so little."

Our behaviour is more influenced by our surroundings than we think.  Our behaviours are a function of what surrounds us – physically, socially and culturally,  We are shaped by norms more than we shape them.  Consequently, when an influential group of people have the chance to re-set norms in visible and newsworthy ways, where results benefit almost everyone both immediately and long term, why wouldn’t we seize the opportunity?

Well, health professionals and health organisations now have such a chance.  The case for divesting from fossil fuel is now very strong.  The British Medical Association (BMA) is committed to this journey and since its 2014 Annual Representatives Meeting (ARM) is actively investigating how best to send out a powerful message on health and social justice.

This very welcome move will hopefully start a trickle and then a tidal wave of divestment from the fossil fuel industry which, like the tobacco world, has spent outrageous sums of money on sowing doubt about the harmful effects of a high carbon world and the beneficial health and equity effects of a low carbon society. Read Oreskes book: Merchants of Doubt.

In retrospect, the data now strongly suggest that the fall in smoking levels amongst many groups did not really happen until health professionals (particularly doctors) stopped smoking.  We all have bizarre habits where our creative energy is used more to justify them than to address them.  If we struggle to justify our smoking habit to our peers or to ourselves, where better to reassure one’s self than by pointing to a health professional smoking.

Change does happen though, often quickly, although rarely planned (witness the banning of smoking on the London Underground).  Such changes are often not driven primarily by the law (smoking on planes and overground trains).  If health professionals and organisations simply all say: no, we do not invest any assets we have supporting an industry which knowingly perpetuates an addiction (to fossil fuel) and does not actively attempt to address this threat in the radical ways needed.

Fossil fuel companies need to understand that their so called wealth is largely based on resources still in the ground – which the incontrovertible evidence (supported by the UN, the World Bank; The Pentagon, the UK Ministry of Defence, and the CIA) says needs to be left there.  City investors are already having doubts about the real worth of some fossil fuel companies if their so-called assets are theoretical.

We should therefore welcome the move of the BMA to be the first large health organisation to tread this path.  A full description of the background to why we should actively divest from the fossil fuel industry is in MedAct’s latest report. What we will do in future might appear odd and different now, but in retrospect nearly always appears normal surprisingly quickly
We have a duty and responsibility to help shape the future as much as we are shaped by it.

The great mystery to historians at the end of the 21st century (if there is anyone left to write our history) any of us left) is why, at the beginning of the century, we did so much talking and research on what is happening and took so little action.  Never in human history has the health and welfare of so many people (already living and yet to be born) depended on so few people who know so much and are doing so little.  Do something good today and write a letter to the President, CEO, Chair and Treasurer of the BMA and congratulate them for at least actively and publicly committing themselves to this journey.

And ask your own organisation how much is invested in the fossil fuel industry. These are not easy questions. What constitutes a fossil fuel company? Are any savings I have ethically invested? But they are not impossible. We must not let perfection be the enemy of pragmatism and we must start today not tomorrow.  This is all happening on our watch and will be our legacy.

When our great grandchildren say to us: what did you do at the beginning of the century, let us all try and do more than just mumble we that we knowingly and passively conspired with circumstance. Health professionals, rightly or wrongly, are still well respected, are numerous and interact with all members of society every day and in every community in the land.

Numbers matter: one person is a crackpot, two is a pressure group, and three is a social and political movement. If health professionals don’t draw a line in the sand, then who will? And if we don’t do it now, then when will we do it?

Further reading:
1.    Oreskes and Conway: Merchants of Doubt: How a Handful of Scientists Obscured the Truth on Issues from Tobacco Smoke to Global Warming.  2013.
2.    MEDACT’s call for Fossil Fuel Divestment by the Health Sector. “Unhealthy Investments”
3.    BMJ 2014;348:g2407  Why doctors and their organisations must help tackle climate change: an essay by Eric Chivian
4.    The Faculty of Public Health “Sustaining a Healthy Future – taking action on climate change” 2009
5.    The Global Climate and Health Alliance Civil Society Call To Action at the World Health Organisation Conference on Health and Climate August 2014

A version of this blog was first published on the BMJ website.

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By Alan Maryon-Davis

Health Secretary Andrew Lansley wants to encourage people to eat healthily, drink sensibly, stop smoking and get more active without lecturing or hectoring them. People don’t like being told what to do or not do – least of all by the Government – so Lansley says we should provide them with information and incentives and let them choose for themselves – nudging rather than nannying. Hence the Great Change4Life Swapathon with its supermarket discount vouchers for healthy options. Lots of carrots, no sticks.

There’s also much nudging behind Lansley’s Responsibility Deal with the food, drink and fitness industries. Double nudging – Lansley nudging them to nudge the public. Industry will “pledge” to provide information and incentives encouraging healthier choices.

So where’s the fudge? In return for industry cooperation (and cash) Lansley has said he’ll go easy on mandatory regulations around such things as marketing, labelling, availability and pricing. To be fair, he doesn’t rule these threats out completely. He talks about the Nuffield Ladder of Interventions, with the least intrusive (information, education and incentives) at the bottom and the most intrusive (regulation and legislation) at the top. But he’s made it clear he doesn’t want to climb that ladder unless he absolutely has to. It wouldn’t fit his political philosophy.

So there’s a big fudge around how he’ll monitor adherence to voluntary approaches, assess progress and judge when to bring in mandatory controls. The food and drink industries are notoriously slippery, evasive and foot-dragging – just look at labelling and marketing. Meanwhile the health lobby is going along with the Responsibility Deal in the hope that things might be different this time – well aware they risk being be-smudged as part of the fudge.

I’d like to see a solid pledge by the Government to regulate or legislate if voluntary approaches fail and to be crystal clear about how and when such judgements will be made. Without an explicit commitment to use force if necessary, the deal will be seen as no more than a charade letting Big Business off the hook.

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Secretary of State Andrew Lansley’s speech plus short Q&A, Wednesday 7 July at the Faculty of Public Health annual conference

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One in 20 deaths in Scotland is linked to alcohol, said Dr Lesley Graham at the Scottish FPH conference.

Scotland has the fastest growing rate of liver disease in the world, said Graham, public health lead for alcohol and on the policy team for alcohol in the Scottish government.

The estimated cost to Scottish society was £2.25m per year, she added.

Price and consumption were linked, she argued. “Tackling price is so important,” she said.

Education is not powerful enough on its own, she said, putting the argument for minimum alcohol pricing.

Graham’s speech at the annual FPH Scottish conference, being held in Peebles, caused a call for a vote from the floor in support of minimum pricing.

The ad hoc vote was massively in favour of the proposal.

 

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