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Posts Tagged ‘manifesto’

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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As expected, all three major political parties have this week made strong references to public, or, as they most commonly term it, preventive health in their election manifestos.

Ahead of the General Election on 6 May, the Conservative party have, at least superficially, made the most explicit commitment, with their pledge to re-title the signs outside Richmond House “The Department for Public Health”. As we already learnt in their draft manifesto back in January, they intend to rechannel public health funding to the most deprived areas, offering a financial “premium” to target health inequalities. Confusion reigns as to how this might be implemented, and the manifesto in general is long on the whats, but short on the hows, but the proposals are certainly attractively packaged, at least for the floating voter.

The present incumbents have of course to defend their record, as well as identify areas where they could do better. Labour face the accusation, made in the Tory manifesto, that inequality has increased on their watch. An interesting spin on this was printed by the Institute of Fiscal Studies, but Labour’s manifesto is relatively weak on how they would further level the playing field. The author of the Labour manifesto, Ed Miliband had previously trailed the idea of universal free school meals, something that FPH had also touted in our manifesto. This pledge is somewhat toned down in the manifesto proper, instead promising to “trial free school meals for all primary school children in pilot areas across the country … [to] thoroughly test the case for universal free school meals, with the results available by autumn 2011”.

Most commentators agree that the NHS has improved under Labour, (at least enough for the Conservative party to want to claim themselves to be the rightful heirs of Bevan’s legacy) but their commitment to the preventive agenda is vague at best. Citing their current (and, in some quarters, heavily criticised) Change4Life social marketing campaign, and the smoking ban as evidence for the defence is fine, but where are the plans to make a healthy “future fair for all”?

The Liberal Democrats, with their eminently sensible and intelligent spokesperson Norman Lamb, possibly have the most tangible pledges for the nation’s health. The cynic might of course argue that they can afford to make such idealistic and resource-intensive promises, unlikely as they are to assume the reigns of power. Nonetheless, persuading a party to nail its colours to the mast of minimum alcohol pricing is no mean feat, particularly when their colleagues north of the border are more reticent to declare themselves. The Lib Dems also follow the Conservative’s lead in linking financial incentives to addressing inequalities, “linking payments to health boards (as they would rename Primary Care Trusts) and General Practitioners more directly to prevention measures”. Lamb has talked previously about what essentially amounts to a beefed-up Quality and Outcomes Framework (QOF), paying GPs for achievements rather than measurements.

A curate’s egg for public health then from all the parties; whichever the colour of the incoming government, they still have work to do to clarify how they will improve the nation’s health, particularly in financially straitened times.

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Sir Liam Donaldson, the Chief Medical Officer has published his Annual Report 2009 this week. In the report the CMO highlights the key areas of public health requiring action and looks at progress made since previous annual reports.  One issue that he reflects on is the damage caused by “passive” drinking and the recommendation he made for a minimum price for alcohol in his last Annual Report.

FPH President Professor Alan Maryon-Davis  commented:

We’re strongly behind Sir Liam on this issue. The government should never have bottled out with minimum pricing. It makes total sense to ban ultra-cheap booze. We call on this government and future ones to reconsider all the evidence that is available.

In fact, the CMO’s Report refers to FPH’s public health manifesto calling for minimum pricing earlier this year:

The Alcohol Health Alliance UK brings together the Royal College of Physicians, the Royal College of Surgeons, the Academy of Medical Royal Colleges, the Faculty of Public Health and 20 other such organisations. To see such a group of medical bodies speaking together with one voice is very powerful. They speak in particular of the passive harms of drinking. They, too, call for a minimum price per unit.

Other professionals have echoed this call. The Faculty of Public Health represents 3,000 public health specialists from the United Kingdom and elsewhere. The Royal Society for Public Health has 6,000 members from health-related professions. In January 2010, these two institutions joined forces to publish a public health manifesto. It listed 12 actions that government could, and should, take to tackle a range of public health concerns. The first action on the list was a minimum price per unit of alcohol. (p.16)

The major challenges the Annual Report discusses this year include climate change and health, the benefits of physical activity on health and risk of cold weather on health.

FPH has produced a booklet about climate change and health called Sustaining A Healthy Future – A Special Focus on the NHS .

There is plenty of evidence about alcohol minimum pricing being the best public health intervention to problem drinking, for instance an independent review by the School of Health and Related Research at Sheffield University.

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The Faculty of Public Health today publishes our joint manifesto on public health, alongside the Royal Society of Public Health. 12 Steps to Better Public Health offers a dozen practical recommendations that, if adopted by the next government, will improve the UK’s health and well-being for the new decade.

The joint public health manifesto calls for:

  1. A minimum price of 50p per unit of alcohol sold
  2. No junk food advertising in pre-watershed television
  3. Ban smoking in cars with children
  4. Chlamydia screening for university and college freshers
  5. 20 mph limit in built up areas
  6. A dedicated school nurse for every secondary school
  7. 25% increase in cycle lanes and cycle racks by 2015
  8. Compulsory and standardised front-of-pack labelling for all pre-packaged food
  9. Olympic legacy to include commitment to expand and upgrade school sports facilities and playing fields across the UK
  10. Introduce presumed consent for organ donation
  11. Free school meals for all children under 16
  12. Stop the use of transfats

The full manifesto is available to read here, and the front-page Guardian story, with an accompanying podcast from our President Alan Maryon-Davis, is available to read here.

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