State must play central role in public health

The food and drinks industries have a duty to help consumers make healthier choices, but the Government has an overriding obligation…

The food and drinks industries have a duty to help consumers make healthier choices, but the Government has an overriding obligation to protect its citizens' health, writes Dr Jane Wilde.

Our health depends on effective and equitable stewardship by the State. The choices that we make about our health are made more easy or more difficult by the actions and attitudes of Government. Our health service, education system, built environment and business all have a crucial role in determining our choices.

In discussing the role of the State, it is worth recalling the classic definition of democracy as "government of the people by the people for the people".

Critical decisions about the allocation of State resources are taken by people through their public representatives and in turn through the organisations that make decisions about the deployment of health and social care services in local economies.

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Health was recently identified in the Eurobarometer survey as the most important issue for European citizens. The public health community agrees. It also believes that the State has an obligation to protect its citizens' health. To quote Prof Joe Barry's letter in The Irish Times on Tuesday last, "the public deserve no less".

This expectation stems, not from an ideological or political perspective, but from facts. It cannot be expected that solutions for complex challenges such as obesity or alcohol abuse can be tackled on an individual basis or found in a pill. Evidence at home and abroad shows the positive health and economic benefits that stem from effective State intervention. Investment in public health pays dividends.

The 2005 report from the Commission on Macroeconomics and Health shows the quantitative impact of life expectancy on economic growth. It estimated that a 10 per cent rise in life expectancy at birth increases economic growth by 0.3-0.4 percentage points of GDP per annum.

Public health cannot be sacrificed at the altar of shareholder dividends. Government needs to show courage and leadership to challenge the worst excesses of the market and the emphasis on profit, which is often gained at the expense of people's health.

How is this best achieved? A recent report by the Nuffield Council on Bioethics sets out a stewardship model that balances the goals of reducing risks and protecting health with the need to minimise invasive intervention. The State needs to adopt an ethical approach, ranging from the provision of information and enabling choice through guiding choice by means of incentives and disincentives to a more restrictive approach when other approaches fail.

As highlighted by Prof Ivan Perry in The Irish Times recently (Opinion, November 26th, 2007), the food industry has an ethical duty to help people make healthier choices through the composition and marketing of its products. We need a stronger cross-Government response to the obesity epidemic and the appalling damage done to public health by alcohol abuse. The drinks industry needs to demonstrate its understanding of the harm that the marketing of low-cost alcohol does and the real cost to the State, evident in A&E admissions every weekend.

There is international recognition that a healthy population is a prerequisite for economic development as much as a byproduct of prosperity. Investment in a common future is vital to create a healthy workforce.

Recent research by the Institute of Public Health in Ireland predicts diabetes will increase by 37 per cent in the Republic by 2015. Research by the London-based National Institute for Clinical Excellence shows the cost-effectiveness of public health intervention in this area, including measures like the reduction of obesity and physical inactivity in high-risk groups and the tight control of blood glucose and blood pressure for those with diabetes.

High levels of poverty and inequality underpin poor health records in the Republic and the North. Inequality in health is not inevitable. The causes are the unfair and systematic distribution of the social determinants of health. The magnitude of the difference in health between the rich and the poor varies between countries.

There is a widespread assumption that efforts to improve health will automatically improve inequality. This is not so.

Effective policies must meet two criteria; improvements in health available to all and a rate of improvement that increases all the way down the social ladder.

Governments in the North and South must demonstrate leadership in public health and honour the commitments made in their strategies. Politicians must make good their commitments by recognising that any individual's health is not just a medical matter. Effective, equitable and accessible public services are a key aspect of good government. But good government is also about the wider actions needed to protect health, eradicate poverty and reduce inequality. Good health stewardship should be at the heart of government.

Dr Jane Wilde is director of the Institute of Public Health in Ireland