Hooray for The Nanny State

Bullying into health is back.

The Government, despite a barrage of criticism from the well-fed, wishes for us to smoke and drink less, to adopt better diets and to live in more secure, healthier homes. A jolly good thing too, says Will Hatchett! But are there enough EHOs left to help make a difference?

With optimism thin on the ground, it’s no wonder people are excited about Oasis reforming. Anyone who is now in their late 30s, or older, will remember the last time that an old, tired government in the UK was replaced overnight in a seismic demographic, cultural and political shift.

Tony Blair’s smile when he arrived in Number 10 matched the bright colours and catchy, patriotic jingles of Britpop. For a while, he basked in the radiance of Cool Britannia. It was a great time to be an EHO because the Blair government refreshed policy areas that had withered from neglect in the market-ruled politics of the previous two decades.

New Labour promised upstream, generously funded health intervention. It appointed the UK’s first public health minister, Tessa Jowell. It created a Health Development Agency and a health-focused Food Standards Agency, and focused firmly on the deadly triad of smoking, poor diet and alcohol in a programme of ‘lifestyle politics’.

Labour’s radical approach to health was vigorously opposed by right-wing commentators. Their views reflected those of a famous editorial in the Times, opposing the 1848 Public Health Act. It stated: ‘We prefer to take our chance with cholera than be bullied into health’. They revived a term that had been used by Margaret Thatcher, to lampoon measures designed to level up the life chances of the least well off, i.e. the non-rich, ‘the nanny state’.

Well, the nanny state is back, or so The Daily Telegraph and Daily Mail would have one believe. It’s the latest example of the UK’s traditional oscillation, in government, between interventionism and libertarianism – Labour and Conservative.

We are unhealthier

The statistics on health have worsened since 1997, when New Labour took office. Life expectancy is no longer increasing; there is an epidemic of child and adult obesity linked to food consumption and lack of exercise. Poorly insulated housing in the UK kills old people in the winter because they are too cold. A child in a housing association property in Rochdale died in 2020 because his house was infested with mould.

The causes of these ‘crises’ are avoidable. As a society, we could eat better food, exercise more, smoke and drink less and ensure safer and more affordable housing – of course we could. These lifestyle changes would save money for the state on health interventions in our lives.

Keir Starmer, with his subsidised spectacles and Taylor Swift tickets, is no Tony Blair. The Oasis brothers won’t be dropping into Downing Street any time soon. But his government has re-occupied the interventionist territory of Tony Blair and Gordon Brown. On housing, Labour’s Renters’ Rights Bill promises to ban no-fault evictions and improve private rented housing. Health-wise, tobacco is, again, public health enemy number one.

A proposal to outlaw smoking in pub gardens has the Mail and Telegraph frothing at the mouth. And nanny has confiscated the keys to the tuckshop: a pre-watershed ban on TV advertising for junk food is proposed from next October, alongside banning the sale of high-caffeine energy drinks for under-16s. Disposable vapes are also in Labour’s sights.

Anticipating a second term, more strategically, it has indicated that NHS reform should include structural change aligning more funding to upstream interventions designed to prevent people from becoming sick. Yes, we have been here before. Remember the Acheson report of 1998 on tackling the determinants of health? By its second term, New Labour had lost momentum on shifting the focus of health funding, towards tackling the social and environmental determinants of ill-health. It reverted to what all governments do – pouring more money into the leaky bucket of the NHS while holes are banged in with six-inch nails. 

Post-Grenfell landscape

The landscape has changed since New Labour. Since the crash of 2008, politics has been all about crisis and firefighting. The Food Standards Agency, set up in 2000, made a strong start on promoting healthy eating and reigning in ‘big food’. But it was soon tamed and ‘de-politicised’. Now it’s a managerialist body. The Conservatives removed the NHS’s public health function in the privatisation-friendly Health and Social Care Act 2012 and failed to transfer savings to local government.

One of the casualties of the Covid pandemic was Public Health England, a flagbearer for ‘lifestyle politics’. Set up to replace it, the UK Health Security Agency has a microbiological focus, and the Office for Health Improvement and Disparities is an invisible body that gathers statistics. Civil servants prefer public health to be passive, not active.

We also saw the Grenfell Fire of 2017. It was a wake-up call. It showed us that maniacal, ideologically driven deregulation kills people.

Housing is political. Food is political, Smoking, drinking and vaping are political. EHOs are not political, nor should they be – they are public servants. However, their skill-sets, for example, in coercing food businesses and pub owners into behaviour that is in the public interest and in reigning in bad landlords through an effective blend of education and coercion, have a century-long record of effectiveness.

In the late 1990s and early 2000s, historically well-resourced environmental health services were active in tackling food deserts and improving sexual health. It’s hard to remember now but, in those days, EHOs visited shopping centres, dressed as giant vegetables or pieces of fruit. They were active champions of the smoke-free laws of 2007 and played a major role in their enforcement. The fact that EHOs were initially ignored and sidelined during the Covid pandemic is a testament to our broken politics, the short memories of politicians and the unerring ability of the civil service to douse down innovation and revert to bean counting.

Other worlds are possible

Dare I say this: the time has come for the UK to revisit the almost forgotten Black, Acheson and Marmot reports and to address the causes of ill health – poor national diet, insecure over-expensive housing and generally unhealthy lifestyles, embraced understandably and most enthusiastically by the poor. EHOs can and should be part of this. They have been before, and although their teams have been reduced to skeleton status by cuts to frontline services, they could be again. The motto of the CIEH, Amicus Humani Generis, translates as ‘Friend of the Human Race’. 

Punch and Judy politics are highly entertaining. That’s one reason we still have them. But they are ineffectual. A downstream treatment-after-the-damage-is-done model dominates health and social care as it inevitably will under a political system that is based on five-year electoral cycles and ministerial musical chairs. Such a system will always be defended by the well-paid flag-wavers of libertarianism – lower taxes and ‘small government’. How dare a ruling party think that it might be in office for more than five years – long enough to make a difference – and that things could be done differently! More nails! More buckets!

In truth, the noisy opinion influencers of GB News and newspapers owned by billionaire press barons, are largely talking to each other in print and online, while claiming that they are denied a voice by mere ‘experts’ and the ‘legacy media’. EHOs are, or should be, the primary health champions within local government. I’m not calling for them to become more involved in political debate – those in managerial roles, quite rightly, are not allowed to. I’d just like them to be given a rightful role in fixing broken Britain. It can happen. As the situationists used to say, ‘other worlds are possible’.

William Hatchett, Journalist.
All views expressed are his own.