Compulsion or consensus?
This week’s publication of the White Paper on public health for England has drawn expected complaints from the usual suspects: “Nanny knows best!” proclaimed the Daily Mail on p1, with the accompanying comment: “It’s not just smoking. New health bill interferes in EVERY area of our lives.”
Yet, arguably the most successful public health initiative ever — making
the wearing of front seat belts in cars compulsory in 1983 — was
only achieved by government interference. This campaign, spearheaded
by the British Medical Association, was bitterly opposed by right wingers
but when the legislation came into force the British — a largely
law-abiding nation — meekly belted up.
In Utopia, nobody smokes or needs to abuse drugs, nobody eats or drinks
to excess, young people do not sleep around and the elderly have no vices.
In 21st century Britain, things are rather different. Smokers know about
the dangers but find it difficult to stop, and children and their parents
are beginning to be aware of the long-term price to be paid by over-eating.
There is still a long way to go with binge drinking, particularly among
young people. It is quite acceptable — in many workplaces it is
positively encouraged — to boast about how much alcohol was drunk
the night before, how little can be remembered of the night and how it
compares with the last drunken session the week before.
Public health is just that: the health of populations. And, at some level,
it inevitably interferes with the rights of the individual.
Smoking is not allowed in pharmacies. Neither is it allowed by many bus,
train and underground operators, cinemas and shopping malls. It is a
short step to making all other public places smoke-free, as well, and
if it sends smokers outside, or back to their homes, the public at large
will benefit. Moreover, there is a school of thought that the Government
has not gone far enough: sending heavy smokers back to their homes will
not protect their children.
Other aspects of the White Paper will be harder to legislate over: few
would suggest that moderate eating and drinking should be controlled.
However, the children and teenagers of today will benefit most from public
health initiatives. After all, they comprise the group of people who
will most likely be in need of the NHS in 30 or 40 years’ time
if they do not heed the messages.
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