Making the difference on public health and inequalities: what do the public think?

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By general consensus, the Olympics and Paralympics have been a triumph – not just from a sporting point of view and for the legacy they will leave – but also because of the games-makers – the thousands of volunteers who freely gave their time to make the experience so positive for visitors and athletes. The implications of this have been interpreted very differently, either as a shot in the arm for the Big Society or proof that this success can only be explained by the co-ordination of big government.

So what has all this got to do with public health? Well behind, these responses are different perceptions of how much the government, individuals and self-organising communities are, and should be, responsible for driving efforts to improve wellbeing and public health. The Olympic experience is a hook for this wider debate, for which the ground is newly fertile for three reasons: first, because there are signs that central government is becoming more pragmatic in its approach to public health (for instance, the commitment to a minimum unit price on alcohol, notwithstanding the  liberal instincts of both coalition partners); second, because local government – and therefore the public – will have more control of the levers of public health; and last but not least, because there is a new set of ministers in Richmond House with track records that suggest there could be room for manoeuvre on the government’s approach.

In this context, Ipsos-MORI's assessment of how Britain and the attitudes of Britons have changed since the previous Olympic games in Britain in 1948 is therefore particularly timely and informative. It turns out that we hold strong views: more of us think 'the government should not get involved with interfering in people's lifestyles' than 'it is the government's responsibility to influence people’s behaviour to encourage healthy lifestyles' but not by much (37 per cent compared to 32 per cent). But we also worry that the government will do too little to help people in the future. And while we hold a strong aversion to postcode lotteries and the perceived unfairness this implies, there is support for greater local control over services.

These findings are reinforced by results from the latest round of the British Social Attitudes Survey published today. John Appleby has already reported on satisfaction rates with the NHS, but it also asked a broader set of questions, about the public's attitude to public health and inequalities. Many more thought that the government was not doing enough to reduce inequalities – 38 per cent, as opposed to the 16 per cent who thought they were doing enough – but alongside this many people saw a rather restricted role for government in public health, with almost half (48 per cent) agreeing that the best thing the government could do was to provide information. There was some support for higher taxes – for example, on smoking and alcohol (22 per cent) – but less for law and regulation (9 per cent) and next to none for paying people to be healthy (2 per cent). But then, neither did the public want the government to step away – only 18 per cent saying that the government shouldn't interfere in people's personal choices that affect their health.

These results are not necessarily contradictory, but they are certainly far more nuanced than the general level of political debate on where the responsibility for public health lies. I’m therefore more convinced than ever that national and local politicians will have to work hard to understand and deliver what their electorates really want and expect from them on public health.



Janet Portman

Comment date
20 September 2012
No one seems to want to address the causes of ill health, namely poverty.
Increasing the price of alcohol will not stop people drinking too much. We need to look at why they need to drink too much and smoke.
We need to have a more equal society so that we prevent the alienation that many people feel.
We have enough money to spend on killing people enough for bombs, enough for the Royal Jubilee and the Olympics on which we have spent billions but not enough for health services.
What kind of society do we want at present we have a society run by the rich for the rich.

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