Whether you agreed with Andrew Lansley or not, it was pretty clear where he stood on public health, as on much else. He had a real commitment to change and to localism, and despite concerns over transition and potential fragmentation, public health reform was one of the few areas where there was almost universal agreement that the direction of travel – giving much greater say and responsibility for public health to local authorities – was right.
He also set up the Public Health Sub-Committee, a cross-government committee to champion the public health cause across Whitehall, which the Conservatives in opposition argued would ’send a powerful message that public health is the responsibility of all government departments’. The potential was then for a powerful dual-track approach – more power for local authorities, but holding the rest of government to account for their actions too.
So, it’s worth reflecting on what’s happened in recent weeks. There has been a historic decision from Tesco that they will join with all the major supermarkets in working with the government on food traffic-light labelling. This can be seen as a victory for one of Lansley’s legacies, the Responsibility Deal, although it’s hard to judge whether the Deal is really the cause, or whether that rests with consumer demand or years of effective lobbying of government and the industry by non-governmental organisations.
On the downside, the government has announced that the Public Health Sub-Committee is being done away with. Its initial function was primarily to navigate the public health reforms through the machinery of government. Now the function has gone, there is no point in keeping it merely as a symbolic fop to the public health community. But, in our view the sub-committee had the potential to challenge the rest of Whitehall on the public health impacts of their policies. We argued, in our submission to the Health Select Committee in June last year, that the Public Health Sub-Committee should have a more powerful role, and the Health Select Committee agreed with us, arguing that 'its remit should be defined to include consideration and publication of evidence-based health impact assessments prepared by each department of state on policies within its sphere of responsibility'. Now, that it has gone, there is no well-placed high-level mechanism to ensure that these considerations are championed, or even undertaken, and there is nowhere else in government where national level policies on public health are evaluated. On this one, Lansley’s legacy has lasted barely two months.
These two decisions do not allow a fair assessment of the government’s record on public health. Public health policy since 2010 has seen significant reforms the centrepieces of which have been the shift of responsibility to local government; new strategies on tobacco, alcohol and obesity; and the Responsibility Deal. All are characterised by a commitment to localism and a preference for nudge and partnership with industry rather than regulation and statute. However, the government has recently shown it can be pragmatic and use legislation, with its commitment to legislate on minimum unit pricing of alcohol and possible moves towards plain packaging for cigarettes.
Our mid-term assessment of the coalition’s overall performance on health policy due out towards the end of this month, will reflect in more detail our view on whether the governments approach to public health so far is likely to achieve its stated objectives of improving health and reducing health inequalities.