21 April 2020

After coronavirus, we have a chance to redefine what ‘public health’ really means


The Covid-19 epidemic is one of the greatest, and certainly one of the most high-profile, public health crises of the past hundred years. Yet the reputations of some of the highest-profile organisations dedicated to this topic must be counted amongst its victims.

At home, Public Health England’s ham-fisted approach to testing has been partly blamed for the Government struggling to reach its intended targets, which will form a key plank of any strategy to get us out of lockdown and restart the economy.

Meanwhile overseas the World Health Organisation has become mired in scandal. Not only is it not obvious what it’s really doing in a crisis where individual nations are largely overseeing their own coronavirus strategies, but it stands accused of failing to warn the world about the danger due to being in hock to the Chinese government.

Despite this, both organisations have found the time to concentrate on what they’re really about: badgering us about what we eat and drink and pushing – in the face of the evidence – the idea that Covid-19 reinforces their longs-standing campaigns against smoking and vaping.

When the dust has settled on the pandemic, the inevitable inquiry will surely include the role of our public health establishment in preparing (or not preparing) the UK for this sort of event. Whilst Donald Trump’s decision to defund the WHO without any replacement is reckless, such a reckoning will very likely offer the Government a rare opportunity to undertake root-and-branch reform of the sector.

It’s therefore vital that this doesn’t just amount to a superficial restructuring or swapping out a few key personnel. If Boris Johnson was serious when he said he wanted to take on the nanny state, he should seize this opportunity to redefine what the state means by ‘public health’.

As I have explained in previous pieces, the current definition rests on some pretty extreme ideological assumptions. Underlying it is the idea that the public owe a duty of health to the state and that government is entitled, if not morally obliged, to intervene to maximise our lifespans and avoid ‘preventable deaths’. 

The full logic if this position is seldom admitted, so as not to frighten the horses, but it creates a bottomless well of justification for restrictions on consumer behaviour. Thus, every public health campaign talks the language of reasonable, limited ambitions until the moment it has fulfilled them, at which point it chooses another target. The funding and prestige of these dragon-slayers rests on there being dragons to slay, so they always find more.

(All of this is often justified on the basis of ‘cost to the NHS’, but once you factor in the huge financial costs involved in providing end-of-life care to an increasingly long-lived population the maths on that justification gets shaky.)

Had coronavirus not hit, this mission-creep could have been written off as the inevitable response of a crusading institution to a world with fewer genuine problems in it. But it now looks extraordinarily negligent. How many resources have been channelled to these public-payroll puritans whilst the nation’s pandemic response architecture was starved of funding?

If the Prime Minister is bold enough, he has a chance to give PHE a much tighter remit, focusing on challenges arising from external factors, such as pandemics and pollution, rather than lifestyle choices. It will be hard to argue against the idea that when public money is tight – as it surely will be after the lockdown – scarce public health cash should be concentrated on ensuring we don’t need to go through this again.

On the international level, meanwhile, he could try to rally support for either reforming the WHO or replacing it entirely with a body that does not kow-tow to Beijing. In so doing he could free the UK from its current commitments to the organisation’s international directives on things like tobacco, set at secretive conclaves and used to restrict British policymakers’ freedom of action, just as EU law has been.

Such moves won’t in themselves be enough to turn the tide against the puritan lobbyists who have been setting the agenda on these issues since the 90s. But it will deprive them of powerful institutional support, and shift the battlefield in freedom’s favour.

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Henry Hill is Assistant Editor of ConservativeHome.

Columns are the author's own opinion and do not necessarily reflect the views of CapX.