Public health Reid offers blueprint for fitness
From smoking bans to personal trainers, government unveils how it wants people to help themselves to live longer
James Meikle, Sarah Boseley and Felicity Lawrence
Wednesday November 17, 2004
The Guardian
John Reid, the health secretary, yesterday championed personal choice over state dictation as he launched the government's wide-ranging blueprint for disease prevention ranging from smoking bans to personal health trainers, curbs on advertising junk food to children, and speedier access to sexual health clinics. The white paper on public health in England, Choosing Health, went further than some expected in restricting tobacco in public places - smoking at the bar will be illegal even in pubs where cigarettes are not banned - but the emphasis was on allowing individuals to make their own health choices, with NHS support where wanted. Food and advertising industries were also given the chance to respond to concerns about their part in tackling the obesity epidemic, while an industry-funded lobby group was left in control of health messages related to sensible drinking. The medical profession was disappointed but Mr Reid said: "In a free society, men and women ultimately have the right within the law to choose their own lifestyle, even when it may damage their own health. But people do not have the right to damage the health of others, or to impose an intolerable degree of inconvenience or nuisance to others. We therefore intend to shift the balance significantly in favour of smoke-free environments." Justifying his decision not to implement a total smoking ban in public places, he said: "I am not a medical officer. I'm a politician charged with maintaining a free democratic society ... A lot of effort is about making sure that people who cannot afford personal trainers and lifestyle gurus - all those whose needs have been ignored for 60 years - are going to get their needs met." He said about £1bn would be devoted to putting proposals into action and that could save £30bn in preventable ill health over the next few years. The mantra behind the white paper shifts public health approaches from "advice from on high to support from next door", and central to this is the appointment of NHS-accredited "health trainers" to whom people can turn for advice. These will at first be available only in the 20% of local primary care trusts with the worst healthy and deprivation profiles, but will later spread throughout England. These trainers are likely to be a mix of health professionals, volunteers and community workers, and they will first be properly trained. These "health stock-takers" will draw up guides against which people can then measure their own progress. The government also plans a new NHS service, Health Direct, available via telephone, internet and digital television, to offer information on health choices. There is also a bigger onus on employers to help reduce sickness absence that costs at least £11bn a year. People were often apprehensive about returning to work, said the government, and companies should do more to put their minds at rest. Tim Lord, chief executive of the Tobacco Manufacturers' Association, said: "This goes beyond what the public has said it wants. We are disappointed at this missed opportunity to strike the right balance between sensible regulation and voluntary measures that accommodate non-smokers and smokers alike." Anti-smoking campaigners Action on Smoking and Health (Ash) said Dr Reid had made a "ridiculous bodge" in his smoke-free proposals. "There is no excuse at all for the government to accept that secondhand smoke is a serious health and safety issue, and then to try to exempt some of the employees most at risk," Ash director Deborah Arnott said. Professor Alex Markham, chief executive of Cancer Research UK, described the move as a "huge missed opportunity". "It seems bizarre that the government has accepted the wisdom of a ban but is then happy to deny the benefits of it to people who work in private clubs and pubs where food is not served," he said.
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UK Health Secretary John Reid has proposed widespread legislative and health care changes in a new white paper on public health released Tuesday. Titled "Choosing Health", the paper details government plans to restrict smoking in public places, limit 'junk food' advertisements to children, make available "lifestyle trainers", campaign against sexually transmitted diseases and tobacco, and improve food labelling.

The white paper comes after extensive public comment that involved 150,000 people.

Smoking would be restricted in enclosed public spaces, restaurants, workplaces, and some pubs. The ban would be enacted gradually, affecting government and NHS buildings in 2006, enclosed public places in 2007, and private property in 2008. Permanent exemption would be granted to pubs that do not serve prepared food -- though not at the bar -- as well as private clubs, a decision that has provoked some to call the measure incomplete. Up to 90% of pubs are expected to be affected. The Scottish executive proposed a complete ban on smoking in enclosed public places last week, and Ireland has already banned smoking in pubs and restaurants.

Food advertisements targeted to children would be banned until 9pm, under the White Paper's proposals. The restriction is a measure to tackle rising rates of childhood obesity. The government also intends to develop voluntary standards on food and drink advertisements to children with industry, only threatening legislation if an acceptable standard is not reached by 2007. Additionally, low income families would receive vouchers for fresh fruit, vegetables, milk, and infant formula. School lunches would also be held to stricter nutritional standards. Reid has warned that unless childhood obesity is tackled, "we face the prospect of children having shorter life expectancy than their parents".

Food labelling would also be improved, with a "traffic light" system implemented. Packaged food would be evaluated based on its fat, sugar, and salt content.

The paper is unusual for suggesting a more holistic approach to health care, offering for the first time "lifestyle trainers." The National Health Service would be funding with an additional £1bn to make people's overall lives healthier, which is expected to save £30bn in preventable illness.

The paper additionally makes mention of reducing accidents, which affected 2.7m people last year and is a leading cause of child death, curb binge drinking, and reduce substance abuse among youths.

The paper has been criticized by many parties. The Tory Shadow Health Secretary has criticized the Labour government's comprehensiveness and creation of a "new nanny state approach". He has additionally described it as "gimmicks". The Liberal Democrats have accused the government of not being comprehensive enough. It has also been criticized by the British Medical Association as being implemented too slowly, saying "When lives need saving, doctors act immediately".

Mr. Reid has argued against the nanny state label, saying "In a free society, men and women ultimately have the right within the law to choose their own lifestyle, even when it may damage their own health. But people do not have the right to damage the health of others, or to impose an intolerable degree of inconvenience or nuisance on others ... This is a sensible solution which balances the protection of the majority with the personal freedom of the minority in England".

The full white paper "Choosing Health" can be read  here.