"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Monday, 18 January 2010

Conservative Public Health Green Paper: Part 1

Last week, I wrote about the Conservative plans on the NHS, including their plans for public health. The "draft manifesto" is a little sparse on details and the 2009 health policy document from the Conservatives offered little help in explaining some of the new policies. The Conservatives have now provided more information in what they call their Policy Green Paper No 12. In these next three blog posts I will examine in more detail what the Conservatives plan for us.

The Department of Behaviour Change

The big announcement in the policy document is:

"The Department of Health … will be renamed the Department of Public Health and its role will be focused much more strongly on the prevention of disease, rather than just its cure."

The Conservatives think that changing the name of a department will have an effect on public health. To be fair to them, changing the name of government departments is nothing new, New Labour has been doing this during their term in office, although usually the name changes have been due to the amalgamation of departments (for example, the Department for Children, Schools and Families) or the devolving of responsibilities to new departments (for example the new Department of Justice).

Changing the name of an existing department is an interesting concept, however. I suggest that the new name is not correct, for the reasons I will give in a moment. The sentences above indicate clearly that the Conservatives intend an expansion of the nanny state. Of course, nannies are usually employed on a private basis, and this is the case with the new nanny state planned by Cameron:

"Whenever possible, we will ensure that national public health initiatives funded by public money are paid for on the basis of the results they achieve. … By paying organisations running national campaigns by the results they achieve, we can encourage such innovation and improve the value we get from the money spent on public health."

This is clearly indicating that a Conservative Government will franchise public health responsibilities to new private corporations: these are private super-nannies who will tell you what you should eat and drink: "public health initiatives funded by public money".

However, as usual, it is the citizens who are at fault because any corporation that affects our health, but also makes a profit, will be gently allowed to decide if they want to participate:

"We will work together to extend to all media voluntary restrictions on marketing to children to all media, including online advertising, and also support industry-led initiatives to promote better health, such as reducing food portion sizes and reformulation." [sic]

(So they will "extend to all media … restrictions … to all media"? Editing of policy documents ain't what it used to be!) While it is clear that advertising has a significant effect on purchases (otherwise, why do corporations have such large advertising budgets?) this says that the industry will "voluntarily" apply restrictions, ie they will be allowed to be let off the hook. So what will be done to persuade people to change their lifestyles to be more healthy?

"people are powerfully influenced by the behaviour of others, in that they want (often unconsciously) to do what others do, particularly "influential" others."

This suggests celebrity endorsements: our televisions and newspapers, our favourite websites and even our mobile phones will be inundated with the images and messages being endorsed by the latest winner of the X-Factor. That's something to look forward to!

Clearly this "new" department will not be able to get industry on its side, so what will it do to promote public health to the rest of us? In the policy document there is a section marked:

"A new Department of Public Health focussed on evaluation and behaviour change"

"behaviour change"? What does that imply to you? Well, if that is the focus of this new department then clearly its name should be the "Department of Behaviour Change". Do you want your behaviour changed? Well apparently you'll get no choice, as we will see in a moment. First, however, what is the science behind this?

"We will want the providers engaged by the Department to undertake such activity to be paid by results; and we will insist that the methods used are linked to the recent advances in behavioural economics."

Here is yet another hint of wholesale privatisation that flows throughout the Conservative health policies: "providers … paid by results".

Now look at the Orwellian phrase "recent advances in behavioural economics". The new Department of Public Health clearly wants to tell us what to think and how to behave. How do you make people think differently, well apparently through "default options":

"Case studies from around the world have shown how it is possible to use default options to help people make better choices without restricting their options at all."

This convoluted sentence indicates that in future a Conservative government will choose what you will eat and what exercise you take, and make you think that it was you who chose. Clever! I wonder if they will apply the same science towards what we put in the ballot box? It makes you wonder, doesn't it? A nation who has been conditioned to accept the "default option" is then asked to vote in an election, without restricting your options at all.

What will this new department do? Well we learnt from the draft manifesto that it will hand over all of its NHS responsibilities to the unaccountable super-quango, the NHS Board. So will the Department of Public Health be an empty husk? No, it will grab responsibilities from formerly independent public organisations:

"we will put parts of the Food Standards Agency which are responsible for the nutritional content of food and a slimmed down Health Protection Agency into the Department of Public Health"

Government agencies are deliberately "hands-off" so that political interference is kept to a minimum. The Department of Public Health will be under the political control of the Conservative Secretary of State, which implies that the "nutritional content of food" and more worryingly, the functions of the Health Protection Agency (who are entrusted to protect public health from infections, chemicals and radiation hazards), will be under the direct political control of the Secretary of State. This is from a party who say that they want "less political interference" in health.

The new Department of Public Health is appearing to be more and more like a Big Brother organisation, and to cap it off, here is a delicious statement from the policy document:

"'Self-contracting' allows one fix preferences over time. Research by social psychologists has shown that self-contracting is highly effective in regulating individual and organisational behaviour in a non-bureaucratic and voluntary way."

Wow! What is all of that gobble-de-gook? I have no idea, but it certainly sounds like fun for someone! Get ready, because clearly this is the "behavioural economics" that we will see more of from the Department of Public Health!

The message is clear. Under a Conservative government the Department of Health will be renamed the Department of Public Health but we all know that it will really be the Department of Behaviour Change. This new department will use behavioural economics to tell us what to eat and drink and make us think that we chose to behave in that way. The private nanny state meets Big Brother.


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