Public Health: should evidence always dictate policy?

Monday 18 October, 7.00pm until 8.30pm, Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE

Venue: Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE

Tickets: Free, tickets are available from the Institute of Ideas website.


In the Green Paper A Healthier Nation, Prime minister David Cameron declared ‘many of our most severe health problems are caused…by wrong personal choices’. From the national smoking ban in public places, to local authorities designating certain streets and parks booze-free zones, the urge to legislate against ‘wrong personal choices’ has grown ever stronger in recent years. While some saw such Nanny State-ism as peculiar to New Labour, the new coalition has announced that it too will encourage the public ‘to make the right choices about what they eat, drink and do in their leisure time’. Despite the language of right and wrong, we are reassured that this is not moralism. Policy-makers are simply responding to what the latest research shows. But the type of evidence cited, and the conclusions drawn, reflect a broader change in the role of public health. Where once it was about society-wide schemes such as mass vaccinations or sanitation, now its focus is on micro-managing individuals’ lifestyle choices. As primary health care has shifted away from diagnosis and treatment towards managing patients’ behaviour to prevent future illnesses, GPs are often on the front line of delivering endless evidence-based ‘advice’ as to how patients should live.

Critics object that in this context, medical evidence has become politicised. Indeed, Richard Smith, former editor of the British Medical Journal, and one of the experts responsible for government recommendations on how many ‘units’ of alcohol we should drink, has admitted the figures were ‘plucked out of the air’. When research published in April showed the much-vaunted ‘five a day’ (portions of fruit and vegetables) confers only marginal health benefits, campaigners insisted the advice should be promoted anyway, to drum home a wider message about obesity and junk foods. And while politicians have embraced ‘evidence-based policy’, when government advisor David Nutt went off-message on drugs policy, he was punished for overstepping his jurisdiction.

How far can evidence go in deciding what is a ‘right’ or ‘wrong’ choice? The consensus seems to be that healthy means good, regardless of anything else. Healthy, clean-living restraint may appeal to some, but others may feel more sympathy for Clement Freud’s famous quip that in giving up life’s irresponsible pleasures, ‘You don’t actually live longer; it just seems longer’. Do preventative health initiatives risk becoming moralism in disguise, or are they simply a responsible way of stopping people harming themselves? Are politicians offloading responsibility and avoiding debate over contentious policies by variously citing and blaming scientific evidence? With advances in medical technology, might we find cures and treatments for conditions caused by ‘unhealthy living’, saving us the trouble of changing our behaviour? What role should the latest evidence play in forming public health policy?

The session will be introduced by Claire Fox, director of the Institute of Ideas.

Speakers
Timandra Harkness
journalist and writer; co-writer and performer, BrainSex, Humans V Nature: Engineering FTW! and Your Days Are Numbered: the maths of death

Nigel Hawkes
director, Straight Statistics; columnist, British Medical Journal; former health editor, The Times

Dr Amanda Killoran
public health analyst, National Institute for Health and Clinical Excellence; co-editor, Evidence-based Public Health: effectiveness and efficiency

Dr Jon Rohrer
member, Royal Society of Medicine Council; neuroscience researcher; neurology trainee

Chris Tyler
executive director and member of executive committee, Centre for Science and Policy, University of Cambridge

Chair:
Tony Gilland
associate fellow, Institute of Ideas

Produced by
Claire Fox director, Institute of Ideas; panellist, BBC Radio 4's Moral Maze
Recommended readings
Peer-reviewed journals aren't worth the paper they're written on

'Is it in a peer-reviewed journal?' journalists are meant to ask themselves before launching into another story about rice pudding causing cancer, or chocolate prolonging life. The truth is that peer review is largely hokum.

Nigel Hawkes, Independent, 22 August 2010

'Statins with your burger?' Doctors want heart pills on menu

Cardiologists propose putting pills beside salt and ketchup to balance heart disease risk

Denis Campbell, Guardian, 12 August 2010

Public health, private lives

But even where the science is clear cut, how far should we go to cut our life according to its (potential) optimum length? Is it not a matter of personal choice whether we choose to risk our life and health by indulging in pies, whisky and cigarettes (or, for that matter, canoeing, ecstasy and hang gliding)?

Timandra Harkness, Prospect, 9 August 2010

Don’t call us fat or obese. Just leave us alone

The spat over how officialdom should refer to plump people overlooks the fact that it should be none of its business how much we weigh.

Rob Lyons, spiked, 6 August 2010

A pound for a pound

Could financial incentives that encourage fat people to lose weight solve the obesity crisis?

Liz Hollis, Prospect, 22 July 2010

Call for tougher GP questioning on alcohol

Government health advisers urge doctors to monitor patients' drinking habits as a matter of routine

Denis Campbell, Guardian, 3 June 2010

Session partners



in association with