I am proud to have been the minister for child health in the coalition government that introduced new laws to ban smoking in cars with children. This was an important public health law that prevented children from developing cancer, asthma, bronchitis, pneumonia and a whole host of other chronic breathing problems that can be caused by inhaling secondhand cigarette and cigar smoke. Putting it simply, banning smoking in cars with children has saved lives. I only wish that the new secretary of state for health held the same view.
Since her election in 2010, Thérèse Coffey has always had a questionable voting record on measures to curb smoking – a unique evil and destroyer of health. The health secretary previously voted against measures to restrict smoking, including a ban on smoking in enclosed public spaces, the outlawing of smoking in cars with children and plain packaging for cigarettes.
I cannot overstate my disappointment when, last week, in a series of extraordinary media interviews, she repeatedly doubled down on her personal support for parents to make the choice about exposing children to the dangers of passive smoking in cars – even though it is now (thankfully) against the law. Worse was to come, when she also confirmed that the government’s long-awaited tobacco control plan – which could save thousands of lives – may never see the light of day, and does not accord with her stated priorities for the health service.
But it is not just anti-smoking measures that Coffey has in her sights. Within a few days of her appointment, in her role as deputy prime minister and against the advice of 32 previous health ministers, she supported a Treasury review to potentially abandon existing and planned anti-obesity measures.
Disappointingly, the government has also recently scrapped the long-promised health disparities white paper, which would have examined and made important recommendations about how to better address health inequalities and better care for those living in marginalised communities with poor health experiences and outcomes.
There has always been a political consensus around public health priorities – from the work led by Norman Fowler (a Tory) in raising awareness of and improving care and treatment for people with HIV, to the huge achievements of the last Labour government in combatting the life-limiting dangers of smoking by banning it in pubs and clubs, and (later) in public spaces. However, that consensus has now been shattered.
Coffey is in danger of being a health secretary who appears opposed to the need for bold government action to tackle the great scourges of our health, notably smoking, unhealthy food and excess drinking. She prefers to prioritise her own ultra-libertarian ideological worldview – hostility to what some like to call “nanny statism” – above evidence-based policies to improve public health and save lives that are backed by most respected UK and international health bodies.
Smoking and obesity are major killers. Every year, smoking alone causes nearly one in five cancer deaths worldwide, and more than one in four cancer deaths in the UK. Smoking and obesity are also leading causes of hypertension, many other life-limiting chronic illnesses, heart attacks and poor cardiovascular health. Significantly, smoking and obesity are more prevalent in people from poorer backgrounds and in the communities with the greatest health inequalities, and are important factors in why people from poorer backgrounds lead (on average) shorter lives.
As both a former health minister and a practising NHS doctor who has seen close up the devastation that smoking wreaks, I find Coffey’s approach to be deeply alarming. More smoking and more obesity mean more illness, more pressure on the NHS and shorter lives – particularly among the poorest in society. If, as it states, the new regime’s priority is economic growth, then its current approach to public health is poorly conceived, as it will also result in increased numbers of days lost to work, and reduced economic productivity from people unable to work because they have chronic breathing problems induced by smoking or joints that are in constant pain from bearing excess weight.
The health secretary will soon discover that problems with her ABCD – ambulance response times, treatment backlogs, social care, and having sufficient numbers of doctors and dentists to care for the needs of patients – will only be made worse by the government’s new approach to public health. Prevention is better than cure. Public health should be about reducing the disease burden on the NHS and supporting people to live and enjoy longer, healthier lives.
It is the duty of every government – for ethical and practical reasons – to take action against smoking, obesity and other key causes of early mortality and morbidity. I am acutely concerned that Coffey’s ideological hostility to what history shows is government’s potentially very positive role in protecting us against these grave threats to our health will exacerbate the problems they already pose. At its worst, such a radically different approach to public health could cost lives, as it will inevitably lead to more people smoking and becoming dangerously overweight.
The health secretary claims to make decisions based on evidence. If that is true then it is time she put ideology aside, followed the evidence and started implementing policies that will help, not imperil, the nation’s health.
Dr Dan Poulter MP is a practising NHS psychiatrist and a former health minister (2012-15)
