The Risk-Monger

My apologies for the silence over the last couple of weeks – I was busy with exams. If you ever want to punish academics, have them sit in a room all day and force them to listen to other people. I did manage though to attend Sanco’s Open Health Forum 2010 last week and was startled by the impotence of EU health policy.

Firstly, I was impressed with how everyone attending knew with absolute certainty what was wrong and the easy solutions to fix the EU health crises and lead to a better, healthier Europe. For example, the problem is smoking so we need a total ban on cigarettes. Or obesity is a problem of sugars and food quality so all we need to do is implement a fat tax. Heart disease is related to increased salt in our diets, so get the salt out, point. Increased fitness levels will lower obesity and heart disease, so we are urged to build more parks and green spaces. Cancers would be reduced if we only ate natural, organic foods, grown locally and not processed with additives. It was obvious to all there that if we only banned alcohol, society and public health would be so much better. We just need to get people out of their cars and onto their bikes – that would change so much. More money for prevention would save a kilo-tonne of cure. This is all simple stuff and all we have to do is act.

Simple stuff, yes, but still we can’t seem to act – IMPOTENCE. People still smoke and drink too much, eat too much and exercise too little. The more we seem to tell these evidently stupid people to change, the worse they are behaving. Why can’t they see this? Well, the answer there is simple too. Industry gets in the way and poisons us for their profits: tobacco, alcohol, sugars, salts and additives. Through their marketing and pressures, people cannot resist the temptations (especially children). So the answer must then be for the Commission to get tough with industries and their marketing and advertising campaigns. Still they don’t. The answer there is simple too – industry is so good at lobbying and influencing policy-makers to continue what they are doing. We must then stop the lobbying!

Things are not so simple though. We are talking about lifestyle choices – cultural, socio-economic variations that make personal choices distinct (what makes every individual unique). If we ban smoking, the rich won’t mind (they have other pleasures like polo or yachting); other less privileged parts of the population may not be so happy to have people who know so much more than them making choices on their only personal pleasures. These same poor people would not be able to afford any fresh fruit and vegetables should those who know better try to ban pesticides, putting them at greater risk of cancer by not eating a minimum of five daily servings of fresh fruit and veg. People enjoy soft drinks and chocolates and should be allowed the choices of how to enjoy their meals. We are living in a generally free society and people do have the right to be stupid (they should be encouraged not to, but there are limits to how far people who know better should interfere).

About the role of industry, they follow laws and markets. Changing the laws against activities that people enjoy is something that only the very courageous would embrace (remember prohibition). Even Robert Madelin, after four years of toying with restrictions on alcohol knew his limitations (although we all enjoyed the cat and mouse game with the spirits industry – too bad the wine and beer industries could not coordinate their positions or join in effective debate). Industries will spot market trends (Coke’s move away from sweet fizzies to waters, juices and sports drinks) and may try to lead in other areas where public concern is high (the food industry’s shift towards nutriceuticals). Perhaps Sanco should work more with industry rather than hire watchdogs to attack them. To say that industry is the root of all evil is indeed simplistic.

And here is where it gets sinister. Health groups have got it into our heads that industry is out to hurt us for their profits. In this, they have done a good job destroying public trust in the industries that provide us with food and medicines. For example, the Commission has been promoting an increased use of vaccines (especially with the recent fears of pandemics) but the public does not trust industry and has been led to believe by some who think they know better that vaccines are risky (kind of like antibiotics). So governments are stuck with a surplus of unused H1N1 vaccines and a reputational crisis that they were in collusion with the pharmaceutical industry over swine flu. How dare the pharma industry pretend to care about health. As cancer research (from industry!) is shifting from cancer treatment to preventative vaccines, health NGOs have made such a mess of public trust in industry and vaccines that “sinister” is the only word BlogActiv will let me print.

Solving public health issues would be simple if only people listened to those of us who know so much. This means that it is merely a communications problem. Communications problems are matters of trust. The public does not trust government, and industry certainly can’t be trusted. We used to be able to trust our doctors. Now we have a symphony of voices on health and wellness telling us what is best for us, no trust and a lot of confusion. Where is the simplicity there?

There are lines leading everywhere. Where do we draw the line? Should we ban alcohol but not coffee? Should we label packages that contain sugary foods with red lights but continue to promote meat? Meat after all must be banned before any other health risk is addressed (Oops, not popular!). Labelling works if only people read labels; sin taxes (eg, fat taxes) work if people can afford other solutions. Choices are limited and policy-makers are stuck feeling quite impotent between those who know better and those who enjoy certain pleasures.

The wish list is long and soon Christmas is coming so Sanco organised this Open Health Forum conference to listen and propose. DG Sanco packaged its wishes into some sort of nine-point plan (it is hard to know what exactly this plan is: not an action plan, not a legislative agenda, not a healthly lifestyle marketing campaign that its NGOs run …). When you are impotent, the only thing you can do, it seems, is wish.

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