Few experts would argue that the coalition has done anywhere near enough over the last five years to tackle the deep-seated public health problems that are damaging millions of lives and adding significantly to the growing pressures on the NHS.
Shirley Cramer, the chief executive of the Royal Society for Public Health (RSPH), speaks for many in the field when she voices disappointment and frustration. “With plain packaging [of cigarettes], it was moving along fine and then sort of came to a grinding halt. I assume that was to do with industry lobbying. It was slightly pushing water uphill, but we’re glad to see it finally happened. It’s good news that public health finally won the day”, she says, in her office in the society’s London HQ.
“On alcohol, we’ve been less successful because we haven’t got minimum unit pricing. Again we think that’s probably because of industry”, adds Cramer, citing the drinks trade’s legal challenge to the Scottish government’s bid to introduce it. (Wales want to do the same.) She remains optimistic, though. “Let’s see what happens in Scotland, but I think it will happen. It’s like everything else, sometimes it takes a little longer.”
Cramer, whose organisation represents 6,000 public health professionals in the NHS, academia and local government, cites the ban on smoking in cars with children, which comes into force on 1 October, as another recent notable victory. And she is pleased that public health in England returned to being the responsibility of local councils as part of the Health and Social Care Act 2012.
But she sees the Responsibility Deal – a voluntary programme with the food companies to combat obesity, which is widely viewed as a dangerous abrogation of the government’s duty to use its power to enhance and protect public health – as inadequate to that task. “It’s time to review the approach of the Responsibility Deal. It’s had its successes [such as traffic-light labelling on packaging], but I think at this next stage we will probably have to do something just a little bit stronger. We need to say, what success have we seen and what would we like to have seen, and to see what the gap is and how we might close it,” she says.
Whoever wins the election on 7 May, making food healthier has to be a top priority, adds Cramer. “We saw with salt that taking it out of a lot of products that didn’t need it was very successful, and we could do the same with sugar.” Earlier this week the Local Government Association, which represents more than 370 councils in England and Wales, demanded that manufacturers of sugary drinks – a major contributor to obesity – should be going “further and faster” in reducing sugar levels in their products.
But Cramer is sketchy on how sugar reduction might be achieved. The Food Standards Agency drove much of the salt reduction programme in the 2000s, partly by naming and shaming the worst offending products, but it is now neutered and a shadow of its former self. Maybe it could be re-empowered to do this sort of work, she muses. She mentions that “Public Health England (PHE) can have considerable clout in this area, and we’d expect them to”, but that sort of chivvying of vested interests is not part of its current brief.
The RSPH’s profile has soared since Cramer took over two years ago. It has made headlines by calling for a ban on the sale of psychoactive “legal highs” and for its work to raise awareness of calories in alcoholic drinks. Its recent league table of the 70 healthiest and unhealthiest towns in Britain, based on the number of bookmakers, tanning salons and fast-food takeaways, or leisure centres and libraries, in major shopping areas, attracted widespread publicity. It also sparked a debate on how more and more high streets are becoming dominated by premises such as payday lenders and shisha cafes.
But she has a potentially transformative big idea for her specialism. With Simon Stevens’s call in the NHS Five Year Forward View for a radical upgrade in ill health prevention in mind, she wants to vastly expand teachers’, firefighters’ and even hairdressers’ roles to include some public health in their work. “England’s core public health workforce is 40,000. But we have another 19 million people in 170 different occupations who could possibly help improve the public’s health. Let’s look at those categories of workers whose jobs are not defined as public health but who can make a significant difference to it,” says Cramer.
She wants to see pharmacists, leisure-centre staff and housing staff all talking to the people they encounter in their day job about issues such as their weight, smoking or mental health, and either helping them directly or referring them elsewhere. A joint Department of Health/PHE group which she chairs, called People in UK Public Health, is examining how to pursue that approach.
It is not as far fetched an idea as it may seem. On Jersey, postal workers already check on the welfare of elderly and vulnerable residents under the “call and check” scheme. “The UK’s 172,686 allied health professionals (AHPs) – which include physiotherapists, dieticians and occupational health therapists – have over 4 million client contacts every week. If they’re helping someone with their bad back, they should be able to talk to them about smoking cessation, sexual health or healthy eating,” Cramer says. A recent survey showed that almost 90% of 2,000 AHPs would like to be part of a big push to improve the public’s health and wellbeing.
“Firefighters have access to the most vulnerable people in our society and 98% of the public like them,” she adds. “The West Midlands fire service uses visits to fit smoke alarms to advise older people on how to prevent falls, maybe by seeing that they need rails in their home. They might see that a frail, older person is not eating or drinking properly or is smoking hazardously. They have even gone as far as to make some of the firefighters ‘vulnerable person officers’ who are responsible for working with young people, or the homeless. Some fire services help with mental health, for example, by working with mental health services to help hoarders, who can be a fire risk,” adds Cramer, in a whirl of can-do enthusiasm.
“We need to have people who have knowledge and we need a golden thread of health prevention through everything” she continues, even in hair salons as hairdressers chat to customers while cutting and blow drying their hair.
With avoidable illness estimated to cost the UK some £60bn a year, ensuring all these “healthy conversations” start to happen can only help.
Curriculum Vitae
Age 59.
Lives Buckinghamshire.
Family Married, two daughters.
Education Cockermouth grammar school, Cumbria; Bradford University, BA (Hons) applied social studies and CQSW; Columbia University, New York, MSc social administration.
Career 2013-present: chief executive Royal Society for Public Health; 2012‑13: interim CEO Alzheimer’s Research UK; 2000-11: chief executive, Dyslexia Action; 1992-99: chief executive, National Center for Learning Disabilities, New York, and director Coordinated Campaign for Learning Disabilities, New York; 1989-91: voluntary sector consultant; 1986-89: head of fundraising, Muscular Dystrophy Group; 1982-86: programme manager/fundraiser, Lenox Hill Neighborhood Association, New York; 1978-81: social worker, LB Ealing.
Public life Chair, British Future; trustee, Alzheimer’s Research UK; chair, Department of Health/Public Health England, People in UK Public Health group.
Interests Travel, hiking, US history, theatre, reading.
