‘The crisis in public health is really a crisis of culture’

I was once employed to set up health-promotion initiatives in a very poor area.

My brief was simple: establish asthma, diabetes, smoking-cessation and healthy-eating clinics for people who like heroin.

I led a one-strong team onto the estates of east London armed with very little knowledge, a cheery smile and a box of leaflets that were stolen on the first morning.

Of course I had loads to learn and was sent on some courses about diabetes and hypertension. I sat at the back hiding my ignorance from a chiropodist with the haircut of a man who spent too much time thinking about feet. He showed us a picture of a foot of a woman with diabetes. Her nails had grown so much they curled around her foot and climbed up her leg like ivy.

‘You,’ he said, staring at me accusingly. ‘What would you recommend for this person?’ ‘Flip flops?’ I offered. Which to my continued surprise was not the right answer.

Now, of course, nurses working in public health are far more knowing. They have training, strategies, investment, more leaflets. Yet every week a report comes out suggesting they are fighting a losing battle.

Last week it was reported that, despite a concerted public health effort, there was an increase in new diagnoses of sexually transmitted diseases, especially among the young. And the UK has the third highest rate of new HIV infections in Europe.

Experts called for more investment in sexual health. You can see their point. If we could just afford to appoint one worker for every young person in the country and offer them a health-education chat and a condom just prior to any snogging, we’d be able to bring STD rates in line with wealthy European neighbours such as Greece or Poland. But it isn’t just about money, is it?

We have constructed a culture that imagines our well-being is the responsibility of the health service. Anyone who suggests otherwise is a moaning old busybody who is attacking our ‘rights’ to bumble infection and disease across the nation.

We are big on rights – we have the right to get drunk and throw up in the street, and we have the right to have bad sex with people we don’t like very much, and the right to eat kebabs without chewing. Indeed, there are people whose life ambition is to somehow manage to do all of these at the same time. How on earth are health professionals going to change that?

The crisis in public health is, in truth, a crisis of culture. People can keep relieving themselves of the burden of responsibility for the way they live, the things they
value and the lack of respect they have for themselves. They can expect health professionals to sort it out for them all they want. But is it realistic to imagine we can construct a public healthcare response to that? I don’t think so. It stopped being a health problem a long time ago.

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