I took some solace from a news report last week saying that search engines such as Google may be to blame for my failing memory.
I was getting worried about my inability to remember certain words, or where I put my shoes or the fact that I had an appointment with a sadistic former Polish special forces assassin now employed as a dental nurse last Thursday.
Fining the parents of children not wearing a sun hat isn’t a vote winner
Anyway, scientists are suggesting that we are adapting our memories because so much information is so easily available to us. So that’s all right then.
My wife has a different explanation. She says we need a holiday. She has been saying this since 1997 and has even been known to say it while we are on holiday. But paradoxically, if you go on holiday, there is so much to remember. Not least suncream.
I was reading last week about an uproar over primary schoolchildren getting sunburnt on sports day. “Why didn’t the teachers smother them in suncream?” sobbed one mother. Well, the fact that there are 300 kids, one tube of suncream and some teaching to do may explain it. But, outrage being outrage, it wasn’t long before a charity was demanding that all UK schools develop a comprehensive sun safety policy to protect children from skin cancer.
Who is to blame for sunburnt kids? Parents? Schools? The law? The government? Legislation has brought about the biggest recent changes in public health, from banning smoking in pubs to making the wearing of seat belts compulsory. But, for every law banning something, there is a pressure group protecting civil liberties.
The alternative to legislation is “nudging” and involves us being persuaded to make life-improving changes through social cues. The traffic light system on food is an example. But it seems people need more than cues and information to make better choices, as any nurse working in health promotion would probably testify.
We can’t over legislate. Fining the parents of children not wearing a sun hat isn’t a vote winner and, anyway, maybe legislation diminishes our sense of personal responsibility. Yet prompting people to try to stay healthy doesn’t make much difference. One could even argue that, for many people, small acts of recklessness - a ciggie behind the bike sheds for example - are the most potent expressions of personal power or “freedom” they have.
It is largely about economics, can we afford to manage avoidable or long-term illnesses? Maybe we could increase income tax. But that doesn’t win votes either.
And so it goes on. We wander around in the space between nudging and legislation, persuading and enforcing until, as the Wanless report on public health told us, the consequences of our choices become simply unmanageable.
Don’t you think it is interesting that often we simply don’t care about ourselves? Why is that? Are our choices psychological and personal? All about the struggles in our inner world? Or are they socially constructed? All about coping with the external pressures of modern life? And, whichever one of those it is, what on earth can health professionals do about it?
It may be that trying to do anything about how people live is absurd and invasive. If people want to smoke or take drugs, then that is their business and the only reason we even talk about it is because it costs us all money.
But whatever your position - libertarian, legislator, health educator or taxpayer - it is apparent that public health strategy is as muddled up as we are. Will that ever change? And, if it doesn’t, where will the NHS be in 10 years’ time?