Public health white paper offers hope for wellbeing

Public health white paper offers hope for wellbeing

 By making healthy changes, our chances of developing certain preventable illnesses reduce across the board. Photograph: David Levene for the Guardian

Whatever proposals a government makes on health are always going to be met with some cynicism, but this time I am quietly optimistic. Finally, there is a determined focus on wellness rather than the traditional approach to 'treating disease'.

Let's face it – health and wellbeing is not sexy. It's something many people take for granted and when we feel ill we seek help. Moreover, as a nation, we don't like being nannied or told what to do by those who think they know it all. We know that smoking is bad for us and that alcohol abuse causes severe societal and health problems, but hearing medical and ministerial suits go on about it is somewhat tiresome.

The public health white paper tries to take a step back from this approach and lays out options for us to make choices about our health. Of course people also have a choice not to be healthy, but my feeling is that the health secretary, Andrew Lansley, feels that by permeating health into most types of organisation, he can make people healthier by sheer osmosis. He may well be right.

One of the problems is that those of us who are 'well' need to put some effort into staying well. On an individual level, that can mean making small and gradual changes. Walking briskly to the shops instead of taking the bus, swapping regular cans of fizzy drinks for green tea, eating a bowl of oats every day and limiting bacon sarnies to weekends.

All of these things, dull as though they may sound, over the course of many years, will help to prevent illness. Those that already look after themselves will not benefit hugely. But in communities where there is a high prevalence of disease (such as deprived inner city areas), I honestly believe that there is a good chance of making change through inclusive schemes.

Reaching out to people without nannying them is the toughest challenge. For instance, a smoker will only give up when she is ready, not just because a doctor tells her to stop.

The other side of the issue is urgent and chronic care. What happens when you develop diabetes, have a heart attack or a stroke? And, as one patient pointed out to me, why should those of us who look after ourselves well have to indirectly pay through taxes for those who carry on being unhealthy? There are several issues here. Firstly, many illnesses are not lifestyle related. Secondly, by making healthy changes, our chances of developing certain preventable illnesses reduce across the board – from heart disease, diabetes, obesity through to certain cancers. But in most cases once people actually feel better after making positive lifestyle changes (for example the increase in energy levels and improvements in skin a few months after stopping smoking), their good health habits are reinforced. Again the issue is how to get this message to the people who are hardest to reach.

As for Mr Lansley involving industry, there will always be some conflict of interest. There are many ways industry can help, from salt reduction in foods to sponsorship of local health schemes. But will the advertising power of some food and drink brands reduce the effectiveness of any 'nudges'? The danger is that we become saturated with health messaging and promotion to the point where it feels like we're being nannied again.

Employers will also have a part to play and this could be an excellent way to make contact with some hard-to-reach groups. Men – who in my view, are a high risk group – have no in-built health screening and no obvious reason to forge a relationship with primary care until things go wrong or it's too late.

At the end of the day, why bother with all this? For the government, it may save money in the long run. A healthier population means a reduction in long-term disease and the number of stays in hospital. But as a doctor, at least part of my job is to promote health and prevent illness. Ramming it down people's throats doesn't work, but as with anything, a real life example illustrates just why public health initiatives are so important. The kind of outcome we are trying to prevent is the all too common story of the hardworking person who never goes to the doctor and drops dead at 47 of a heart attack, because he never knew he had high blood pressure, high cholesterol and diabetes, all of which are preventable and treatable. It may not happen to you, but it happens all too often. We're too civilised to die of ignorance, surely? That's why we should bother; because it can save lives – and ultimately each of us still have the freedom to choose how healthy we want to be.

• Dr Ayan Panja is a north London GP

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