Choosing or losing health?

If neo-liberal thinking is gripping health care reform in many countries with its focus on market style competition and individual choice, a similar revolution may be underway in public health policy. The example of recent developments in England is instructive and offers a warning to other countries that are also rediscovering public health or are perhaps discovering it for the first time. Although welcome and overdue, the manner in which the (re)discovery is taking place and its implications for public health policy and practice may be less encouraging.

The government published its English public health policy statement in November 2004 to general acclaim from the public health community.1 Indeed, the reception given to the policy proposals was perhaps a little too uncritical. This was certainly the view of the United Kingdom Public Health Association (UKPHA), which published a critical assessment of the policy statement and the political ideology underpinning it.2 It concluded that the policy is seriously flawed, pulls too many punches (for example, refusing to opt for a total smoking ban in public places), and is emasculated by its entanglement with the choice agenda that has little or no place in public health. In fact, far from being a progressive document that builds on the previous health policy statement, Saving Lives: Our Healthier Nation, published in 1999,3 the new statement, Choosing Health, displays a number of regressive features.

To understand the shift from a public to a private conception of public health policy, for that is in essence what Choosing Health amounts to, it is necessary to trace its antecedents. These lie in the two seminal reports produced by Derek Wanless, …