• health reform
• minister of health

The perfect minister of health would have to understand about health—not so much the desperate manifestations of ill health. Such a person would have to understand that a large proportion of chronic illness—at least until age 75 or thereabouts is essentially avoidable. Then health policy might change so that in the longer run the population served would be healthier and the expenditure of medical services proportionately less. That should be their objective.

But all that requires courage and a commitment to experiment sensibly and efficiently. Policy would incorporate, as matter of course, rigorous evaluation components and would get to serious grips with changing circumstances and opportunities to enable real choice for people that matter. The minister would involve the public in a serious public health endeavour that eschewed all coercion, all patronising, and all nannying. The objective would become a national enthusiasm—that would be different and special among different communities. Nobody wants to be ill but few have real opportunities for doing much about impending disease 40 years on. But this is a social and political choice for government to facilitate under a national initiative. Immunisation and vaccination are well accepted and clearly require support, both intellectual and actual, to enable them to work.

Why then are highly cardiotoxic diets (in the longer run) widely marketed and the safer and (in many people’s view) better options more expensive, less available, and culturally alien. And they taste worse too. Why do governments with a minister for health allow schools to sell their sports fields, procrastinate about tobacco advertising, take no lead on dietary change, and so on. Mainly because they don’t understand that health is, in the main, not determined by health services. And also because they relish the power of controlling an important and vital public institution.

Get a strong minister who understands the basics of the biology of health—most chronic diseases have 50 year gestations and hence attitudes and options available to youngsters are worth thinking about. Many have common causes and we need to know about their relative potencies. So public money needs to be spent on finding out. This is not to get stern or impose restrictions but to invest in making healthy options more attractive—indeed sexier.

All this needs a new and credible scientific infrastructure to ensure that a competent workforce is well consolidated in daily life. Odd that we have lawyers, doctors, engineers, teachers, and whatever else and not even a word, never mind a coherent function, for public healthists. Public health really is quite as important as the rest, surely?

So we need a minister for public health in the highest echelons of government power whose remit is maximising health and hence minimising health services, to deal much more effectively with unavoidable illness and the needs of the elderly population. At the moment we are mostly getting the worst of both worlds—too much avoidable illness and massively inadequate health services. It is time to break out of that vicious cycle in all of our interests.