Alcohol has been in the news a lot recently, with minimum pricing being looked at in Scotland, Labour thinking of banning ‘irresponsible’ drinks promotions in clubs, pubs and bars across the Country and general concern about 24 hr binge drinking culture of Broken Britain.  And last week was the turn of the Conservatives to air their views on drinking - and public health more generally.

Reading through the launch document, A Healthier Nation, I am pleased to see some of the focus is on encouraging behavioural change. A key element in Conservative thinking is the emphasis on personal responsibility and personal choice. The philosophical difficulties for me occur when one person’s choice becomes another person’s irresponsibility.

There is no question that alcohol abuse and excessive consumption are at the root of many social problems – there can be no disagreement that it fuels domestic violence, potential family break-up and anti-social behaviour. But, moderate alcohol consumption can be part of an enjoyable night out – no-one would suggest a return to the era of Prohibition, since it didn’t work.

The problems occur with the unregulated ‘all you can drink’ dentist’s-chair mentality of many drinkers.  This is a behaviour that I am not sure legislation and direct government intervention can eradicate completely.  Might minimum pricing just see a greater percentage of household income spent on alcohol and therefore make some of the social consequences of drinking worse? Or make responsible drinkers pay more for their once or twice a week tipple because of the bad habits of the few?  Would this just fuel supermarket profits yet further? This isn’t to say it’s a bad idea – but health policy must always be evidence-based and not prejudice-based.

Conservatives want to tackle binge drinking and all the social problems it causes by banning cheap alcohol being used as a loss leader in shops and supermarkets. Alcopops and super-strength beers will be taxed more heavily. We will treble duty on alcopops, we will significantly increase tax on super-strength beer and we will more than double tax on super-strength cider. And a tougher licensing regime will also be introduced so that problem venues which encourage irresponsible drinking can be tackled.

I have no desire to encourage the nanny state. People of an older generation may think back to a time when it was socially acceptable to drink and drive.  Drink driving, although still around, is now socially unacceptable.  Did this change as a result of the stick of a driving ban, or the carrot of social unacceptability?   Or did the ban lead to social unacceptability?

But public health is not just about irresponsible drinking.  I was talking to a friend who is a family doctor the other day.  In our discussion we talked about life expectancy and how it has increased over the years in some places but has plateau-ed out in others.  His reply was “If people stopped smoking, drank less, took moderate exercise, and we could screen against prostate, bowl and testicular cancer and ensure all heart attack victims got an ambulance within 8 minutes, we would pretty much crack inequalities in life expectancy”.

A simple solution you think.  But here in Blackpool, despite the best efforts of NHS Blackpool and the Victoria Hospital, life expectancy is well below the national average – for males it is about 6 years less on average.  We can put the screening in placeb or provide the ambulance, but it can’t make people stop smoking, drink less or take up exercise. Only a change in attitude can make that happen and I think that this is where societal change comes in.

The Conservative Party’s Public Health Policy can be summarised in these four points.

1. There must be a focus on reducing health inequalities, in a locally led public health strategy and throughout government – from the strengthening of support for families with young children to reducing preventable winter deaths among elderly people.
2. Some parts of public health policy need to be led nationally – immunisation programmes, emergency planning or behaviour change campaigns. Wherever possible, these should be evidence-based and linked to the latest advances in social psychology and behavioural economics, so that they work intelligently with the way real people live their everyday lives.
3. Responsibility for improving public health, and the budget to do so, must be decentralised as far as possible – away from central government control and out to local communities.
4. Councils, communities and independent providers should be rewarded for reducing health problems like obesity, teenage pregnancy and alcohol abuse – when they make serious savings for the NHS and the taxpayer, they should be rewarded for it.

Perhaps the most exciting news for Blackpool and Cleveleys is that we will introduce a new ‘Health Premium’ to target resources towards areas with the poorest health to progressively reduce chronic health inequalities. The public health funding we devolve will give enhanced support and incentives to deprived communities, where health problems tend to be much worse. Based on the results achieved, the ‘Health Premium’ will incentivise and reward the improvements in the health of the poorest communities. NHS Blackpool already does a superb job co-ordinating multi-agency working – this will mean it can do even more!

Public health is a massive issue – the cost is enormous in terms of health, quality of life, the effect on those around us and the tax burden.  I don’t want to come across as ‘preachy’ as I do believe in people living their own lives as they see fit, but we can’t carry on like this.  Life is so enjoyable when we are well, fit, active and able.