Farewell, Public Health England. Hello, National Institute for Health Protection. As expected, the hammer has fallen on the agency that promised to ‘protect the public’s health from infectious diseases’ but floundered hopelessly when tested by coronavirus. PHE failed to expand diagnostic testing, failed to engage with the private sector, stopped contact tracing when the virus was just getting going, discouraged the use of face masks, refused to share infection data with local authorities and couldn’t even count the number of people who died of Covid-19 properly.
Good riddance. According to Matt Hancock, its replacement will have a ‘single and relentless mission – protecting people from external threats to this country’s health’. In his announcement yesterday, he made an important distinction between ‘health protection’ and ‘health improvement’. The former involves infectious diseases, antibiotic resistance and environmental hazards. The latter involves encouraging people to eat their greens, exercise and stop smoking. For too long, these two different agendas have been bundled together under the umbrella of ‘public health’. Covid-19 has forced us to relearn the distinction between risks that threaten us all and justify a certain degree of coercive action and those which are the result of individual choices and pose a threat only to the individual concerned.
The great conceit of the ‘public health’ movement over the last thirty years has been to conflate collective health risks with individual health risks. ‘Public health’ problems have been redefined to include any health risk that affects a large number of people, such as binge-drinking or obesity, rather than its original meaning of a health risk that can only be dealt with by collective action, such as air pollution or Covid-19.
The redefinition of ‘public health’ was more than a rhetorical shift. By portraying individual health issues as public health issues, the impression was given that collective action – which is to say, government action – is appropriate when it is not.