In a speech in July, Health Secretary Andrew Lansley signalled to a room full of healthcare professionals how the Coalition Government’s public health policy would differ from that of the previous administration. Gone are the days, he said, of “lecturing and nannying”. Instead, the strategy would be “nudging individuals in the right direction, encouraging positive choices [and] making people feel empowered.”
The speech, together with other recent announcements, has sparked extensive debate about exactly where the balance between personal choice and state intervention should lie. Writing in the Observer, Dr Steven Field, the UK’s top GP, weighed in:
[Lansley] is right when he says that more of us should be taking more responsibility. The truth is that too many of us neglect our health and this is leading to increasing levels of illness and early death. The evidence is all around. There is the dramatic increase in diabetes, much of it related to obesity. Then there are the dreadful effects of excessive alcohol consumption, which we are seeing in younger and younger people.
Too many people do not face up to the hard facts, as they perceive them to be an attack aimed, in particular at the poorer members of our society. But it is impossible to argue on medical or ethical grounds that such behaviour is acceptable.
But Dr Field was less enthusiastic about the need to avoid ‘lecturing’ – in fact he was rather unapologetic about the role GPs should play:
Please don’t take offence if we tell you to lose weight or stop smoking or drinking. You need to face facts and take responsibility. Support is out there and it could save your life – and save the NHS a fortune.
He also praised public health initiatives such as our campaign to protect children from sunbeds, and Jamie Oliver’s high-profile attempts to improve school meals. On top of this, legislation to protect people from secondhand smoke has led to an immediate improvement in public health, with more people quitting smoking than ever before, and fewer hospital admissions from acute heart problems.
Clearly, then, there’s a balance to be struck between the role of the health services and the role of the individual – and this is as true for cancer as it is for other public health issues.
Our lifestyle is as important as our genes
When it comes to cancer, our lifestyle is important. In the genes we’re born with, we’re dealt a ‘hand of cards’ that affects our chances of developing cancer. But although they’re important, our genes aren’t the only thing that affects our risk – we can all try to play our cards to sway the game in our favour. A large number of cancers are linked to smoking, obesity, poor diet and lack of exercise, and – although nothing’s a given – cancers are less common amongst people who lead healthy lifestyles.
But people and public services can work together to make lifestyle changes. For example, as smokefree legislation was introduced in 2007, record numbers were motivated to quit – and the NHS ‘Stop Smoking’ services helped many of them to do so.
Yet, as Lansley noted, “smoking, which has declined for decades, remains stubbornly high and still claims over 80,000 lives a year.”
So as well as encouraging “a new sense of community and social responsibility”, there are other things government can do to build on its previous successes, and further protect children from tobacco marketing. We’d like to see government implementing the legislation on cigarette advertising and vending machines that Parliament voted through earlier this year. This would help further reduce the UK’s ‘stubbornly high’ smoking rates.
Detecting cancer early is a shared responsibility
Another area where the tension between personal responsibility and state provision is keenly felt is in diagnosing cancer.
The later cancer is detected the harder it is to treat, and statistics suggest the UK has a sizable problem in this area in comparison to other European countries.
But this isn’t a problem with a single cause. There are problems all along the chain; from people seeking help from a GP all the way up to the time spent waiting for test results. But there’s no point in people conscientiously going to their GP with possible cancer symptoms if there aren’t sufficient resources to refer, test, diagnose or treat them.
And it’s worth noting that this week’s great news about falling breast cancer death rates came about partly because more women are attending screening, but also because of improvements in diagnosis and treatment.
So all of these issues need tackling together if we’re to beat cancer – and the National Awareness and Early Diagnosis Initiative is starting to get to grips with this issue. This initiative needs supporting and nurturing over the coming years if we’re to catch up with the best in Europe.
Providing the right information
At Cancer Research UK, one of our core purposes is to help people make informed, responsible decisions about their lifestyles, so that they can minimise their chances of cancer. So we produce wide range of evidence-based information about the links between lifestyle and cancer; videos to help spot early symptoms; gadgets to help track drinking levels; roadshows to help people make healthy choices and, of course, this blog, to help people make sense of the mixed messages that we’re constantly bombarded with.
Rather than ‘telling people what to do’, these information resources are produced to help people take control of their lifestyles and, hopefully, reduce their cancer risk.
So as the nation’s capital takes to its shiny new bikes in an effort to combat what Mayor Boris Johnson cheekily called the ‘Big Society’, we’d like to urge the health secretary to find the right balance between encouraging people to take responsibility, and supporting public health services. Because it’s only together that we will beat cancer.
Image courtesy of TfL