Cartoon from Punch, London, 1848. (Photo by Universal History Archive/Getty Images)

Why public health has become a dirty word

The field has been hijacked by a politicised and self-serving class of experts

Artillery Row

The 175th anniversary of the Public Health Act (1848) has spurred the British Medical Journal into publishing an op-ed by Professor John Middleton. The Public Health Act greatly improved sanitation in Britain. It provided clean drinking water, better drains and a sewage system upon which we still largely depend. It addressed problems that could only be solved through collective action. It created public goods. If public health means anything, it means policies like this.

175 years later, “public health” has degenerated into a self-serving and self-indulgent racket. It is a bloated, state-funded caricature of a wing of medicine populated by left-wing academics and single-issue fanatics who don’t know one end of a microscope from the other. They wouldn’t recognise a public health problem if it called itself COVID-23. The anniversary article in the British Medical Journal shows vividly, if inadvertently, how far the profession has fallen.

English bathing waters are cleaner than they have been for decades

John Middleton, an honorary professor of public health at Wolverhampton University and a past president of the Faculty of Public Health, has nothing to say about recent public health success stories, such as semaglutide, HPV vaccines, mRNA vaccines and e-cigarettes. Nor does he propose any new solutions to existing public health problems, other than “greatly expanded investment” in the public health industry. He does, however, have a great deal to say about the Tories, Brexit, “austerity”, neoliberalism and — above all — the urgent need for him and his colleagues to be given more money.

The picture he paints is a gloomy one. He claims that “poverty has accelerated” in Britain (it has not). He bemoans “13 years of austerity policies” (tax receipts as a share of GDP are at their highest level since the 1940s and public spending is even higher). Not unpredictably, he attributes the many failings of the NHS, which now consumes more than 10 per cent of national income, to “underfunding”.

Worse still, the gains made by the 1848 Act are, he says, are “being frittered away by a combination of neoliberal policies, vested and destructive commercial interests, a populist culture war, and industrial-scale disinformation”. Golly! How exactly do any of these pose a threat to tap water? I have never been quite sure what the “culture war” is, but I didn’t think it had anything to do with drains.

“Incredibly,” he writes, “we are now confronted with the return of Victorian sanitary ill health.” This does indeed seem incredible. There hasn’t been an indigenous case of cholera in Britain for well over a century. Our water is, he reckons, being “sacrificed on the altar of corporate greed”. This is a reference to the pumping of sewage into the sea after heavy rain, a consequence of the population tripling since the sewers were built. It is pretty disgusting, and we all wish it didn’t happen. Despite the attention given to it by the tireless campaigner Feargal Sharkey, though, English bathing waters are cleaner than they have been for decades. They are no worse than in Scotland and Northern Ireland where the water industry is state-owned. In 2022, 93 per cent of bathing waters in England were rated as good or excellent, very similar to the EU average of 94 per cent.

Speaking of the EU, it will not surprise you to hear that Professor Middleton is no fan of Brexit. He writes:

Brexit is forcing up wages in the private sector, compared to the public sector and one of the reasons UK inflation is higher than western European country comparators. It also makes the cost-of-living crisis worse for those on lower wages.

The last line is either a tautology or nonsense. He seems to be saying that inflation makes the cost-of-living crisis worse for people on low incomes. Inflation certainly hits the poorest hardest, but the cost-of-living crisis is inflation. It is just a media-friendly term for higher prices. Did Brexit cause inflation to be higher than it would have otherwise been? Possibly, but Middleton can only cite an article from the i newspaper (written by its Brussels correspondent) as evidence for this. At 6.4 per cent, UK inflation in July was not much higher than the euro area’s 5.3 per cent and barely any higher than Germany’s 6.2 per cent. As for Brexit forcing up wages in the private sector, that’s news to me, but it sounds pretty good. Stick that on a bus.

Straying even further away from whatever his field of expertise is, Middleton goes on to insist that “corporate profit is the driver for high inflation” and that higher interest rates “do nothing to address the problem”. Neither of these claims reflect the consensus amongst economists, to put it gently.

What does any of this have to do with public health, let alone sanitation? This is just a soapbox for some entry-level political ranting, buttressed by questionable factoids plucked from newspapers and some armchair economics. Even if everything Middleton says were true, which it isn’t, what are honorary professors of public health going to do about it? What special insights do such academics bring to contentious political questions and economic problems that have plagued humanity for millennia? Middleton only mentions COVID-19 in passing, but some of us have not forgotten that Britain’s well remunerated public health establishment were as much use as a chocolate fireguard during the only genuine public health crisis of our lifetime.

Now they want more money to do … what? Fight neoliberalism? Write angry op-eds about “destructive commercial interests”? Rejoin the EU? No wonder they want to bask in the reflected glory of the public health achievements of the 19th century. Never has there been a more wretched case of stolen valour.

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