The paradoxes of public health

The promotion of public health is a liberal policy. It is an effective tool in the development of fairness and equality, it contributes notably to health and happiness (thereby reducing the need for, and the expense of, medical care; and reducing the cost to businesses of time off work), it enables people to have much more effective control over their own lives, and many of the activities associated with it resist financialisation, which is one reason why it is so unpopular in right wing circles.

It is also a wide ranging field. Healthy populations need good quality, warm, dry housing; good education; good food; good opportunities for both rest and exercise. On the other hand, reduction of social housing, the obsession with reducing education to league tables, corporate control over food prices and ingredients, the selling off of parks and playing fields, all contribute to reductions in public health.

Fundamentally, good public health reduces the impact of poverty, ignorance and conformity in people’s lives.

Public health requires a community based rather than an individualistic response. This again is a liberal value. While we champion the freedom of individuals, we also champion the notion that we live together in communities, and that we affect, and must support, each other. It is an effective sphere for government to do what we cannot do so well ourselves. It utilises “the power of government to change conditions that are constraining people’s freedom”.

As a country we allow the debate to be dominated by advocacy of a freedom that takes no responsibility, by far too much misinformation, and far too little information. (A very clear example at the moment is when both government and media notice that the number of people off sick has notably increased recently, and wonder why. Without ever mentioning Covid, which we know has severe long term consequences for many who have had it.) As a party we allow ourselves too often to be trapped within those terms rather than campaigning to change them.

The party currently has very creditable policies on public health: well thought out, detailed and workable. (I encourage you to go and read them.) I doubt that they will gain much prominence in a LibDem manifesto in the near future, any more than any other party’s. (I understand the reasons for this; the bandwidth in an election campaign is severely limited.) But perhaps we, as the foot soldiers of liberalism, should be making a much more concerted noise about the benefits of public health as well as the possibilities for local as well as national action in that sphere.


* Rob Parsons is a Lib Dem member in Lewes. He blogs at He curates Liberal Quotes on Facebook

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  • Nigel Jones 26th Apr '24 - 2:28pm

    Rob, I welcome your points about a community based response to public health rather than purely individualistic and about responsibility that comes with freedoms. Responsibility is encouraged when people work freely together, getting to understand and lean from each other. I remember Nick Clegg in a special January one day conference before the coalition stressing the need to realise that people now want more approaches that support individualism and I was not completely comfortable with that. Liberalism to me means establishing frameworks in society where people can freely engage with each other in ways that both respect all views and help each other. It is contrary to Margaret Thatcher’s view that there is no such thing as society. As you imply, both Conservatives and Labour now stress individualism in their policies and that leads to both harsh expectations of conformity and picking off individuals against each other.

  • Nigel Jones 26th Apr '24 - 3:03pm

    Further to my comment, you are pessimistic about whether public health will feature in a manifesto, but there is no reason why in campaigning it could not be part of the message about the NHS. Last night on Question Time Munira Wilson strongly mentioned social care in a debate about people being not fit for work, since this does not only apply to the elderly. That is even more the case with public health.
    Note that I put the word ‘lean’ where I meant LEARN in previous comment.

  • Simon McGrath 26th Apr '24 - 3:22pm

    oh dear. ” corporate control over food prices ” , The UK has a hugely competitive market for food, indeed writers on LDV in the past have been known to complain food prices are too low.

    How do you think food prices should be set ?

  • Rob Parsons 26th Apr '24 - 5:41pm

    well, not by corporations. The supermarkets between them exercise hefty control over our prices. As I understand it, in recent months prices of supermarket goods have been rising not because of their input prices but because they are taking more profit. At the other end, production of food is largely controlled by agribusiness which is keeping prices lower than they might be but at the cost of ruining our environment with fertiliser and slurry run off and compromising the product with antibiotics and other chemicals.

  • Rob Parsons 26th Apr '24 - 5:43pm

    @ Nigel Jones 3:03pm

    I understood that you meant “learn” 🙂

    You make a good point; it could be part of the message, but I’m not holding my breath.

  • I was of the understanding that current sickness absence rates are due to a rise in mental health problems such as anxiety?

  • Steve Trevethan 26th Apr '24 - 6:01pm

    When we are being guided by theory, might we bear in mind that freedom to/individualism is only valid when coordinated with freedom from?

    When we are guided by practicality, might we keep in mind that states without and effective national health system, sentence their citizens to shorter lives, eg. the USA.

    Might a crucial assessment of governmental policies and practices be the extents to which they have symbiotic and predatory effects on citizens and their children?

    What is our party doing about the 25%+ of our nation’s children who are chronically/permanently underfed/undernourished?

    P. S. World wide, people who have had the experience of tertiary education live longer and better, so what are our policies on tertiary ed?

  • Rob Parsons 26th Apr '24 - 8:00pm

    @Steve 6.01pm: the answers to your questions are in the plan: – read the sections on health and on pensions and benefits. But also the answers to these questions lie not in individual policy areas but in a whole government approach, which is why the first section of the plan “our fair deal” is important.

  • @Steve Trevethan
    Please provide a source for your claim “…25%+ of our nation’s children who are chronically/permanently underfed/undernourished…”

    I understand that we have a problem of children who are overfed and yet undernourished (because they, or their parents, make bad dietary choices) but would expect the number of those chronically underfed to be less than 2.5% (rather than 25%.)

  • Steve Trevethan 27th Apr '24 - 9:24am

    Thanks to Rob Parsons!

    Might we have attention grabbing, attitude changing, vote gathering slogans which present our “headline” policies powerfully?

    On child food deprivation:,the%20start%20of%20the

  • Rob Parsons 27th Apr '24 - 1:52pm

    @Marco 26th Apr ’24 – 6:00pm There has been an increase in anxiety and related illnesses but that is not the whole story. The stats on mental illness don’t show the cause of the illness. Some people are still trying to claim that the cause is lockdown, which is rubbish. Much of the increase in anxiety is caused by people living in anxiety producing circumstances. The number of people living in povety is high – in the millions – and still increasing. If each week you don’t know if you’re going to be able to feed your children next week, the result is potentially crippling anxiety, and that’s not going to go away until you can have some confidence that you and your children will not go hungry. That’s why a LibDem approach, increasing equalty, is a must for good public health.

    The other key issue is that the increase in sickness and absence levels is often analysed without any mention of that which must not be mentioned, ie Covid. We now have 2 million people in this country with Long Covid, some of them severely affected and off work as a result You wouldn’t know from official sources, but eg this demonstrates that Long Covid numbers are still increasing. The same goes for children off school – there are more than 111,000 children with Long Covid. But the government is running campaigns to get sick children back into school, where they can infect other children, and their teachers.

  • Rob Parsons 27th Apr '24 - 2:01pm

    @Mary Fulton 26th Apr ’24 – 10:07pm

    “I understand that we have a problem of children who are overfed and yet undernourished (because they, or their parents, make bad dietary choices) but would expect the number of those chronically underfed to be less than 2.5% (rather than 25%.)”

    Steve has given you the source for the 25% figure, which does not surprise me at all. While some of those are persistently underfed, the issue is not so much that they are never well fed, but that they can fall in and out of periods of hunger. Their wages, and hence their lives, are unstable.

    The key issue here is not under- or over-feeding, but wrongly feeding. It is possible to buy a lot of very cheap food, but most of it is dreadful from the health point of view. Buying good food for your children is much more expensive, and often beyond the reach of a poor family’s budget. It is not poor choices that mean children are badly fed, it is poverty.

  • Rob Parsons – do you have evidence that lockdown had no effect on mental health? It would be surprising if the isolation imposed along with fear based messaging did not have any impact. There was a meta analysis in the BMJ in March 2023 and whilst they tried to present their findings as showing minimal effect, if read closely there was an increase in mental health problems among women particularly lone parents.

  • @Mary Fulton 26th Apr ’24 – 10:07pm…

    If anything the number of those undernourished children is under-estimated at 25%..

    As both the Child Poverty Action Group and Joseph Rowntree foundation estimate that around 4.3 million (30%) UK children are living in poverty I doubt if many of those 4.3M are ‘well fed’..

  • The way this discussion has progressed shows how interconnected so many factors are. Hence the need to recognise the need for more integration of public services and policies and that no single policy (e.g. on public health or even NHS) can provide the solution to people’s problems. That is not surprising when you remember that everything should be people centred not organisation-centred and that surely is at the heart of what Liberalism is all about.

  • Marco 27th Apr ’24 – 4:12pm I didn’t say lockdown had no effect; it did not have the major effect some Covid minimisers suggest. I’m sure it put stress on a lot of people. By and large many people will have recovered from that stress – the human race is quite resilient; but I’m sure that some small proportion will have suffered long term effects. (Nevertheless, I believe that lockdown was fully justified – the long term effects of dying of covid are also quite severe.)

  • On food insecurity: Steve made the claim that “25%+ of our nation’s children who are chronically/permanently underfed/undernourished?” The FoodFoundation link he provided to actually makes the much lesser claim that 25% of families with children have experienced food insecurity at some point within the previous month. While any food insecurity is bad and a cause for concern, it’s not at all the same thing as being chronically/permanently underfed/undernourished – since it appears that even one day in the month when you can’t reliably obtain healthy food would meet the criterion for ‘food insecurity’, but would fall a long way short of ‘permanently undernourished’. So it looks to me like Steve’s claim is not true.

  • It’s a good call, and a timely reminder that the structure of the U.K.s food system is a choice not a natural evolution.

    Take food availability. Across continental Europe government policies have prioritised local food production and retail over mass supermarketisation, keeping fresh foods available at affordable prices and in local markets and small retailers. Such providers don’t bend as easily to the large processed food manufacturers, and mean that fresh ingredients are given better priority than processed foods.

    We do all suffer from the creep of fast and highly processed food however, which is supported by huge multinational corporations with very large advertising budgets. They jump on every new trend and bend it to their commercial interests, as we’ve seen most recently with the rise of highly processed vegan foods.

  • Rob Parsons 28th Apr '24 - 5:28pm

    @Simon R 28th Apr ’24 – 5:59am The evidence suggests that you’re right in terms of the specific claim. But that does not detract from the fact that even intermittent food insecurity is enough to keep people permanently on the edge of hopelessness. It should not be the case, in the sixth largest economy in the world, that anybody ever has to go without food. That so many do is iniquitous.

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