Shirley Cramer CBE, Chief Executive of RSPH

​Shirley Cramer CBE, Chief Executive of RSPH, looks back over recent victories for public health and the moral dilemma of public health versus individual choice.

Last week was a good week for public health, when we celebrated two legislative victories related to tobacco; banning smoking in cars when children are present and standardised packaging for cigarettes. These are victories for commonsense and indicate, given the overwhelming parliamentary majorities, that the public and their representatives take a pragmatic and moral approach to public health.

I had reason to think more philosophically than usual last week when I was invited to be a ‘witness’ on Radio 4’s Moral Maze (Wednesday at 8pm) chaired by broadcaster Michael Buerk.

The format is that a panel of four individuals from different parts of the political/philosophical spheres question four ‘witnesses’ on different aspects of the issue of the day. They then discuss amongst themselves who has performed best, or argued most cogently. The difficulty last week was the title ’Public Health v Individual Differences’, as from my point of view these are not irreconcilable.

Most people that I have met in the public health world think that a balance should be struck between protecting the collective health of our country (think of infectious disease outbreaks) and protecting individual freedom (you can still smoke even though we know it is bad for you). I tried to argue that in public health we want to give people accurate and helpful information so that they can make good choices, for example eating healthily, not drinking to excess and not smoking, but at the end of the day, the individual will make the choice.

It didn’t help that I was referred to as the ‘Arch Nanny’ at the beginning of the piece despite the fact that they didn’t know my views! I suppose that a moderate view doesn’t make good listening but it does seem ridiculous that someone can posit that smoking yourself to death is not only your right (yes) but also makes you cheaper because you die early (no). I think that several years of preventable ill health where you are likely to become a costly burden on your family, friends and the state is a moral issue too.

I am sure that there will be more debates of this nature over the next few years, but overall I think the balanced approach of public health will prevail.