The Bill that could have been

The Welsh Government’s Public Health Bill has arrived and already the main focus of attention has been on the banning of electronic cigarettes in enclosed public spaces. Whilst the organisation I work for and some others remain unconvinced at the rationale behind such a decision, the inclusion of e-cigarette restrictions has almost acted as a smokescreen for a piece of legislation that will ultimately fall short of enhancing and protecting Welsh public health.

Devolution in Wales provides the space for doing things differently; we should expect our political leaders to be pushing the boundaries of our settlement and making substantial inroads to improving the health of our nation. You will often find instances of brilliance, interventions that are levelling the playing field and improving health– whether it’s taking the lead on tobacco controls in enclosed-spaces, the Active Travel legislation or setting families up for healthier lives through Flying Start. Unfortunately, and all too often, the ideas for innovating and improving public health are held by a small number of experts, with public and external involvement frequently being left behind.

At the beginning of June 2015 we saw the latest publication of the Welsh Health Survey, an important barometer of current lifestyles and a good way of assessing the challenges to come. The results showed 58% of adults were still classified as overweight or obese with 22% obese. It was perhaps more alarming to see that only 31% of adults reported being physically active on five or more days in the previous week. These results read alongside the substantial projected increases in chronic diseases such as cancer, diabetes and heart disease means that the Prudent Healthcare agenda set out extensively by Mark Drakeford may never be realised because our health service will be overrun.

I am not for a moment suggesting that this Public Health Bill, even if substantially different, would be the silver bullet for our future health problems but it should be able to make a serious contribution. When the Welsh Government published their Green Paper assessing the need for Public Health legislation in 2012, the paper brimmed with ideas. It set out the obvious future chronic disease threats from physical inactivity, obesity, alcohol and smoking. In turn, consultation responses to the Green Paper supported and provided more context for practical ideas to improve public health. The consideration of Health Impact Assessments or a ‘health in all policies’ approach for policy/planning decisions received wide support as a way of making our governance smarter in contributing to a healthier society. Fundamentally, the Green Paper was underpinned by an understanding of the socio-economic ties with poor health and a ‘can-do’ attitude for positive change.

When the Public Health White Paper arrived in April 2014, there were a few surprises for many of us in the third sector with an interest in health promotion. Notably the appearance of electronic cigarettes in enclosed public spaces and secondly, even with the strong support received for Health Impact Assessments in the Green Paper, these were not included in the proposals and with no reasoning provided for their removal.  However, the White Paper made some strides in proposing nutritional standards within public sector settings, such as schools and care homes and posed questions about restricting smoking in hospital and school grounds. These would have both been positive steps, however at some point between the White Paper and today’s legislation – these have also been lost.

What we are left with is a much less ambitious piece of legislation; one that uses a sledgehammer to tackle e-cigarettes whilst shying away from the issues we know are hurting the health of our public.

The media has naturally targeted the issue of e-cigarette restriction in public spaces; it’s high profile and Wales would be the first to press ahead with such restrictions in the UK. Charities and academics have already been portrayed as drawing battle lines on the issue, when much of the challenge could have been remedied by greater discussion and debate around the evidence. At the very core of the discussion around this legislation is a real desire and insistence from the third sector and experts that our Public Health Bill is something that makes more substantial inroads in health promotion.

The health service in Wales faces unprecedented challenges; many of these will come from the projected increases in preventable chronic diseases, largely caused by obesity, tobacco, physical inactivity and alcohol. Tenovus Cancer Care’s message to Welsh Government is simple – be evidence-based and bold.