1. Things We Forgot to Remember History, Public Health, Politics, Power and Collusion: Failing the Poor and Avoiding the Blame Dr Patrick Saunders Visiting Professor of Public Health 3 rd October 2012

2. Introduction Personal forgetfulness is an inevitable human characteristic Professional and corporate amnesia are not Some things are just too important to forget Add in neglect, abuse of power and privilege, political, personal and professional complicity My reflection on the lessons of history and five decades working in public health

3. Lessons from History Radio 4 recently had piece on what defines a ‘Brummie’ Victorian city fathers recognised the virtue of a clean and reliable water supply Joseph Chamberlain forced through legislation and compulsorily purchased Birmingham Waterworks Company for over £94 million This was fantastically courageous –conflicting science, vested interests, fierce political opposition, personal, professional and financial risk

4. Lessons from History “We have not the slightest intention of making profit...We shall get our profit indirectly in the comfort of the town and in the health of the inhabitants” Didn’t stop there-’discovered’ Elan Valley and embarked on the massive civil engineering project to dam and pipe clean water 118 km to the City by gravity Project required eight years, £200m, 50,000 men, a small town and a newly constructed railway

5. Lessons from History James Mansergh reported on facilities to the 1901 International Engineering Congress Clear political and moral principles at work: – commitment to do good, improve the conditions of the poorest, willingness to take personal and professional risks, commitment to collective responsibility and benefits, values above costs

6. Ignoring the Lessons Birmingham Waterworks empowered in 1826 – for the purpose of providing a sufficient and constant supply of good and wholesome water for domestic, manufacturing and other purposes Water Undertakers privatised in the 1990s Underpinning moral and political principles? Section 2 Water Industry Act 1991: – to further the consumer objective; – to secure that companies.......are able (in particular, by securing reasonable returns on their capital) to finance the proper carrying out of those functions

7. Ignoring the Lessons General duties of water undertakers are defined in s37 – to develop and maintain an efficient and economical system of water supply........; – to provide supplies of water to premises............; and – to maintain, improve and extend........water mains and other pipes

8. Ignoring the Lessons Led to major increase in investment funded by huge increases in bills and redundancies Sections 60-63 gave undertakers the power to disconnect properties for non-payment of bills Massive increase in disconnections Can’t pay or won’t pay? Section 68 requires undertakers to supply wholesome water

9. Ignoring the Lessons The underlying political and moral principles appear to be firstly generate and protect profits, secondly transfer collective responsibility to personal and thirdly to provide safe drinking water How come it took us about the same time to make disconnection illegal in the 20 th Century as it took the Victorians to develop Elan Valley and deliver safe water to all?

10. Ignoring the Lessons Did we not forget the lessons of history? Did we not fail the poor and blame them? Was the economic regulatory model used stacked in favour of initial share prices and continuing returns rather than public health Drinking water the new ‘capitalism in a glass’? Are we now doing the same with the NHS? Is Monitor about competition rather than provision of effective healthcare?

11. Ignoring the Lessons and Colluding "It is clear that what the NHS desperately needs is public support for planned change to services. But politicians have consistently failed over many years at national and local level to put the long-term interests of their population's health above their short-term electoral interests.” Is support for the Public Health Responsibility Deal not collusion?

12. Collusion All this needs to be seen in the context of the flight from a generally shared collective responsibility to one dominated by individuality Concerted effort to engineer a shift in public attitudes to the poor and working class Traditional working class values such as solidarity, collective defiance and aspiration have been systematically ridiculed, marginalised and eroded by the media, politics and the state

13. Blaming the Poor The Victorians talked about improving the health, education and environments of the working class-now the talk is about escaping the working class to join the property owning middle classes This at the same time as the working class is not only impoverished by unemployment and low pay but blamed for the consequences Inequalities are due to personal moral failings, becoming natural, rational and inevitable

14. Demonising the Poor This has created a poisonous hierarchy of virtue Those left behind are feckless, lazy, incompetent and inevitable-the return of the (un)deserving poor When Christ and Marx said that the poor or the lumpenproletariat respectively were always with us-this wasn’t a manifesto commitment but a statement of fact The British Social Attitudes report shows the success of this drive to shift public opinion

15. Demonising the Poor Inevitably leads to accusations of the irresponsibility and immorality of subsidising them Twas not always so 1970s are routinely portrayed as a grim time but we had Culture the Cramps one of the most equal societies Is this important? Being poor seems to have a biological effect Absolute and relative inequalities are both important

16. Failing us all The Spirit Level argues that economic growth has done as much as it can, in some cases it appears to be damaging health If Britain’s incomes were as equal as those of Japan and Scandinavia, seven extra weeks' holiday a year, we would be thinner, live a year or so longer, trust each other more, and we’d be happier

21. Losing the War We are rich enough to be fairer but not fair enough to be richer “Show me where to surrender” Kinnock when asked if the Tories were the new class warriors replied ‘No-because we signed the peace treaty without realising they hadn’t’ Inequalities are widened by the rich getting richer rather than the poor getting poorer?

22. Losing the War Patently not true and in any case where is the moral compass pointing here? Some of the partners to the Responsibility Deal are notorious for low wages subsidised by the State through tax credits Winston Churchill recognised the iniquity of low wages and the moral value of organised labour and bargaining in 1909

23. Losing the War War on the poor rather than a war on poverty? Pernicious cultural dimension-become acceptable to sneer at the ‘chavs’, their lifestyles as documented in grotesque peep shows, the ways they work, rest and play-as if they were the architects of their destinies Smug assumption that this is a value based choice

24. Failing the Poor The journey of football from honourable working man’s sport to hideous, tawdry, over priced freak show is an interesting case study Football was the quintessential working man’s sport, both in terms of participants and spectators, and a source of huge local pride and identity Poorly managed, restrictive employment practices, indifference to safety standards, supporters viewed and treated as the enemy

25. Failing the Poor Regular mortal incidents including Ibrox and Bradford, culminating in the maelstrom of lies, indifference, blame shifting, cover up, demonisation, criminal incompetence, and 96 entirely preventable deaths that characterise the Hillsborough scandal Football has been transformed into a rich man’s toy to the exclusion of most of those who founded it Why football? Could this ever have happened to tennis, rugger, golf, cricket, equestrianism?

26. Failing the Poor Did these sports ever stick it to Hitler? Did they open up a world of adventure and discovery otherwise closed to the working classes? On another note why does the BMA want to ban the ‘sweet science’ which is safer, more accessible and empowering? Continue to send 17 year old working class kids to be killed in far off lands where there is absolutely no prospect of success

27. Using and Communicating the Science Historically massive demand for vaccination against deadly diseases Pandemic flu 2009/10 Sandwell led the country! Enormous demand for Tamiflu Limited demand for vaccination Within a generation we have gone from queues to 16% of pregnant women vaccinated against flu

28. Enabling the Unacceptable Complacency Giving anti-vaccination movement equal status when there is NO respectable evidence Professional irresponsibility Losing the imagination and information technology wars Perverting human rights legislation and individual freedom to threaten the health of everyone especially the vulnerable

29. Other Things We Continue to Forget One of the few highlights of the current NHS reforms is the return of public health to local authorities This is where it all started, where it had its great triumphs, and where the great potential for the future lies – harnessing the local power of democracy, the great sweep of local authority responsibilities, adding value through evidence and analysis Yet in a mere 38 years both sides appear to have forgotten which is not just unfortunate but a real risk

30. Other Things We Forgot The ‘grand’ environmental issues dominate policy and research concerns When asked, the good folk of Stoke, West Bromwich and the like have other concerns – Litter, fly tipping, noise, bonfires, housing disrepair, street lighting, derelict land As Dr Simon said in the 1800s ‘The interests of health and the interests of common physical comfort and convenience are in various cases identical’

31. Other Things We Forgot Forgotten the power of the great canon of Victorian based public health law especially around nuisance There are reasons why much of it remains intact "an act not warranted by law, or an omission to discharge a legal duty, which act or omission obstructs or causes inconvenience or damage to the public in the exercise of rights common to all Her Majesty's subjects“

32. Reflection We have forgotten things we should have remembered We have failed the poor Politically, corporately, professionally and as individuals We need to be humble, imaginative, less po- faced, challenging, righteous, use the science and communicate it, take risks, remember why we’re here and who needs us most