Professor Chris Whitty, the Chief Medical Officer for England, was the opening speaker at Medicine 2022. Professor Whitty gave a wide-ranging talk on the relative roles of the state, the medical profession and the individual in improving public health.Shared below is a summary of the key points from the presentation.
Public health aims to extend healthy life by preventing or delaying disease, death, ill-health, indignity and disability. Individual citizens, medical professionals and the state all have responsibility and a role to play. While much of public health does not require the state, the state has powers and resources that can prevent death or ill-health in many citizens – the question is when should the state use them? How a person answers this question depends on their discipline, nation and time in history.
Primary care physicians and specialists have the central role in most secondary and tertiary prevention while primary prevention, for those who are not yet unwell, and health protection against infectious outbreaks and other emergency threats, often falls to the state. It is the job of health specialists to lay out the evidence and say what can be done by the state to improve health, and the risks either way, while it is the job of elected politicians, on behalf of society, to say what should be done by the state. Medical professionals can support this process by presenting the data and evidence clearly to government.
To illustrate this, Professor Whitty outlined the public health concept of the ‘ladder of possible state intervention’. He explained that options at the bottom of the ladder can include supporting science to test possibilities, informing the public of risks and engaging with industry to help them improve the health of their products or services. Further up the ladder is regulation, ‘nudge’ taxes, behavioural interventions and mass voluntary programmes, such as vaccination or screening, in which individual consent is possible and essential. The top end of the ladder includes heavy taxation, banning products or making individual citizens subject to civil or criminal law, and in these cases the complex trade-offs must be decided by politicians. For some public health issues, the state may choose to implement multiple interventions from across the ladder.
Weaving in a range of examples, including vaccination, air pollution and obesity, Professor Whitty explained how the public’s opinion on when the state should or should not act on public health depends on the health issue in question and can shift over time.