PUBLIC HEALTH Health secretary defends controversial views on the pleasures of nicotine

Published: 02/12/2004, Volume II4, No. 5934 Page 11

Health secretary John Reid has refused to apologise for his comments this summer about smoking being one of the few pleasures left to the working classes.

In a speech to the Faculty of Public Health, which at the time condemned his comments made at a Labour Party Big Conversation event in June 2004, he said: 'I got into trouble for empathising with a single young mother who might enjoy smoking. Apparently it was wrong for a secretary of state to understand that this might not be the worst thing in the world and might be the last thing on her list of worries, quite frankly.' This was not a call for people to smoke more but for public health workers to understand how people make health choices, he said.

'If we do not understand that the smoking or the sex might be the most pleasurable thing in some people's lives, we will never be able to help them change.' His speech, the first since publication of the public health white paper, outlined his vision of government creating the material circumstances in which people can take responsibility for their own health.

Defending himself against 'nanny state' accusations, he said: 'The only way you can attain good health is by taking responsibility. It is true not just for the rich, fit people but for people from severely disadvantaged backgrounds. We can provide advice but unless people take responsibility nothing much will happen.'

But people made different choices about their health depending on their circumstances. 'The opportunity to make healthy choices is not evenly distributed, ' he said.

Public health would in future be a central part of the health service, he said, with 10 of the 20 performance targets for 2008 being about health improvement. 'If we are re-elected, 50 per cent of the endeavour of the government and NHS will be in health, not sickness. No English government has said that before.' His speech was well received by the audience, many of whom told HSJ that he had understood what their profession had been telling him.

But British Dental Association chief executive Ian Wylie said that in order for the government to create the opportunities for people to make healthy choices, it might have to limit freedom: 'Take sugar, which is almost an environmental hazard as it is so pervasive. In order for any individual to exercise their choice to avoid sugar we need to limit it.

That is where this gets interesting.'

. The government has pledged£300m to 'modernise and transform' sexual health services in England,£50m of which has been earmarked for 'the biggest advertising campaign on sexual health in 20 years'.

The funding will cover£80m for the national roll-out of chlamydia screening by 2008,£130m for modernising genito-urinary medicine clinics, and£40m for improving preventative services such as contraceptive clinics.