Public health and the NHS at 70: Fit enough for the challenge of new enemies in a new landscape? An example of public health measures to address alcohol consumption

The advent of the NHS saw a monumental shift in British policy and influencing attitudes and expectations of health care provision ever since. The NHS heralded a profound change in thinking, that health and the provision of health care were not a commodity that could be bought but a fundamental human right. Health care free at the point of delivery, was radical in its ideology and its consequent impact on British society and population health, particularly of the poor for whom access to health care had been limited or unobtainable. Unsurprisingly, the passage of the Act of Parliament that would invoke the NHS was not easy and there were strong objectors to the NHS initially, not least the medical profession for whom it threatened a loss of income. As Aneurin Bevan, the then Minister for Health, argued, ‘A free health service is a triumphant example of the superiority of the principles of collective action and public initiative against the commercial principle of profit and greed’. Health for the many, and particularly the health of the poorest, has often been vulnerable to the commercial interests of powerful actors such as corporations and industry. This is exemplified by the efforts of the alcohol and tobacco industries to fight public health policies aimed at curbing alcohol and tobacco consumption: through the publishing of poor science, political lobbying and finally through legal action at national and international levels. There is clear evidence that better public health cannot be achieved solely through the promotion of healthy behaviours but also requires active efforts to counter those powerful entities with vested interests in commercial profit. The manner in which the British government’s commitment to introducing a minimum unit price (MUP) for alcohol in England and Wales saw an extraordinary U turn has been described as a cautionary tale of the power of the alcohol industry to influence public health policy. In Scotland, where the bill was passed, legislative success was followed by a five year legal battle with alcohol industry trade bodies. MUP as a policy exposed just how strategically and earnestly industry will fight to preserve its profits and its interests at the expense of public health. The NHS exists not just as a provider of health services to the masses, but as a policy tool to address health inequalities and safeguard public health. It is needed as much now as it was at its inception