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Last Updated: Tuesday, 13 November 2007, 09:02 GMT
Do public health interventions work?
By Nick Triggle
Health reporter, BBC News

Whether it is the pasteurisation of milk or a ban on smoking in public places, public health interventions have always been a contentious issue.

But are we set to see even more?

Milk and cigarette
Measures have included milk pasteurisation and smoking bans

It seems strange now, but back in the 1930s the issue of milk pasteurisation was controversial.

There were about 2,000 deaths a year from bovine TB, mainly due to people drinking raw milk.

But despite experts recommending milk be pasteurised - heated to kill bacteria - the public and parliament thought it was an unnecessary interference.

Only in 1949 did a bill finally come before parliament with campaigning MP Dr Edith Summerskill saying: "Pasteurisation has been prevented by ignorance, prejudice and selfishness."

The statistics show she was right. Nowadays the infection of humans with bovine TB is virtually unheard of.

Since the pasteurisation of milk - and indeed before then - a series of public health measures have helped to prevent disease and ill-health.

Possibly the first intervention was the Sanitary Act of 1866 which forced local authorities to supply running water and the disposal of sewage and waste.

Regulatory control

Air pollution was brought under regulatory control in 1956 with the Clean Air Act following the death of 4,000 people in the London smog of four years earlier.

And the 1960s and 1970s saw a series of measures, including drink driving and seat-belt laws, to curb the number of deaths on the road.

The latest measure - taken in England last July and the rest of the UK even earlier - was the introduction of a smoking ban in public places.

All these, experts say, have played a role in improving life expectancy which has increased by 70% in 150 years.

Air - Clean Air Act was passed in 1956 following the London smog four years earlier which killed 4,000. First piece of legislation to control domestic and industrial air pollution.
Water and sewage - The Sanitary Act of 1866 was introduced after the industrial revolution saw a huge rise in the numbers living in urban areas. Forced local authorities to supply running water and sewage and waste disposal
Smoking - Smoking in public places outlawed in 2007 in England following similar bans in rest of the UK.

But not all of them have been successful. Shortly before the link was made between smoking and lung cancer a lung cancer screening programme was introduced.

Suffice to say, it was quickly dropped.

Nonetheless, Dr Chris Spencer Jones, the chairman of the British Medical Association's public health committee, said: "Public health measures can have a huge impact and at times have played a more important role than medical breakthroughs.

"The UK has often not been the first to introduce these, but we have been good at implementation and that has saved many thousands of lives."

But does that mean the 21st century will see even more interventions than the last?

The government set the foundations with its 2004 public health white paper which paved the way for the smoking ban in England.

The guiding principle in the document was that the government should only intervene if an individual's or organisation's actions were harming others.

Food labelling

As well as a smoking ban, this has also led to a ban on junk food advertising during programmes watched by children and more voluntary food labelling in stores.

The Nuffield Council on Bioethics is now calling for the government to go further.

And while public health experts have welcomed this, there are still doubts over whether it will happen.

Birmingham University health expert Professor Chris Ham, a former government adviser, said while in some cases there may be a strong case for action, politicians were naturally cautious about such steps.

"The government was initially reluctant to introduce a full smoking ban. Blair and co had to be dragged kicking and screaming in the end.

"Political parties are sensitive about being given the nanny state label. They will always have one eye on how it will play with the electorate."


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