Health Promotion

On October 30th I was a guest at a reception in the Palace of Westminster to celebrate the 50th anniversary of the Institute of Health Promotion and Education (IHPE). Hosted by Rosie Cooper, MP for West Lancashire and a member of the Commons Health Select Committee, the reception was attended by around a hundred people, including several MPs and peers.

I had never before visited the Palace of Westminster. An instruction sheet warned of airport style security, but whoever wrote that had clearly never experienced an airport. The exceptional cheerfulness and friendliness of all the staff of the Palace of Westminster made it as unlike an airport as you could possibly imagine. I am not much impressed by vaulted ceilings, stained glass and paintings of Henry VIII, but I was very impressed by that.

The reception began with afternoon tea, which was very pleasant, the sandwiches being markedly fresher than the scones and markedly firmer than the extremely gooey cakes. The tea itself was excellent. Even if you didn’t like tea, it would have been worthwhile asking for a cup just to see it poured with such aplomb.

Speeches followed.

Prof. Choudhury and Rosie Cooper

Professor Choudhury, President of the IPHE, acted as compère for the event, though somewhat incompetently. He was hard to make out, and he didn’t seem to be quite sure what was happening. He introduced Rosie Cooper MP as the keynote speaker.

Rosie Cooper dismissed the suggestion that she would make a keynote speech. Instead she gave a short introduction and welcome in which she kept stumbling over the phrase “Institute of Health Promotion and Education”. She would have been better to stick to “IHPE” or just “the Institute”.

Prof. Kelly

Professor Mike Kelly, Director of the Centre of Public Health Excellence at the National Institute for Health and Clinical Excellence (NICE), gave an interesting but essentially confused presentation about NICE’s new role in public health.

His view is that changing people’s behaviour is central to public health, and that this work is opposed by commercial interests:

“The food industry, the advertising industry…circle the wagon train rather menacingly.”

However, at one point he asserted the goal:

“Above all, make sure we’re doing no harm.”

At a later point admitting:

“Our ability to predict is minuscule.”

These are obviously incompatible. In order to do no harm it is necessary to be able to predict any possible harm quite accurately. He was keen on understanding human behaviour in its social context, and critical of current attempts to control misuse of alcohol by what he called “one-size-fits-all interventions”.

Although he spoke well, and with enthusiasm, his enthusiasm seemed to be for highly targeted social control directed from an office in High Holborn, unfettered by any ability to predict the unintended consequences. I was not convinced that he is safe to be let loose with such power.

Prof. Lynch

Professor Edward Lynch, Head of Dentistry at Warwick Medical School, made a general-purpose speech that was mercifully short.

Mike Rayner

Mike Rayner, Director of Oxford University’s British Heart Foundation Health Promotion Research Group, had brought along a jar of Nutella, which he criticised for containing too much sugar. He was happy that its manufacturer, Ferrero, could no longer advertise it to children on TV.

He also brought along a pizza packet. (He had eaten the pizza.) He was happy that the packet had traffic-light style labelling to show how healthy the pizza is, or isn’t. However, he admitted:

“I avoid the ones that have all green. I find them somewhat tasteless.”

He was disappointed in the poor response that there has been to health education leaflets, and disappointed that bans on advertising are not complete, saying that in the past:

“What I wanted was skulls and crossbones on certain foods.”

It was pointed out that children associate skulls and crossbones with pirate adventures, so that had he got his way it could have had the opposite effect to the one he intended.

I thought he came across as a superstitious fanatic who should be kept well away from that office in High Holborn from where our behaviour is soon to be controlled. It was no surprise to discover his religious leanings when I Googled him to find a biographical link.

David Wells

David Wells, Deputy Director of ChiMat, a Child and Maternal Health Observatory quango, made a promising start:

“Infant mortality is a good measure of the overall health of the community.”

But he quickly seemed to lose the plot as his presentation rambled on to breastfeeding, obesity, alcohol and mental illness, which he seems to believe are all linked in ways that hardly anyone else believes. Pauses between his sentences progressively increased in length, until at last there came a time when the next sentence just wasn’t there, and he stopped. Fascinating to watch, but not in a good way.

I suspect that ChiMat will come under Public Health England from April 2013, and that some reorganization might be on the cards.

Prof. Stephen Palmer

Professor Stephen Palmer, emeritus Editor of the IHPE’s journal, spoke about the history of the journal. It had had only four editors in its fifty years, partly because its initial editor stayed on for thirty of them.

The journal had changed its appearance many times, and we were told of each change in tedious detail. I would have been happy just to have compared the first edition with the latest, though Prof. Palmer had not been able to find a copy of the very first.

I winced to hear this distinguished professor and editor of an international journal use phrases like, of the journal’s Internet presence:

“literally into the aether”


“promote the system over different medias”

(Hint to the bemused: The aether is just a metaphor, so it can’t possibly be taken literally, and “media” is already the plural of “medium” so you can’t make it even more plural by adding an “s”.)

He went on to present the IHPE’s award for the best research paper, the Pittu Laungani Award. It went to Linda Quan at the Seattle Children’s Hospital Research Foundation, and others, for a paper on the risks of drowning in open recreational water. Prof. Palmer mentioned that the UK loses around one child a week from drowning. The winning paper is: Use of a consensus-based process to develop international guidelines to decrease recreational open water drowning deaths

The IHPE strikes me as an organization whose time has come, after 50 years. It seems full of people with strong beliefs who are certain that everyone else would be better off believing those same beliefs. The Guardian’s obituary of Pittu Laugani described him as “at odds with western counselling methods” because of his belief that people should accept what gurus tell them. However, the IHPE’s wannabe gurus in public health now find that engineering behaviour change has become fashionable, even if it is still controversial.

A recent House of Lords Science and Technology Committee report on Behaviour Change concluded that:

“…it is important that ministers are always able to explain the evidence-base of any proposed behaviour change intervention, and why it is a necessary and proportionate means of addressing a well-defined problem…”

I didn’t hear much about evidence-based and proportionate means in the speeches at the reception. Unless the IHPE takes on these difficult issues, I fear that in another 50 years it might again find itself on the wrong side of history.


About Rod

Chairman of the Gloucestershire charity Suicide Crisis, Vice Chair of Relate Gloucestershire & Swindon, and an enthusiast for public involvement in the NHS.
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