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| The Welsh Government have launched a consultation of their - slightly controversial - Public Health Bill, which has led to accusations of "nanny stateism". (Pic : chronicallive.co.uk) |
About a fortnight ago, Health Minister, Mark Drakeford (Lab, Cardiff West), unveiled draft proposals for a flagship Public Health Bill, which has been put out for consultation until June 24th (more details here).
The Public Health Bill will be a key piece in the jigsaw surrounding another (slightly bizarre) law in the pipeline – the Future Generations Bill – which is supposed to address long-term, generational challenges like climate change, the economy, demography, the future of the Welsh language and long-term health problems.
The British Medical Association describe the proposed Bill as a potentially "seminal" piece of legislation.
I've done quite a bit over the last few months covering public health – most notably childhood obesity and drugs – so I'm not going to go into extensive details (heh).
The proposals include measures on obesity, registration of tattooists & cosmetic piercings and community pharmacies. Alongside these, there are three "headline policy proposals" that could make their way into the Bill : minimum pricing of alcohol, a ban on the use of electronic cigarettes (e-cigs) in enclosed public spaces and public toilet provision.
Booze : A minimum price for alcohol
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| A 50p minimum price per unit of alcohol is included in the draft proposals, which could see the price of a standard bottle of whiskey set at £14. (Pic : Daily Record) |
As I covered last month, there are around 500 alcohol-related deaths each year (mostly men), contributing to liver disease, strokes, high blood pressure and depression. The total cost of alcohol-related disease in Wales is said to be somewhere between £70-85million per year, and there were more than 15,000 hospital admissions related to alcohol in 2011-12.
Although it's said the number of adults drinking to excess has decreased slightly, some 42% of adults report drinking above the daily recommended guidelines (3-4 units for men, 2-3 units for women) at least once a week.
Most of the powers over this are in the hands of the UK Government, and licensing alcohol is a non-devolved matter. The Welsh Government have requested licensing powers, but they've been consistently refused, though the devolution of those powers could be included as part of inter-governmental negotiations arising from Silk II.
The main measure the Welsh Government propose is to introduce a 50p per unit minimum price of alcohol. "Setting a floor" for alcohol prices means it can't be sold for anything less, restricting access to cheap, high-strength alcohol (White Lightning, Special Brew etc.). It's said a 70cl bottle of whiskey would sell for a minimum of £14 under this price arrangement.
The UK Government rejected a similar move to cover EnglandandWales because they weren't convinced it would reduce alcohol consumption, while minimum pricing at 50p per unit was introduced in Scotland in 2012 – though it's currently subject to a judicial appeal from alcohol producers.
The Welsh Government say "there is indisputable evidence that the price of alcohol affects consumption", with a particular affect amongst younger drinkers. They cite research from Sheffield University (pdf) which states a 50p per unit minimum price would reduce alcohol consumption by between 7-11%.
Bans : Use of e-cigs indoors
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| In a slightly controversial move, the Welsh Government are considering extending current smoking bans to e-cigarettes. Is this the "nanny state"? Or is it prudent public health policy? (Pic : The Independent) |
I should probably declare an interest here as I know someone who runs an e-cig store.
This is perhaps the most controversial proposal, and certainly caused a stir, with accusations and counter-accusations about encroachment of the "nanny state" (related blog from Peter Black) and the dangers of "normalising smoking".
Without question, tobacco is the deadliest way to take drugs in Wales. As covered last month (again), smoking-related diseases kill ~5,000 people in Wales each year, estimated to cost the Welsh NHS £302million, and a further economic impact of £90million in sickness and smoking breaks. The numbers starting smoking have shown consistent falls, however the number of Welsh adults who smoke remains static at around 23% of the population.
There's nothing Welsh Labour love more than a good ban, proving that not all left-wing parties are as progressive or liberal as they think they are - what I described last month as, "a social conservatism based around wanting to protect people from themselves". I'm certainly a "lefty", but I've come round to disliking this sort of paternalist collectivism as much as the rampant free market.
Recent tobacco restrictions include banning vending machines sales, banning smoking in enclosed spaces and bans on open tobacco displays at point of sale. They also support standardised packaging for tobacco products - which could be introduced across EnglandandWales at some point - as well as a ban on smoking in cars when children are present.
Proposals here include the creation of a register for tobacco retailers, and a ban on "proxy sales" of tobacco (adults buying fags for kids), making it a criminal offence. They are also asking for views on internet sales.
The headline proposal was, of course, a ban on the use of e-cigs in enclosed public spaces in the same way as the current ban on tobacco smoking. Around 14% of smokers use e-cigs. There are no current restrictions on sale, though the UK Government are going to introduce an 18 age limit in line with cigarettes.
The Welsh Government say health authorities are concerned that e-cigs are "normalising" smoking, acting as a gateway to full tobacco, risking "a new generation addicted to nicotine". They also believe e-cigs make it harder to enforce current smoking restrictions and/or make people think they can smoke when they really can't.
Current evidence points towards there being little to no harmful effects from e-cigarettes other than nicotine addiction – which is harmful in itself, but only one small factor in the harm caused by smoking.
Although they'll almost certainly have an affect on the lungs, e-cigs don't contain many of the harmful ingredients found in cigarettes (tar, formaldehyde, nitrogen oxide, carbon monoxide etc.) which causes chronic lung disease. The exhaled "smoke" is mostly steam, though it does contain traces of chemicals and nicotine - albeit to a much, much lesser extent than cigarette smoke. Until more thorough research is undertaken, it's hard to argue that e-cigs are harmful to anyone else other than the user.
E-cigs work the same way as a nicotine patch but used in a similar way to a normal fag, potentially - though not 100% conclusively (pdf, pdf, pdf) - making them powerful tools in getting people to stop smoking, and they're certainly more healthier than fags. The Bevan Foundation's Victoria Winckler (also discussed on Syniadau) argued that the primary goal in any public health policy on smoking should be to reduce the use of cigarettes, and e-cig restrictions would "only have a marginal effect".
I fear this is another case of policy-based evidence making. The consultation reads as though the Welsh Government and health authorities are fishing for evidence from the public in order to say e-cigs are bad. It'll probably take the form of the usual "argumentum ad filium".
There's nowhere near a strong-enough case to ban e-cigarettes in public places (yet). Restrictions would perhaps be medically-sound as nicotine is one of the most addictive drugs, but it's scientific nonsense. Having said that, there is clear need for better regulation, and the British Medical Association have called for e-cigs to be regulated like medicines - which is what I called for in relation to all recreational drugs, so I'd agree with that.
If the Welsh Government are absolutely determined to do it, a ban should be provisional with a "sunset clause", and accompanied by high-level research into the relative risks and harm. If it's proven there's minimal risk to anyone else other than the user from e-cigs, any ban should be rescinded by the Assembly.
I don't mean to be scatological....well of course I do, and I doubt I'll be the first or last person to make this argument....but a paint-stripping, face-melting fart is probably more toxic than e-cig vapour. Methane and hydrogen sulphide aren't things you should breathe in casually. Not wanting to put too fine a point on it, but I'm sure we've all been victims of "passive guffing" in an enclosed public space at some point.
I once experienced one, worthy of The Western Front, in a German class (ironically) during a rather hot summer's day. Portacabins aren't exactly renowned for their good air conditioning, so despite the best efforts to diffuse it, it hung like a mushroom cloud above everyone's heads, raining down sulphur. It was like the River Styx. As a result, all the boys were kept behind afterwards and lectured on etiquette. That just prolonged the misery, as everyone was desperately trying not to laugh and draw suspicion to themselves, enduring something that could only be described as drowning in ass.
I'd rather inhale puffs of strawberry laced with nicotine than be exposed to someone else's dietary issues.
Moving on....
Bogs : Access to public toilets
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| Public toilets are the forgotten son of public health, but are absolutely vital. (Pic : BBC Wales) |
Though, of course, men have an in-built anatomical privilege which turns any vertical surface into a urinal. Ahem. But that does public health or general hygiene no good at all.
It's not a particularly pleasant thing to think about, but provision of public toilets is – genuinely – no laughing matter; especially if you're elderly, have young children, have certain health conditions, or brought a catastrophe upon yourself by eating too many sugar-free sweets. It's one of the most overlooked and unappreciated areas of public health, and as a marginal expense, it's under attack due to local government austerity measures.
One of those much-maligned and overlooked short debates in the National Assembly could've played a role in the getting this measure on the table. Kirsty Williams AM (Lib Dem, Brecon & Radnor) held a short debate on the topic last November.
She explained that in rural areas in particular, public toilets are being eyed up for closure due to austerity, or – in Carmarthenshire's case (more from Carmarthenshire Planning) – being offloaded to community councils which have little in the way of resources. This would not only impact public health but also tourism.
One way the Welsh Government and local authorities have tried to address this is by encouraging local businesses – in particular pubs and restaurants – to open their toilets to the non-paying public through grants of up to £500. It's something that hasn't always happened, as it might be considered rude to use the facilities without paying in some way.
The white paper proposes that local authorities develop a strategy for public toilets, and consider the issue "in all aspects of planning". It could lead to clearer signage as to where they are, and planning conditions used to ensure more toilets are provided to the public.
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