‘Support’: who needs it?

‘England has a proud history of improving the health of its people’.1 The first sentence of the executive summary of the new public health White Paper proposes a dramatic revision of English history to provide retrospective ideological justification for the policies of the New Labour government. When I went to school, England had a proud history of being the ‘workshop of the world’ and of being the home of the ‘mother of parliaments’. For an older generation it had a proud history of imperial conquest; younger and more radical spirits claimed a history of popular democracy and the rule of law. But now we learn that the long procession of monarchs and statesmen, soldiers and adventurers, inventors and manufacturers, was merely preparing the way for Tony Blair's programme for ‘making healthy choices easier’.

There is, of course, nothing new in authoritarian regimes rewriting history to provide legitimacy for current policies. What is historically unprecedented — outside of overtly totalitarian societies — is the scope of state intervention in personal life proposed in the White Paper. The quest to improve the health of the nation requires major changes in the lifestyles of individuals, from childhood through to old age. It demands a range of measures in schools, workplaces, and communities as well as a transformation in the work of health professionals. It is also remarkable that almost all criticism of the White Paper comes from those, notably within the medical establishment, who demand that the government should go still further and take even more punitive measures against smokers and others who defy the imperatives of healthy living.

Although the New Labour rhetoric of choice features prominently in the White Paper, a more significant theme is that of ‘support’. The notion that, as Blair puts it in his foreword, the government should ‘support people in making better choices for their health and the health of their families’ recurs like a mantra through the document. Whereas the old-fashioned ‘nanny state’ bossed around its infantile subjects, the modernised therapeutic state supports its child-like citizens through a process of assimilating public health propaganda that culminates in them making the choices prejudged as ‘healthy’ by the government.

The concept of support is at the heart of the relationship between the therapeutic state and the citizen as client–victim. The state is driven to more intrusive intervention in health in the quest to establish points of contact with an increasingly atomised society, and to recover some of the respect and authority lost as a result of mounting cynicism and disengagement from the political process. In the past, such measures were resented and resisted by citizens jealous of their personal autonomy and independence from government — even when, as in the case of quarantine regulations or compulsory smallpox vaccination, they had a much firmer basis in science than current public health policies. Today, the lack of popular resistance reflects the degradation of subjectivity in contemporary society, the replacement of the spirit of the free citizen with that of the fragile and vulnerable individual who is deemed to require professional ‘support’ in coping with every exigency of life, from cradle to grave.2

The White Paper devotes a chapter to the theme of ‘health as a way of life’, which presents New Labour's public health policy as part moral crusade, part cultural revolution. This chapter develops the theme of the ‘children's health guides’ that will provide the ‘foundation for personal health guides for life’, in the same way that the Sunday School catechism once sought to provide the faithful with a durable code of values. The White Paper proposes a new cadre of ‘NHS health trainers’ — the red guards of Blair's public health revolution — who will go out to the masses to provide ‘valuable support for people to make informed lifestyle choices’.

The notion of health as a way of life makes mere biological survival the end of human endeavour rather than regarding it as the means towards achieving wider individual and social aspirations. Far from marking progress towards a truly healthy society, New Labour's White Paper at the same time lowers the horizons of society and inflates the realm of health. From my reading of history, the freeborn Englishman, never much concerned about health, would be gravely concerned at the cost to civil liberties.

• © British Journal of General Practice, 2005.