Read carefully and digest: The Government is exhorting us to lead wholesome lives. It should also ensure that we have the choice to do so, says Geoffrey Cannon

THE Health of the Nation, the White Paper launched by the Government this week, is a vitally important document. It sets out the clearest commitment by government to the improvement of public health since the foundation of the National Health Service nearly 50 years ago. Following tougher and fuller official reports issued in the United States, Canada, Scandinavia, Australia and other industrialised countries, it accepts that we as a nation suffer needlessly from preventable

diseases.

About time, too. The founding fathers of the NHS imagined that the universal provision of drugs, surgery and other treatments would encourage good health. They were wrong. It was rather like thinking that the answer to insanity is to build attractive madhouses on every street corner.

In any society, disease increases as a function of the investment in its treatment. Virginia Bottomley, our personable Secretary of State for Health, may, like Juno, wish us all well, but at the same time she is formally responsible for the welfare of the medical profession and the drug industry. And she is getting into the habit of boasting that now more patients have more operations, more outpatients have more treatments and more doctors prescribe more drugs, at ever-greater cost to the taxpayer. Thus as a nation we are trained to think that the sicker we are, the healthier we are.

That this government clearly is committed to prevention, as The Health of the Nation shows, is one step in the right direction. What is needed now is a new understanding of what it really means to be healthy. The five 'key areas' targeted in the White Paper are well chosen: these are heart disease, stroke, cancers, mental illness, HIV/Aids and sexual health, and accidents. Some of the targets set are ambitious; these include dramatic improvements in deaths from coronary heart disease and lung cancer.

You, dear reader, already know what to do if you want to wake up with the energy of a child, walk with a spring in your step, seize the day and die in good health of old age. The prescription goes roughly as follows: eat whole, fresh food; don't smoke; avoid other drugs; live in a clean environment; avoid stress; and respect and enjoy traditional family values. The fact that you are more likely to have learnt this from reading women's magazines than from your GP says much about the effectiveness of modern medicine.

These guidelines are, more or less, what our government is now commending. The general advice to us, while being somewhat wishy-washy, is sensible enough. Thus 'Go easy on cakes and biscuits - try fruit instead'. Or 'Go upstairs rather than using the escalator or lift'. Or 'The safest way to avoid HIV infection is to remain faithful to one uninfected partner'. Or, unequivocally for once, 'Stop smoking'.

Only the stately plump Kenneth Clarke among government ministers is reliably known to resist the generally agreed view that government should encourage citizens to avoid eating, drinking and smoking themselves into early graves.

There are even signs of a post-Thatcherite appreciation not only that public health is a public responsibility requiring public money but also that there is more to improving the nation's health than exhortation. Thus 'opportunities for promoting healthy eating' include recommendations directed to industry: reformulating standard foods as far as practicable to reduce saturates, fat and sodium, as well as offering throughout the country plentiful and easily accessible starchy staples, vegetables and fruit.

The bad news, though, is we who live in industrialised societies are under constant pressure to make unhealthy choices; indeed, for many millions of people in Britain today, healthy choices are impracticable or even impossible.

A child cannot eat whole, fresh food if most of what is on offer at school meal time is chips, buns, meat pies, soft drinks and other fatty, sugary food. Incessant advertising of addictive cigarettes is pushing more children and women to smoke. It is difficult - impossible for some - to get away from exhaust fumes and chemically contaminated food. Most people lead lives of relentless frustration, at least some of the time. And in the last 10 to 20 years the family has disintegrated.

Government does have a part to play in changing this, too. To take food policy, the area I know best: farmers should be given incentives to rear lean animals, to grow fruit and vegetables to be eaten fresh, and to convert their land to sustainable agriculture. The Common Agricultural Policy should be redrawn with public health as a first priority. The food manufacturing industry should be encouraged to accept that fatty, sugary, salty food is a major cause of premature suffering and death, and to develop new, benign, processes, while phasing out malign processes such as hydrogenation (that turns unsaturated oils into saturated fats).

However, it is quite unlikely that left to itself, government

will make such moves. National and international food policy is manipulated by the manufacturers of fatty, sugary food. The medical profession and the drug industry dominate national health policy. The real move for change depends on a new national mood, away from illness and towards health.

The writer is chairman of the National Food Alliance. He is author of 'The Politics of Food' and 'Food and Health: The Experts Agree'.

(Photograph omitted)