When I was growing up in the 1970s word had reached us in East Yorkshire that Glasgow had a poor health record. We were told that much of this was because of poverty, substandard housing and a damp climate. No one in those days told us that drinking and smoking was the cause or gave us that pearl of twenty-first century wisdom – that smoking causes health inequalities.
But in the corridors of power there is evidence of change going back twenty more years. (H/tip to Rose for the link.) Published in 2002, this link reports attempts to disguise the impact of air pollution on the London smog of 1952:
Delegates attending an international conference in London today to commemorate the 50th anniversary of the Great London Smog of 1952, which caused an estimated 12,000 deaths, will hear how governments from the late 50s onwards deliberately downplayed the huge threat to public health caused by air pollution, and sought to shift the blame firmly onto cigarette smoking instead.
In 1953, Dr Guy Scadding, speaking on the television programme Matters of Medicine, had expressed a belief that air pollution was as much a factor in whether someone developed lung cancer as smoking, citing the significantly higher number of deaths from the disease among those living in polluted cities, as opposed to the countryside, and assuming that rates of smoking were likely to be similar in both populations.
A few years later, in 1957, the Medical Research Council was planning to issue a statement saying although smoking was a significant cause of lung cancer, up to 30% of cases might be caused by air pollution. But the Cabinet committee on cancer of the lung, fearful of another political embarrassment which could be caused by stressing the air pollution connection, asked the MRC to reconsider its statement. On 31 May 1957 a modified version was published, which asserted that although it was likely that atmospheric pollution did play a role in lung cancer, it was 'a relatively minor one in comparison with cigarette smoking'.The clear conclusion?
'What was happening in this committee was a shift away from a concept of health and wellbeing related to an individual¹s environment, occupation, class or work, towards one focused strongly on that individual's responsibility for his or her health, which smoking came to symbolise. After the 1962 report, it was smoking and the type of public health which it epitomised which was to become the central public health issue. Smoking was something which the individual could do something about; air pollution was not,' explains Professor Berridge.Public health, as far back as 1957, was to become judgemental. The medical establishment was already prepared to take an attitude on the issue, and suppress data that would inconvenience the public health message: 'take responsibility'. (Was this an early revolt against universal health provision free at the point of need?)
The medical establishment has appealed to corporations to take note that poor employee health is costing money. Hell, someone has to support them, and why not have a crack at those who support smokers, drinkers and the obese by offering them a livelihood?
Sometimes this smacks less of altruism than of a deliberate attempt to disenfranchise people. Usually, in fact. Any health problem can be resolved by addressing personal issues (smoking, drinking ...). People are not expected to protest about the extent of air pollution (or any other health issue) because health politics is no longer the domain of those most affected by health inequalities. Their duty is to look after themselves so that their employers can make more money from them.