The UK Covid-19 inquiry is grinding on like some legal reality show. But no Greek playwright would have been so bold as to create a plot that spans such extremes of tragedy and farce currently being performed in front of Baroness Hallett.

This week it was the turn of four of the government's senior advisors to describe what it was like for them. While the measured tones of Sir Chris Whitty and Sir Patrick Vallance hint at the frustration they felt, it was Vallance’s personal diaries written in the evenings of the pandemic that stole the show. There are concerns that the lessons learnt will be too late and even those will be addressing the wrong questions.

Making Health Public: A Manifesto for a New Social Contract

It was also the week that our book based on our ARC South London research during the pandemic was published by Policy Press - Making Health Public: A Manifesto for a New Social Contract.   

The original project explored the reasons why in the middle of the pandemic the Secretary State for Health and Social Care, Matt Hancock chose to close down the main organisation responsible for public health, Public Health England. Our conclusions were published as well as our proposals for changes to how national public health organisations are structured.

However, mulling over the implications of our study, has led us to believe that a more fundamental rethink and change to how public health is approached is required. We are not alone in reaching such a conclusion. The Institute for Public Policy Research recently published its first interim report on health in the UK, advocating a new Health and Prosperity Act supported by a Committee on Health and Prosperity – modelled on the Climate Change Committee (CCC) and designed to independently advise on the above mission (and hold all government accountable to it). 

Our book does not try to revisit all the theories and initiatives to improve public health, but explores some of the fundamental barriers which persist and asks why interventions (even those based on good evidence) are not adequately implemented.

Peter Littlejohns, David J Hunter, Albert Weale, Jacqueline Johnson and Toslima Khatun

We address several key political and governance issues around the idea of a new social contract. We debunk the myth that vigorous public health measures turn government into a “nanny state”.  

Out with Vulgar Individualism and in with Social Individualism

In throwing out libertarian ideas that we call ‘Vulgar Individualism’ we advocate a new ‘Social Individualism’, which would be heralded by a new social contract incorporating ideas of prevention and caution. We build on the thinking outlined in the history of public health by David Hunter.

In our call for a new social contract, we highlight:

  • The failings of short-term versus long-term political commitment and strategy when dealing with complex problems
  • Acknowledge that many of the key public health problems cluster around the same deprived social groups, so tackling health inequalities is key to any public health interventions
  • The lack of cross-government working and the need to end silo-driven departmentalism, since all public health issues transcend any single department or policy sector
  • Tackling the commercial determinants of health, which is becoming harder thanks to Brexit and the absence of health concerns in new trade deals
  • Addressing the central local issues as the power balance between Westminster and local authorities is debated.

The list is daunting. But there appears to be an increasing understanding and acknowledgement that the key way to achieve economic growth is through policies that maximise public health and wellbeing. It is a view that is gaining support across the political spectrum. It was Plato who said that not entering politics dooms you to being governed by inferior people. In the run up to an election, we all have an opportunity to challenge politicians to debate public health and not just the NHS.

About the authors

  • Peter Littlejohns, emeritus professor of public health, King’s College London
  • David J Hunter, emeritus professor of health policy and management, Newcastle University
  • Albert Weale, emeritus professor of political theory and public policy, School of Public Policy, University College London
  • Jacqueline Johnson, executive master of public administration-global public policy and management, New York University and University College London
  • Toslima Khatun, researcher, King’s College London

Find out more

This study is supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.