EHJ September 2004, pages 280-281
The government is failing to deliver economic sustainability for vulnerable groups, says John Corkey. He believes it's time for the profession to challenge government policies that are not sustainable

The environmental health profession has always operated in a culture of sustainable development, even if it has not always been described as such. The massive health benefits we enjoy today would simply not have been possible without the foresight and vision of previous generations of EHPs and would have been unthinkable 100 years ago.

At an international level, the Rio Earth Summit in 1992 provided the context in which future sustainable development can be taken forward in a constructive way. Consistent with this is the CIEH's comprehensive definition of the sustainable development concept, which covers social, economic and environmental concerns. A simpler definition refers to "not using today what we may need tomorrow". Indeed, sustainable development really is about environmental health in its widest sense.

For this reason, it is important that health protection should not be viewed as simply a short-term fix. Rather, it should be seen as forming part of a continuum that reaches into the future to protect those who will ultimately rely on the present generation to consider their future needs. It should be second nature to EHPs to endorse the objectives of sustainability and apply sustainable solutions to environmental health problems. EHPs should instinctively recognise polices and practices that mitigate against a sustainable future. When this occurs people of conscience should be prepared to challenge those who seek to compromise the wellbeing of future generations.

Much of the work currently being carried out by local authorities and others under the banner of sustainability should be praised. It provides demonstrable evidence that, where there is a will, progress can be made and solutions can be applied. But the will to deliver on sustainable development must also form the basis of the overarching umbrella of government policy. It goes without saying that its policies must be consistent with, and support, a sustainable future.

The government does have a sustainability strategy, but its policies often conflict with the objectives of an economically sustainable future. The Sustainable Development Commission's recent assessment of the government's reported progress on sustainable development over the past five years, Shows promise, but must try harder, said as much and highlighted a lot of what needs to be done. The SDC's assessment details the challenges government faces if it is to redirect its strategy to one that is driven by a commitment to sustainability at all levels and in all parts of government.

The SDC sees "...a government whose primary objective is still the achievement of economic growth as conventionally understood and measured with as much social justice and environmental protection as can be reconciled with that central goal". In other words, the government's economic policy will not be deflected by any social or environmental imperatives. Without a fundamental change in its economic approach, sustainable development remains seriously compromised and increasing health inequalities are inevitable.

If we consider sustainability as an undertaking to future generations, then it is essential that we deliver on our side of the bargain. Health inequalities are inexorably linked to sustainability and cannot be divorced from the economic management of financial resources.

While there will always be those who are able to generate their own personal wealth, the poor will continue to place reliance on public finance to protect their basic needs and to provide a level playing field for their children. The relationship between health and wealth is well established. In other words, wealth inequalities equate to health inequalities. As the gap between rich and poor continues to widen, so health inequalities become significantly greater.

It is clear the government has embraced the previous administration's belief in the virtues of the private sector. It has adopted, and developed, many of the initiatives introduced under that regime for the creeping privatisation of many of our public services. Historically, the public and private sectors have always worked closely together, with the latter often able to fill the gaps that inevitably arise in the service delivery process. But this relationship must not allow the private sector to dictate the public service agenda.

There are many opportunities for public servants to learn from others, including the private sector, but it is essential that people understand the clear distinction between the purpose of a public service provider and that of a profit-driven organisation. Unfortunately, the overriding ethos of public service management appears to be virtually coterminous with that of the market place.

Take for example the infusion of private sector terminology into public services and the, now largely discredited and misplaced, over-reliance on statistical outputs as measures of success. While these may not, in themselves, change the approach to service delivery, they can encourage the belief that the public will only be properly served within a profit-driven culture. The government widely promotes the perception that the market place is the most effective and economic provider of public services and the private finance initiative (PFI) is a leading example of their thinking in this regard.

PFIs effectively allow the private sector to borrow money at a low rate of interest. They also provide a public facility, manage and run it, extract profits, pay shareholders and very often enjoy the protection of "commercial confidentiality" within a guaranteed 30 or 40-year contract. Commercial confidentiality prevents the government from revealing details of PFI contracts and costs. The government can even stop the National Audit Office from inspecting the books of companies providing public services.

While this is taking place, the public repays the company, out of public funds, over the term of the contract, at a cost grossly in excess of the original price. It is not only taxpayers who will have to repay these over-priced enterprises but our children and grandchildren.

PFIs are only one of a raft of government policies that fly in the face of thousands of people's future economic sustainability. They are also contributing to health inequalities by limiting future generation's options through a concentration on private sector profit and short-term political expediency.

Stealth taxes on pension schemes have made life a misery for many employed people who now look forward with despair to their retirement on an inadequate pension unless they work well beyond the age of 65. Young people who go to university will, on average, rack up around £30,000 in debt. The government's arbitrary and completely meaningless target of sending 50 per cent of young people to university will ensure that many students will not have the opportunity to fill the limited number of well paid jobs that they are led to believe await all graduates. Rather than contributing to a pension scheme, young people would probably be better served by looking at some alternative means to finance their retirement years.

The UK faces a crippling debt crisis that now threatens to overwhelm millions of people. Consumers now owe over a staggering one trillion pounds. It is now clear that, as interest rates increase and more and more people are unable to pay their debts, the wealth (health) gap will become ever wider.

The government should have contingency arrangements built into its economic policy to protect the weak. But one of its first acts in 1997 was to transfer control of interest rates to the private sector. This means that the setting of interest rates is dictated, not by the needs of people struggling to repay financial institutions or for those with little or no disposable income, but by commercial expediency.

It is unlikely that current government policies will be altered to deliver economic sustainability for vulnerable individuals, or to narrow the health gap, as any change in administration would probably herald in a like-minded group of individuals. If any control is to be exercised on the government, to reign in its obsession with facilitating commercial corporations to assume the mantle of public service providers, or to protect the poor from the impact of transient interest rates in a debt ridden society, then the driver for that change must be external to the party political arena.

The SDC clearly has a role to play, but so too does the CIEH, which must be capable of confronting the government on these environmental health issues. This will require debate, compromise and agreement on those economic policies, or lack of policies, that encourage the rich at the expense of the poor, that favour the privileged over the disadvantaged and that fail to support a sustainable economic future for our children.

The CIEH needs to have clear policies on issues such as the PFI, pension schemes, student fees and interest rates. It has not yet tackled the dangerous waters of open confrontation with the government on these issues. Without a definitive position on the government's approach to sustainability and growing health inequalities brought about by a reliance on private sector principles, political opportunism and profit driven public services, the CIEH will severely limit its ability to influence the health of our children.

John Corkey is an environmental health manager at Belfast Council. The views expressed in this article are those of the author and do not necessarily represent those of Belfast Council.