homeWednesday 8th July 2020

Thatcher’s health legacy

Alan Maryon Davis10/04/2013 - 13:00

| comments Comments (2) |
Margaret Thatcher died this week.
Margaret Thatcher died this week.

Talking Point  - a professional airs their views on an item in the news

Former prime minister Margaret Thatcher, who died this week, led Britain for 11 years. But what was her impact on public health? Alan Maryon Davis, who worked for a health quango in the 1980s, argues she presided over widening health inequalities between the haves and have-nots.

As tributes and brickbats continue to fill the media, what was the impact of the Thatcher years on UK public health, and what is her legacy today?

As we all know, Margaret Thatcher’s brand of conservatism and unstoppable drive meant smaller government, a shrinking public sector, welfare cuts, lower taxes (except the poll-tax), denationalisation of state-owned industries and utilities (with the ‘Tell Sid’ share sell-off), deregulation of the City (igniting the big bang), the rise of the yuppie and a culture of laisser-faire neoliberal economics unleashing an unfettered free market in almost everything (except, perhaps surprisingly, healthcare and education, which were merely starved of funding).

The net result of all this was a marked decline in the nation’s manufacturing base, a doubling in unemployment (peaking at 12 per cent in 1984), rising inflation, marked disparities between the industrial North and leafy South, long waiting lists for hospital tests and treatment, and widening health inequalities between the haves and have-nots. The Thatcher era was not good for the health and wellbeing of the people.

And yet, ironically, in many ways the 1980s were a golden age for the profession of public health. The inequities and social injustices put fire in our bellies. We could unite against a common enemy. The values of Thatcherism - every-person-for-themselves, devil-take-the-hindmost and, famously, ‘There is no such thing as society’ – were anathema to the fundamentals of public health.

I was at the Health Education Council (HEC) throughout most of the Thatcher years. The HEC was a quango – a quasi-independent non-government body under the auspices of the Department of Health and Social Security. But our ‘independence’ was very quasi indeed – everything we did had to be vetted by department officials. We couldn’t use the term ‘health inequalities’ – but had to say ‘social variations’ instead.

Our task was simply to run national campaigns and support local health promotion on behalf of the government. The more we kicked against the traces by trying to influence policy, the more we were slapped down, until ultimately in 1987 we got transmuted into a special health authority under direct NHS control and the entire senior management team was cleared out.

In 1980 the government released the Black Report on inequalities in health on August bank holiday, hoping it would disappear, but it was picked up by a vigilant health journalist, fuelling a massive media furore. And then in 1987 history repeated itself when the launch of the HEC’s follow-up publication, The Health Divide, was cancelled at the very last moment on the firm instructions of the secretary of state. Instead it was ‘leaked’ to the assembled journalists who made sure it had huge media coverage, becoming another instant legend.

Another example of the long hand of Thatcherism. In the mid-80s the HEC had painstakingly developed a small handbook on sexual health for secondary school children, using an open and frank approach emphasising personal responsibility. Hundreds of thousands of copies were printed – and then had to be pulped when the prime minister heard about what she regarded as an out-and-out passport to promiscuity.

The truly worrying thing is that so much of Thatcherism prevails today. Her ideals and policies sound chillingly familiar. Is history repeating itself yet again? Of course the world has moved on – but current government policy leading to a prolonged recession, with swingeing welfare cuts, local government budget squeezes, massive efficiency savings in the NHS and a host of other horrors is bound to lead to further widening of health inequalities. The clock is in danger of being turned back – and, as in the 80s, we in public health have to work together to rise to the challenge.

user image
2641 days ago
0 1
This one sided simplistic article confirms the extreme bias of many in the public sector. Using the term "Thatcherism" as if it was the cause of all this countries ills is the view of those in the public sector defending their jobs and positions. She may not have been perfect, but it took her to bring democracy to the unions, how ironic is that? As for the swinging cuts to welfare this looks like the script from BBC news coverage following her death. The author, as is the labour party and the left at this moment, is just shouting, it was Maggie's fault, no to cuts, but has no viable solution to the mess this country is in following years of labour mismanagement of the economy. I am not inside the cosy public sector, who some, not all, seem to think that the costs of supporting all aspects of our society is not to be challenged or examined. Anti cuts rhetoric when no solution to the huge debts this country has accumulated over the past 15 years, is unhelpful, at best, and extremely stupid at worst. Yes there were mistakes, but to try to level all our ills at a prime minister and a leader who has not been in power for 20 odd years, is the politics of the playground. I could not agree more with Richards comments.

Report this comment

user image
2645 days ago
1 3
How very sad that a professional publication like the EHN has allowed such a one sided diatribe. Above all else Margaret Thatcher the politician was a qualified and experienced research scientist. In formulating public health policies she would have to balance the impact on public health against the affordability to the UK economy. The cliche "can't afford not to do it" is a luxury of the opposition but she would be convinced by evidence based arguments. As Professor Maryon Davis has chosen to highlight Margaret Thatchers approach to sexual health then allow me to offer an allied prime example of how her scientific approach was influenced by good argument. Her public health response to the then new and emergent disease AIDS. While most of the country put their heads in their sand she listened to the pubilc health evidence and poured millions into health education and awareness with hugely positive effects. Anyone who doubts this should look at countries who refused (and some still refuse) to accept AIDS as a public health issue and make the comparisons. Other unheralded and less headline issues are the upgrading of the housing fitness standard, remembering of course that she grew up in a dwelling that would have failed this standard and, of course, the Richmond Committee set up to look at food safety which led the way to the ACMSF we know today. Professor Maryon Davis may have some personal issues encountered during his employment at the HEC but, to quote Margaret Thatcher "Advisors advise, Minister Decide". Perhaps his perception that his narrow views were never listened to says more about his ability and failure to formulate a coherent evidence based argument.

Report this comment

EHN Jobs


Subscribe eNewsletter