Public health is a public good and should be supported in farming policy

Creating a coherent food policy and tackling challenges of diet-related illness have been welcome features in recent speeches from Michael Gove MP, Defra Secretary of State. Yet the ambition is not obvious in the major new Defra consultation ‘Health and Harmony: the future for food, farming and the environment in a Green Brexit’ on the future of farm policy after we leave the European Union. The paper focuses on paying farmers, post-Brexit, for environmental and other outcomes rather than for being simply farmers or land managers. It does cover other areas such as nature outcomes, labour skills, and fairness in the supply chain. Why not health? 

Is it because the concept of a ‘public good’ is now central to the future farm policy agenda – paying farmers for delivery of specific outcomes – and there has been little debate on public health as a public good? 

In economic terms, a public good is an outcome that is available to all and its use by one individual does not reduce availability to others. Classic examples of public goods include air, water, parks, and national security.

“I believe the money we spend, as a country, supporting healthy food production is an investment not an expenditure, a way of reducing significant future costs not an enduring burden on the exchequer. Wholesome food production is an invaluable investment in the health of our nation, from which we all reap the benefits…” 

Michael Gove MP, Defra Secretary of State, in A Brighter Future for Farming speech delivered at the NFU conference, January 2018

Sustain absolutely supports and promote the concept of basing future farm support on public goods and has been lobbying to see this at the heart of the new policy proposals. So it is good to see the public consultation stating that that Defra propose “our new agricultural policy to be underpinned by payment of public money for the provision of public goods”. The definition is not clear but does suggest including: environmental enhancement and protection; better animal and plant health; animal welfare; improved public access; rural resilience and productivity. 

Some outcomes could be potentially beneficial for public health as well, for example on environmental outcomes; animal health and welfare; wellbeing via access to the countryside; and rural renewal. The last ‘good’ – productivity – is problematic however, as it confuses narrow productivity and competitiveness goals with other public goods. These should be covered by other measures (such as addressing market failure). Unless productivity is redefined of course....

Yet the obvious wider public health outcomes are missing. Are they not considered public goods possibly because not everyone will be able to achieve good health i.e. the ‘good’ is not ‘available to all’. This is a mistake and limits our ability to see the true contribution of public health to society.

Public health is owned by all and depends principally on the conditions that create it (i.e. the structural, social, and political forces that produce health of populations) rather than on any individual action. These conditions are features of social structures that are not owned and not buyable by individuals. Additionally, the cost of ill health will be borne by all through costs to health service provision, to individual mental and physical wellbeing, and to the economy. 

So what do we mean by public health ‘goods’ in the context of new farm and food policy? As noted, it is clear that environmental goods will be included in Defra’s new approach, covering for example soil health, wildlife enhancement and reducing harmful emissions. This is good news, and contributes in its own right to public health. However, it is possible additionally to define public health goods for new farm policy (affecting for example farming regulations, public subsidy and publicly supported R&D). These could include: 

• contributing to healthy diets by reducing the health and economic burden of diet-related disease and making sustainably produced, fresh food available, affordable and accessible to all, by for instance: 
  • more and diverse horticultural production based on sustainable methods and decent working conditions,
  • specific support for diversification away from producing products we should be reducing in our diets, such as sugar,
  • better household food security, better physical and mental health for workers and the ability of people on a low income to buy good food - through wages based on decent contracts and a living wage that reflects the actual cost of living, as well as better working conditions in the food and farming sector as a whole (notorious for low pay and precarious jobs)
• reduced or eliminated risk of food borne diseases (such as E.coli, salmonella, campylobacter);
• improved nutritional profile of agricultural products sold as ingredients, for example diverse and less highly processed grain and flours; less sugar; fish and livestock fed in ways to create healthier profiles of fatty acids; more nuts; and more seasonal variety of fruits and vegetables;
• cessation of the prophylactic use of antibiotics in livestock farming, as well as reduction of antibiotic use overall through better hygiene and animal welfare measures and related strategies; 
• reduction of pesticide use, exposure in the environment, and pesticide residues in food; 
• tackling air pollution from farming such as ammonia;
• active promotion of access to countryside, educational farm visits and biodiverse green space and ensuring the access is healthy, for example ensuring opportunities for beautiful and tranquil experiences, wildlife encounters and physical activity;
• policy and contractual requirements for fresh, healthy and sustainably produced food in schools, hospitals and other public sector institutions via public procurement measures, as well as helping diverse and sustainable farmers to access these contracts;
• active promotion and growth in acreage of beneficial farm systems that can deliver some – or all – of these outcomes such as organic, agro-ecological and agro-forestry.

What else needs fixing - market failure 

Many market failures exist when it comes to public health. We don’t curb excessive marketing of sugary drinks and junk food adequately. We still directly or indirectly subsidise production of foods known to be unhealthy and don’t adequately support foods good for health.  We don’t use enough fiscal measures to drive affordable healthy diets or invest in promotion of healthy diets to counter promotion of unhealthy. Wider ill health outcomes such air pollution from farm systems, use and residues of harmful chemicals such as pesticides and antibiotics, are also inadequately addressed. Much focus is on communicable diseases including zoonoses – animal-led infections – with some success, but public health should be promoted all its forms.

What Defra’s consultation should say

In line with Michael Gove MP's comments about wholesome food production (see above), there should be specific recognition of public health as a public good – with positive health outcomes being delivered through support for those farm systems that deliver them. We need to see reference to public health as one of the defined ‘purposes’ (i.e. public goods) in the final Agriculture Bill and related policies, and some specific measures to deliver this. 

The Sustain alliance welcomes comments, engagement and responses to the consultation on this as we are looking for support for positive public health outcomes from the new policy. The lack of reference to dietary public health was a disappointment given the Secretary of State’s comments on the need to address dietary health.

This is a complex area and public health outcomes need to be delivered from multiple directions. But we do believe farm policy should be one of the tools used. 

Vicki Hird, Sustainable Farming Coordinator, Sustain, March 2018