Now the smoke is clearing, we are all health providers

If that were true, the public health white paper launched last week would not concern us for very long. But like so much else, it depends on whether you see glasses as half full or half empty.

Anyone serious about reducing the number of Britons who die as a result of smoking – currently 230 people a day – will lament the timidity and complexity of government plans to create a new-style smoking pub. This will come with pre-prepared sandwiches and bar staff who – unlike anyone else at work in the new order – will be subject to the risks and nausea of passive smoking.

Yet this effort to drive smoking to the margins of society should be welcomed. The white paper is by no means all bad. There are some nuggets of opportunity– not least the recognition that the NHS can only ever be one of a number of agencies working to improve the health of the nation.

We should welcome the bold statement that it is simply unacceptable for some groups and areas in society to be less healthy than others. The white paper calls for action by councils – working with local communities, businesses and voluntary groups – to tackle local issues that affect opportunities to choose healthier lifestyles. There is also strong emphasis on community action, including a commitment to extend the work of the Healthy Communities initiative.

Perhaps we should offer a scintilla of sympathy to the health secretary, John Reid, who has risked “nanny state” accusations as he sought a solution that would command support and not cost his party votes.

Good democrats should hesitate before banning or restricting anything. They should apply simple tests and ask: is the target of the ban clearly harmful? Is the level of harm proportionate to the notion of the ban or the restriction? Is that harm restricted to consenting adults indulging in the harmful activity or is there a wider direct or indirect effect? Does the activity cause nuisance or inconvenience to others as well as physical or psychological harm? Is the ban or restriction an infringement of liberty or just an inconvenience? What does the public think?

When these tests are applied to smoking in confined public places, it is hard to avoid the conclusion that a ban is justified. It does not stop smokers from smoking, so it is actually a restriction, not a ban. The level of harm from other people’s smoke is well established and it certainly causes inconvenience. Employees, in particular, are in no position to choose whether to breathe it in – someone will need to clear the glasses, even when smoking is banned in the bar area. As for public opinion, many smokers want to give up and there is mounting evidence that a control on smoking in public places helps them to do that.

The white paper recognises that the NHS can only ever be one of a number of agencies working to improve the health of the nation

We do not know how this partial measure will work in practice. It will save lives but, given the evidence from Ireland and elsewhere, it looks a wasted opportunity.

The real question is whether all this will prove marginal. Will there be lots of worthy projects that, while doing good things, have limited and short-term impact?

Or are we now going to bring some of these initiatives more into the mainstream? That calls for cultural change, which takes time.

Organisations that in the past did not see health as their business must make it part of their agenda. Employers such as councils and housing associations have a role to play, both in terms of their workforce and the wider communities in which they operate.

There is also a vital role for schools. Helping their pupils to live healthier lives needs to be among their top priorities, just as social housing providers have begun to extend their responsibilities beyond the bricks and the mortar.

In a sense, the white paper should mean we are all health providers. So let us not judge the document by its glossy cover alone.