There's very little point writing more about the precarious state of the NHS.
If the Government were going to act, they'd have done it by now. The Maymite has had plenty of opportunity. Building up a war-chest for Brexit is the main preoccupation and the Treasury's insistence that the NHS can be more efficient is Number 10's solace.
The unspoken policy; the NHS will sort itself out, eventually.
It may, it may not. Who knows. I guess we'll have the answer by the Spring.
What to do? Well the answer is staring us in the face. We should try and stop people getting sick in the first place. The problem is, we are much better at fixing people up, than we are at fixing ways to stop people becoming sick.
It was Thomas McKeown, the iconic public health doyen who (in terms) said; Governments have done all they can about public health. Clean water, adult-literacy, childhood immunisation. The rest depends on the extent to which governments are prepared to interfere in the lives of ordinary people.
He is right. Public health campaigns usually fizzle out, it is the law that changes behaviour. Seat-belts in cars, helmets for motor-cyclists, smoking in the work-place. The law saves lives.
Success is measured in a long look. Politics demands results in the blink of an eye.
The police claim success in cutting car crime. The fact is modern cars no longer have side-windows you can fiddle a coat hanger into and open. They have alarms, steering locks, signature glass and radios you can't rip out. Homes, have double-dead-locks, double glazing, alarms and CCTV.
Banks don't have money, cash machines do and they are all-but impossible to pinch. We have designed out huge chunks of crime.
What are we doing about designing out huge chunks of ill health?
With children, perhaps the easiest group to influence, we have failed, globally.
Public health depends on marketing, it's about all we have. Advertising because advertising works. Maybe?
We can regulate trans-fats and give away condoms but we can't make people choose to be healthy.
Convenience food is so much more... well... convenient.
Fast-food is so much... well... faster.
In the US, despite education and new laws like New York's ban on sugary drinks larger than 16 ounces, rates of obesity continue to rise, especially in low-income communities.
In the UK in 2015, 58% of women and 68% of men were overweight or obese. Prevalence up from 15% in 1993 to 27% in 2015. In 2015/16, over 1 in 5 children in Reception and over 1 in 3 children in Year 6 were obese or overweight.
Not good and a complete failure of Public Health policy and messaging. Or, are we asking too much? The first health-related social marketing campaigns started in 1967. Cardiovascular ads in Finland. They showed you need 'up to ten years' to affect substantial behaviour change.
Is it too late?
Successful marketing needs commitment and a promise. Commitment means a shed load of money and a promise 'what the product will do for you'. Both of these concepts are outside the reach of PH.
For seemingly fit and healthy people to change their behaviour, to stay fit and healthy, is a very complex message. A fundamental of marketing is the message, 'everybody is doing it'. The problem with PH; they are not. And, there's a fine line between educating and shaming.
Australia has a tale to tell. Obesity rates growing faster than any other OECD country. In 2008, they proclaimed obesity 'a national health priority'. A huge number of obesity-related policy and prevention initiatives, with media coverage, followed.
During this time, major fast-food chains launched two of their most successful month-long burger promotions: Burger King's Quad Stack, a 1,080-calorie hamburger consisting of four beef patties, four slices of cheese, two slices of bacon and 71grams of fat.
KFC's Double Down, a sandwich that replaced a hamburger bun with two deep-fried chicken fillets, cheese, bacon, and barbecue sauce; 32 grams of fat and 540 calories.
The evidence base for PH best practice is thin on the ground. The pressures are mounting.
If PH is our last best hope, they need to get busy.
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