Environmental health officers are active in every community in Britain. Whilst part of their role is to inform and advise they are mainly involved in regulatory control. The vast majority of the time this function is carried out calmly and quietly. They help protect the public from vermin, domestic squalor, poor quality food, workplace accidents and pollution; and they also have a public health role. During Covid they were given the role of policing some of the Covid regulations; specifically those relating to businesses. The following article has been published in order to initiate discussion amongst environmental and public health professionals. Comments and contributions may be made via our Twitter site: twitter.com/encentre

MISTAKES WERE MADE

It is over three years since Boris Johnson declared that it was necessary to 'flatten the curve' and I am getting the sense that, as attitudes relax, people are more willing to reflect critically on the decisions that were made during that period ("during Covid"). I've been doing just that by considering our role as environmental health officers and environmental health practitioners.

THE RISE OF BEHAVIOURAL SCIENCE

Many years ago, one of the former policy officers at the Chartered Institute of Environmental Health (CIEH) informed me that "social marketing" was set to play a significant role in public health policy; it was written about at the time in their monthly publication Environmental Health News (EHN). We were able to see one of it's first applications play out in relation to smoking which was supported by many across our profession. Nudge units had been set up at governmental level which were tasked with the role of behavioural change. After a long series of regulatory nudges, the smoking ban (which prohibited smoking in enclosed spaces) was characterised by an ongoing national marketing campaign that shamed smokers into action. Whilst money was allocated for local enforcement purposes the success of the public relations campaign meant that the prohibition on indoor smoking was self-regulating.

Nudging was seen as a successful tool to effect change but it's use has developed further. Nudge units have metamorphosed into publicly funded departments, contracted private agencies and even military battalions; who all specialise in collecting "behavioural insights" and in the use of applied behavioural psychology to direct societal changes. SAGE (the Government's Covid policy consult group), for instance, was made up of a whole unit of psychologists called "SPI-B" (Scientific Pandemic Insights Group on Behaviours). Their behavioural scientists provided advice on the use of fear, peer pressure, coercion and emotional manipulation to achieve control during Covid.

Rapid behavioural change of any kind en-masse requires that the whole apparatus of society is pointed in the desired direction. During 2020 it was therefore felt necessary that all forms of government, media and academia provide consistent messaging. Huge amounts of money were directed towards public bodies, the media and large corporations in order to support this strategy. The volume was quickly turned down on any dissenting voices; to the extent that the degree of censorship and vilifying of those questioning official policy became extremely concerning. Anthony Fauci, the long standing Chief Medical Advisor in the U.S, famously pitched himself as the ultimate expert stating that "attacks on [him] quite frankly are attacks on science" (despite the substance of his scientific certitude changing). After a federal mask mandate was quashed by a federal court in the U.S Fauci even stated that the judgement set a "dangerous precedent" and that the decisions of the CDC [his decisions] should not be subject to challenge. Narrative control was deemed so necessary that even Nobel prize winning professors found themselves censored.

Initially, the public health response featured hand washing. Whilst this advice may have seemed like a bit of an odd strategy for tackling an airborne respiratory virus I wasn’t, at that point, unnerved; after all, in a real crises public health officials would try to reassure and avoid panic. I am old enough to remember, then Minister, John Gummer feeding his daughter a burger during the so-called "Mad Cow crisis"; and so for politicians, times of difficulty require responses that aim to protect public confidence. However, I remember that stance flipped abruptly.

Within a short period of time I became unable to distinguish between health promotion and propaganda. Sentimentality, for example, was weaponised; those who threatened to break extraordinary rules, for instance, were portrayed as monsters. You may remember when Christopher Whitty, one of the UK's ennobled government appointed executives, rather bluntly advised us not to hug elderly relatives if you wanted them to "survive to be hugged again". There was also the increased use of pejoratives as a reaction to alternative viewpoints. Journalists at EHN (the magazine of the CIEH) joined the main-stream media in referring to those who chose not to take up the offer of an injection as "Refuseniks" (and, like the Refuseniks of the 1960's, people in Britain were also being denied employment and the right to travel). The CIEH also called for the vaccination programme for children to be bolstered. They also held regular webinars where, for example, hosts voiced support employers insisting on vaccination as a requirement under general safety laws (a statutory interpretation that seemed beyond elastic) or suggesting the redeployment of those who refused to be vaccinated.

During Covid we were told of financial scandals, listened to media outrage at government ministers breaking rules and abusing powers, and read criticisms of mask mandates and overzealous lockdown measures. Whilst admitting that "mistakes were made", governments across the world have roundly declared that the vaccine roll-out was the one area of success during the Covid crisis. The jab is apparently the one inviolable aspect of the Covid period; and it appears that it is still verboten to question the effectiveness of Covid vaccines in the main-stream media. So much so that speaking about the potential for vaccine harms publicly has attracted levels of outrage that have gone beyond that witnessed during Brexit. Even those who may have been injured by the vaccines, or those who have lost loved-ones, have been maligned with the use of pejoratives after raising concerns; and, worse still, callous responses were actively encouraged by MPs and the press.

Social marketing therefore appears to have expanded into something of a different order entirely; and, unwittingly, many of my fellow colleagues have been actively involved in the psychological process of behavioural control. It raises a number of ethical questions that really shouldn't need to be asked; for example, is it ever right to use coercive control over people or to deliberately instil fear? I wonder how many psychologists or public health professionals have reviewed their own actions during Covid with respect to their professional ethical codes? A few did, of course, raise concerns publicly at the time. In some of those instances, rather than having their viewpoints respected, some actually found themselves subject to disciplinary action from their own professional bodies.

ITS FOR THE PUBLIC GOOD

Regulations imposed for public health purposes, for example for food labelling or pollution prevention, may have a limited effect on our common law rights (to work, own property, to worship etc.). As we have witnessed, mandatory interventions carried out on national scales affect the rights of the entire population; and the potential impacts can be huge. However, regardless of the gravity of the proposal, we have a moral duty to discuss the appropriateness of any proposed interventions; considering differences of opinion and questioning the basis of any proposed policy.

Contrary to popular belief, the constitutional rights of individual citizens trump any international treaty or national statutory provision (think Magna Carta); and not the other way around. However, there has been a concerted effort to move away from individual autonomy (where we are recognised as sovereign beings who make our own decisions) towards more of a collective approach, for the "greater good". Academics and supra-national bodies such as the World Health Organisation have rapidly, and relatively recently, developed this stance through the discipline of "public health ethics"; with enthusiasts justifying interventions that would have otherwise be impeded by medical ethical considerations (think Hippocratic Oath). Who gets to decide what is for the "greater good" though, and on what evidence will they base these decisions? One can easily see how these may be used to assist political or corporate motivations; after all, even the most honest actors will come with their own scientific or ethical biases. Furthermore, what if it transpired that the risk of harm was massively overestimated, that the interventions were not effective or that more harm was caused than good? If we really have moved in this direction, away from an ethical respect for individual rights, isn't this something that should concern us?

THE NEXT BIG THING

Fears over Covid may have diminished for now but some of our profession’s representatives may have spotted other opportunities on the horizon (and, indeed, have recently held discussions with the likes of Whitty). It is not surprising that professional bodies would seek to use crises to raise profiles or look to attract additional funding; after all, we do expect them to be involved in raising professional profiles and in highlighting good practice. However, I think most impartial professionals would prefer them to avoid band-wagons or be used to campaign for political or corporate agendas.

If you are an environmental health professional and think that mistakes were made during Covid, you may be aware that there was one man who could have effected influence on the decisions being made by the Government executive and the votes that were cast in Parliament; and that was Graham Brady, Chair of the 1922 Committee. In September 2022 Brady became a Vice President of the CIEH, stating that "The past 18 months have shown us that health and wellbeing are more important than ever and CIEH will play a key role". So what else has our profession got to look forward to?

The thing is with emergencies or public health issues is that there is always another threat ready to take over the limelight. Whilst there appears to be an unwavering emphasis on bio-security and genomics, the next set of behavioural controls (and perhaps even economic reforms) in the international arena are being brought about to tackle to the "climate change agenda". National policies often follow international agendas set through cooperation between big corporate entities, banks and a number of policy-setting organisations, such as the United Nations. Much of the emphasis currently relates to public and environmental health issues; including the, globally adopted, 2030 Sustainable development Goals. These are rapidly taken up at local level through regulation or local policy frameworks initiated by (often) well meaning local politicians and local government staff.

PAUSE AND REFLECT

It is human nature to revise our views on past events (or reimagine the roles we played at the time); especially where our actions may not fall in line with perceived wisdom. We are witnessing a fair amount of back-peddling currently quoting the phrase "as the science changed" (it didn't). Have you considered that "the current thinking" (and, subsequently, our own understanding) simply changes in line with the narrative that is provided to us? The information we absorb every day is saturated with psychological nudges (think of it as advertising); much of it emotionally driven. We certainly appear to be extremely susceptible to some very powerful tools that are used to steer the public mood and professional opinions. Much of it is backed by a wealth of digital insight.

One aspect of the digital transformation is that it can dehumanise; over reliance on models or intelligence can lead to bureaucratic decision making and a disregard for individual rights and freedoms. Digital advancements provide the perfect basis for technocratic control across almost every area of our work. Heck, real EHOs may not even be needed the next time a Scotch Egg needs to be regulated as a "substantial meal"; but let us assume that we will (at least for now). Traditionally, our roles are often tempered by phrases such as "reasonably practicable" or "balance of interests"; and EHOs have always been recognised and respected for their pragmatism. More recently though, the lexicon has been changing with phrases such as "net zero" or "no-one is safe until everybody is safe". The current mode is alarmist; it demands action immediately and affords no space for alternative views. It can be difficult to resist that sort of pressure and the omnipresent influences that contribute to it.

So, "mistakes were made" during Covid and, almost all of them, justified under the guise of public health. Being so deeply involved in this momentous event you would expect that the profession would undertake a review of their role and seek to learn lessons. Seems not. However, as opinions are so often polarised, is an honest and unbiased reflection even possible?