Dr Dolly Theis is a Visiting Researcher at the MRC Epidemiology Unit at the University of Cambridge, a policy consultant, and co-founder of 50:50 Parliament’s cross-party #AskHerToStand campaign.

In 1987, the Conservative Party under Margaret Thatcher recognised that good health helped people enjoy freer lives and be less reliant on state-funded healthcare. The Party’s manifesto committed to giving “greater emphasis to the prevention of avoidable illness and the promotion of good health to make the NHS more truly a health service and not merely a sickness service.”

Four years later, the Conservative government published its Health of the Nation Green Paper, which led to the first modern government public health strategy for England in July 1992. When launching the green paper, William Waldegrave, then Secretary of State for Health, emphasised that prevention was as important as health care: “my task as Secretary of State is to focus on better health just as much as better health care.”

Today, the health prevention agenda has been put on the back burner by the current Government, with key policies delayed and planned white papers scrapped. In response, Steve Brine, Chair of the Health and Social Care Select Committee, has launched a major inquiry into the prevention of ill health to “set a challenge for the Government to boost prevention as one of the top priorities.”

The current Government’s unease at prioritising health prevention is nothing new. Governments of all hues have struggled with the politics of prevention, doing what they can to avoid dreaded accusations of “nanny-statism”. This makes the clarity and confidence in that 1987 manifesto commitment and Lord Waldegrave’s word even more intriguing.

What was the conversation around health prevention like at that time? And how did Lord Waldegrave make the case – particularly the Conservative case – for public health intervention? I spoke to Lord Waldegrave to get some insight. I wanted to know what the Government today might learn about confident leadership in support of health prevention.

Waldegrave was first appointed to Cabinet in November 1990 as the Secretary of State for Health, just 26 days before Margaret Thatcher left Downing Street. We meet on Zoom. He begins by warning me that his memory is not great without his notes, but as he starts to describe his days in government, it is clear that it is as sharp as a pin.

I ask him about being appointed Health Secretary by Thatcher. “It was totally unexpected, I had no background in health at all, ” he says as he recalls that during the meeting, Thatcher, seeing his surprise, said “I think you need a large whiskey, I’ll have one myself”.

Lord Waldegrave’s main task was to review Kenneth Clarke’s politically contentious NHS reforms and calm the escalating tensions around them by being the “soft cop” to Clarke’s “hard cop”. Having decided that Clarke’s reforms were actually “good” and “well-founded”, Waldegrave became concerned with ensuring that the NHS reforms included actual health objectives, not just managerial objectives.

Like in the ‘87 manifesto, Waldegrave did not just see health policy as being about treating people, but about preventing people from getting sick in the first place. It was his own political persuasion, he says, that meant he saw a legitimate and necessary role for government in “trying to ensure people have reasonable conditions to live in, as well as actual healthcare”.

Backed by his officials and Sir Donald Acheson, the Chief Medical Officer at the time, who he describes as being “a very powerful, principled and attractive voice for public health”, Waldegrave’s thinking helped catalyse the department’s decision to launch “the first modern time health campaign” that would extend beyond the health service.

Waldegrave smiles. “Of course this was not something that Mrs. Thatcher was very inclined to be sympathetic to. It takes you much wider than the provision of healthcare. It takes you into housing and it takes you into the prevention of poverty”, which was “dangerous territory for her because she was inclined to think that everyone could look after themselves perfectly well however much money they had”, which, he adds “is not unfortunately quite true”.

Like governments today, he too faced vociferous accusations of nanny-statism and “health fascism”, including being lambasted by opposition cries at a party conference event in Blackpool in 1991, but recalls those voices being “on the fringe” of the party. Waldegrave does not disregard such ideological discomfort completely. He talks about his sympathy with the public health sceptics, agreeing that a fully centralised, top-down approach should be avoided.

However, he remains emphatic throughout our conversation about “necessary and philosophically based” public health intervention. He points to vaccinations, seat belt laws, and tobacco reduction policies as examples, and admits to being wrong in the early 90s for opposing the introduction of backseat seat belt laws and regulations on tobacco advertising.

For him, government policy to prevent ill health is truly Conservative. “The British Conservative tradition has always had a role for government on more than just defence and law and order and so on,” he says. “Why not help people to avoid becoming dependent on state-funded doctors? It’s a much freer life to be walking about by yourself autonomously.”

It also keeps government costs down. “You can’t just go on pouring in endless [money]”, he argues. Although he cautions about only making the cost argument, as it reduces health to simply a government balance sheet issue.

Lord Waldegrave leaves me with a final reflection: “Conservatives should conserve things. Conserving the planet and individual health is not un-Conservative.”

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