Like other preventive health movements - anti-smoking campaigners, sensible drinking lobbies, get-out-and-exercise groups - agencies providing contraception and safe sex advice have always been part of the health system's many Cinderella services. For all the serious reform groups urging the government to concentrate on improving health - not just the health system - the media and ministers still concentrate on the system. The Family Planning Association's sexual health week, which began yesterday, provides a good example of how short-sighted this approach can be.
Eighteen months ago the medical research council produced the second national survey of sexual attitudes and lifestyles in Britain. The first was vetoed by Margaret Thatcher in 1989, but went ahead anyway, funded, to its credit, by the Wellcome Trust, an independent research-funding charity, founded in 1936. Epidemiology cannot be conducted without facts. The complicated routes of sexual infections could not be traced but for these surveys.
The new survey puts swinging Britain into perspective. On average people in Britain have sex once a week. It found condom use was increasing, but concluded this failed to offset the rising numbers of sexual partners of young people. Only one in four men and one in six women were using condoms consistently. Yesterday the FPA issued an NOP poll with an equally daunting statistic. In the 16-24 age groups (more than a quarter of whom have had two or three partners in the last year) just over 60% said they had never, or only sometimes, used a condom in the past 12 months and over three-quarters of the 25-34 age group admitted the same.
No wonder there has been such an explosion of sexually transmitted infections - both the old forms (syphilis and gonorrhoea) and the new (chlamydia and HIV). Chlamydia is now the most widespread sexual infection. There were 82,000 diagnoses last year of whom 51,000 were aged between 16 and 24. It is particularly dangerous for women because it can lead to ectopic pregnancies and infertility. A 1999 pilot screening programme found one in 10 women aged under 25 were infected. Screening is needed because 70% of women and 50% of men show no symptoms. Yet we still await a national screening programme for a disease, the effects of which cost the NHS £50m to treat.
Yesterday the Conservatives produced a sensible document for raising the profile of public health. They suggested, with some cause, that primary care trusts were inappropriate bodies for running public health programmes. PCTs are finding it difficult enough taking over commissioning and reshaping health services without adding public health. Instead, the Conservatives proposed a national commissioner for public health, reporting to parliament with all government departments obliged to respond to the commissioner's reports. But then they spoilt it with a populist proposal that they must have known would grab the headlines: compulsory screening of asylum seekers for infectious diseases that would bar them from entry if judged too high a burden for the NHS.
The new proposal would be in breach of the 1951 UN convention on refugees. It was rightly described by the Liberal Democrats as "unnecessary, extremist, unethical and unworkable". It would only encourage asylum seekers to pursue underground routes. It will stir up racial prejudice against "diseased" refugees, when, as this week's FPA campaign demonstrates, most sexually transmitted infections are domestically based. In short, it is a contemptible plan.
