The hard-drinking, hard smoking health secretary

He's an ex-smoker, a former hard drinker and he doesn't take a lot of exercise. Sound like anyone you know? Meet the health secretary John Reid talking here about his private battle with addiction and his public health plans for men.

It's two years since health secretary John Reid gave up smoking. 9 January 2005 marked the anniversary, in fact.

So it would be all too easy to see his public health white paper, dubbed the work of the nanny state by the Conservatives, as the work of a health-conscious anti-smoking convert. In fact, it is far from it.

He admits the decision not to ban smoking entirely in public places was a compromise. However, he points out that the research to date on passive smoking has looked at it in the home and says a total ban would drive it back into the living room, with untold consequences.

He clearly had a huge personal battle to kick his addiction, not just with tobacco, but also with alcohol, which he gave up completely ten years ago.

 'Smoking, I think, was the harder of the two,' says Dr Reid, who was brought up in what was then the hard-drinking, hard-smoking city of Glasgow. He had a 60-a-day habit but stopped when he married for a second time (his first wife had died of a heart attack) and decided he wanted to be around to enjoy life a bit longer.

'Getting married concentrates the mind. At that time I was in my mid-50s and your horizon doesn't extend the way it does when you are a 20-year-old. It was obvious to me I would be nearer that final horizon if I didn't stop smoking, so that's what I did.'

He stocked up on nicotine chewing gum, set himself a date to stop, then spent two months on the gum, before — on another pre-set date — changing to sugar-free spearmint gum, which he admits he chewed incessantly for a couple more months before finally dropping that too.

'For the first year, I really missed it, but I don't really feel it now,' he says.

Kicking smoking is hard whether you are a man or woman, but what does he see as the other main health issues affecting men at the moment?

'There are a number of obvious areas where men are significantly more likely to die than women, for instance, lung cancer and coronary heart disease. Thankfully in both those areas we are seeing a reduction in premature deaths — in the first six years of this government, premature deaths in men and women from cancer have fallen by 12.2% and from coronary heart disease by 27%, which is quite significant. But there is obviously a problem there in terms of killers where men are concerned. So you have to ask the question: why?'

It's partly due to smoking, he admits, pointing out there has been a reduction in smoking rates from 28% of adults in 1978 to 26% of adults in 2002.

Obesity is the other major factor: 'It is a problem with men of all ages, and if you can address that, it helps tackle cancer, heart disease, high blood pressure, diabetes. I think obesity, along with the issues of diet and exercise, are the areas that most need addressing.'

But he admits getting that message across to men, who are notoriously difficult to engage in traditional healthcare settings, is a real challenge.

'We have to think outside the box on this one,' he says. 'We have to find a way of delivering health messages and health advice in completely new ways.

'Working class men in particular are not going to understand, identify with or act on a pronouncement made by somebody who is a cabinet minister or who has a knighthood, like the chief medical officer,' he says.

'There is far more chance of working class men in the north of England listening to advice and identifying with a healthy lifestyle if it is promoted by the local football club than if it were by local health officials.'

The Department of Health is producing a guide for primary care trusts and sports clubs to try to encourage measures for health improvement. It has also produced a magazine for young men, FIT, in the style of a lads' mag. Earlier last year it produced Prime, a magazine targeted at the older age group and focusing on chronic diseases, which had separate editions for men and women.

The other key concept in the white paper, and one which Dr Reid thinks working class men might benefit from, is the health trainer — an advisor, possibly drawn from within the community they serve.

'These aren't people who are going to hector you. These are people whose advice you can seek,' he explains, wanting to distance himself from any idea of a nanny state. 'If you are relatively well off, you will find that advice for yourself, up to and including a personal trainer. But why shouldn't the majority of people have access to that advice too?'

Although he is not averse to the idea of a national men's health tsar — 'There is no reason why we shouldn't consider a men's health tsar in the long run,' he says — he's keener to see local people become health champions initially.

He acknowledges the difficulties for anyone living in a deprived area, where poor recreation facilities may make it hard to maintain an exercise regime and points to the 88 priority or 'spearhead' primary care trusts identified in the white paper. He also talks of the journey he made on London's tube in November to open a one-stop shop 'super-surgery' in East London's Canning Town, one of the city's most deprived areas.

'Every stop on the tube, male life expectancy fell. From 76 in Westminster, it went down to 69 in Canning Town.'

He acknowledges the increased health risks in certain ethnic groups: 'We know diabetes is three times more likely to occur in men of Afro-Caribbean background and five times higher in men from an Asian background.

'It's absolutely true men are more reticent about asking questions or getting advice, whether it is about drinking, sexually transmitted diseases or their own worries. But once they open up, it is clear they want to make their own decisions, but they very much want advice and support from the government.

'We are trying to give them that advice,' he says, citing improved food labelling as one example. 'We are trying to reach out in ways we have never done before, by getting people, other than the state and NHS employees, to give them advice. But once we have done that, it is very much up to the individual.'

Dr Reid is not someone to preach what he practises. He may have given up tobacco and alcohol, but he believes individuals have to make those decisions for themselves.

And even he acknowledges he is failing to follow the advice of his chief medical officer in building a little regular, but informal, exercise into his day.

'Until 16 months ago [when he became health secretary] I had access to a gym and used to go three days a week. I liked the running machine and used to do 20 to 40 minutes — I walked and sort of half-ran.

'My exercise regime now is somewhat restricted. All I do is walk a bit, that's the truth. As former Northern Ireland secretary, I'm under a protection team, so, if I go out, I am followed. And the protection team are all much fitter than me, I can promise you!'

John Reid was talking to Lynn Eaton in an exclusive interview for the Men's Health Forum first published in MHF Magazine. What do you think of John Reid and the government's plans?