The BSE crisis showed that health has been the missing link in the food chain. Now, writes Tim Lang, it is time for the government to enshrine public wellbeing at the heart of an open policy-making process

In a week when the government is beset by other difficulties, the case for taking a long-term view on food policy might seem a deviation. Yet the landmark Phillips report on the BSE crisis is an opportunity for just that. The report raises fundamental questions about food and agricultural policy as a whole.

On the day of the report's launch, the government wisely declined the chance to attack the Conservatives. It would have been folly to do so because, apart from setting up the Food Standards Agency, many of the fundamentals in food policy under the Tories are still in place: the commitment to the "cheap food" policy; the backing of free trade; the urging of farmers to compete in the global market; the marginalisation of health and environment; the preparedness to soften the collapse of small farming but to continue driving intensification and so on.

The key and most welcome break with the past is that the rhetoric about public protection having priority is taken more seriously. But, as early pronouncements from the FSA show, the food policy model is still the orthodox one of risk analysis, management and communication. This is of doubtful value when, as with BSE and Creutzfeldt-Jakob disease, we do not know what the risks are, let alone how the disease spreads. This is why it is argued that the European Food Authority should give more emphasis to uncertainty than to risk.

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The FSA is pioneering deeper consultation processes, but these repackage rather than reform the orthodoxy put on trial by Phillips. Ultimately, the FSA does not have the power to transform policy. That is not its role, yet it has already strayed in that direction with a bizarre attack on organic food.

Food safety understandably grabs attention, but wider issues of diet and public health require urgent consideration, too. The Department of Health's National Health Service Plan has a page of ideas for action on nutrition. These ideas should be rapidly expanded because food is a key factor in the main degenerative diseases and causes of premature death such as heart disease, some cancers, obesity and diabetes. One page is hardly a comprehensive food policy, but it is a welcome start.

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As a document on the role of the state in food policy, the Phillips report is on a par with the 1903 Royal Commission on the Supply of Food in Time of War and William Beveridge's 1928 account of state crisis management in the first world war. These reports were signals that a change of direction might be needed. They were reacting to a long British experiment with food policy that began in 1846 with the repeal of the corn laws. Over a century, Britain abandoned its farmers and bought not on the open but in protected markets - the empire - which in return was to buy the goods Britain's industrial masses produced. The food may have been cheap, but so was life and health. Immense social pressures built up for improved welfare and higher wages. The British state responded first not to these pressures but to Britain's vulnerability to blockades and wars, much as the Ministry of Agriculture, Fisheries and Food and the government today are worried about the exposed vulnerability of supermarket supply chains.

The second world war underlined the importance of supply chains, and it fell to Labour, as now, to shift policy. The 1947 Agriculture Act ushered in the "productionist" culture exposed by Phillips. For half a century, first under national and then European rules, farmers and processors were encouraged to intensify. They did so, and the BSE crisis is this policy's apotheosis - and hopefully its denouement. After Phillips, politicians will paper over the faultlines at their peril. The good news is that the government has said it is already reviewing Phillips's "lessons". Ministers should be helped in this task by a vigorous national debate. Maff is setting up a strategy unit, but to do what and under whom is not yet clear. It should not be left to the task alone.

Despite stating that it sought no "villains or scapegoats", the Phillips report gives a long list of people and actions at fault and says public service ought to have operated differently. Understandably, press comment has focused on the culture of secrecy. Openness is clearly required, and a tougher freedom of information act than that which is now before Parliament would help.

But how to achieve a culture of openness? Civil service training needs to be rethought. The tendency to water down bad news is inexcusable. Ministers need the truth, not what they want to hear. They need outside as well as inside advisers. In September, the World Health Organisation's European Region approved a framework for giving equal emphasis to safety, nutrition and sustainable food supply. The United Kingdom has to deliver.

One idea is for countries to set up national food policy councils. The Conservatives considered doing this before the 1997 election, but Labour trumped them with the FSA. We still lack a proper mechanism for monitoring and standardising policy. Scandinavian experience shows food policy councils help.

Another thorny issue concerns the role and capacities of science. Food businesses try to control risk, but Phillips showed the problem was the scientific assumptions that were made and that risk communication had an ethos "whose object was sedation".

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Phillips is pretty scathing about the reliance on expert scientific committees that are central to Whitehall's workings. Phillips gives split messages here, saying Maff did not suffer from a conflict of interest between promoting the producer and public health, but giving evidence of just that - one adviser to the Meat and Livestock Commission was a core Maff adviser on spongiform encephalopathies. The practice of committees declaring interests is not enough. Part of the problem is cuts. We need to rebuild a genuinely independent food science base. Policy is heavily driven by industry "partnerships". The FSA's ? million research budget is too small.

Another fundamental problem exposed by the Phillips report was the DoH's weakness in the face of Maff. What was needed was a breadth of science, awkward thinkers and a culture that allowed people to ask "why?" and "what ifI?" The DoH was so weak by the early 1980s that the relationship between elected politicians, civil servants and expert committees was set to fail.

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In medicine today, all the talk is of evidence-based practice. Evidence-based policy is much harder. Policy can exist in the absence of or despite evidence rather than because of it. There are mountains of evidence to justify policy change to protect health. The European Union's French presidency is working on just that. Europeans spend E74 billion (?44 billion) a year treating heart disease; and obesity accounts for 2 to 7 per cent of healthcare costs.

Where is Maff in this debate? With the FSA running, it appears to be reverting to productionist type. One option is to follow Denmark, which recently reformed its Ministry of Agriculture and Food into a Ministry of Food.

Somehow, tension between health and supply often ends with health coming second. It must not. A culture in which health had no equal status was internalised at both ends of Whitehall. The chief medical officer's role and the DoH in general were so marginal by the early 1980s that a token reform, such as Maff's proposed Consumer Panel, could appear pro-consumer. It was a bolt-on extra. The CMO's post and the DoH's capacity to intervene before crises are priorities. We need the DoH to live up to its name. It has not.

Pressure is mounting to set up a new public health agency. But agencies are not a technical fix for flawed policies. The political question is: do governments take long-term health seriously or are they interested only in healthcare? Big difference. Food actually offers the policy nirvana of prevention.

If Phillips's report only heightens the policy options on food safety alone, it will have been worth the inquiry's ? million cost. The UK has a choice: continue with the intensive food and farming route or invest in better systems that are built on public and environmental health. At the moment, we judge food by its cheapness. Cheap food is actually expensive. BSE has already cost the taxpayer ?6 billion, and these externalised costs are likely to rise. We have no option but reform. The only question is how radical. On BSE, the radicals have been right, uncomfortably so for the Whitehall culture. The government has to act. Let the debate flourish about its options.

Tim Lang is professor of food policy, Thames Valley University, and co-author of a new .

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