Steve Field writes in the Observer about taking responsibility for our health. He says that it is a matter of personal responsibility and in that, he is right.
In the space of three months, the thrust of public health policy has shifted towards a desire for individuals to take more personal responsibility for their health and the health of their children. It is a dramatic change in emphasis from the last government, sometimes accused of wanting to remove all our personal freedoms and make big decisions for us.
Health secretary Andrew Lansley took a bit of a bashing when he referred to Jamie Oliver’s school food initiative as “lecturing”. But he’s right when he says that more of us should be taking more responsibility.
So far, so good. And Jamie Oliver was lecturing. And I agree absolutely about it being a matter of personal responsibility. If people are aware of the risks, then they make an informed decision. Mr Field, however is a doctor…
The truth is that too many of us neglect our health and this is leading to increasing levels of illness and early death. The evidence is all around. There is the dramatic increase in diabetes, much of it related to obesity. Then there are the dreadful effects of excessive alcohol consumption, which we are seeing in younger and younger people.
Excessive alcohol consumption is not new. I recall seeing it when I was a teenager. Anyone who has looked at Hogarth’s cartoon from 1751 will realise that this is hardly a recent phenomenon. Excessive alcohol consumption is as old as the discovery that sugar, yeast and water will produce an amusing little chemical reaction. Of course excessive consumption is bad for one’s health – we know this, we have always known this. Too much jungle juice and eventually the liver decides that it has had enough. There is nothing wrong with one’s GP pointing out that we should cut down for the sake of our health. Equally if diabetes is related to weight, then there is nothing wrong with one’s GP suggesting weight loss for the sake of one’s health. However this is a matter for the individual and their GP.
Public health is a sensitive subject.
Only because the matters being discussed are not a matter of public health. Cholera in the water supply was a matter of public health. Individual lifestyle choices are not. It is beholden on you to respect that decision.
It’s not easy to strike the right balance between “protecting” people’s sensibilities and telling them hard facts about their personal behaviours that are ultimately shortening their lives.
I suppose not. However, in the surgery, this is part of your job. And, some people will prefer to live a more risky life with the consequential foreshortening to living a long, healthy but dull existence.
Recently, I found myself on the receiving end of some vitriolic website commentary after I backed the public health minister’s call for patients to be told they are “fat” rather than “obese“. The Royal College of General Practitioners’ call earlier this year for parents to be banned from smoking in cars carrying their children and for parents to act as role models by giving their children healthier food rather than sugary and fatty rubbish that leads to heart disease and diabetes both caused an outcry, with some even accusing me of attacking their civil liberties.
Now this is where you cross the line. You are attacking civil liberties. It is not your role, nor that of the state to ban people from smoking in cars – not least because there is no evidence to support the second hand smoke canard. Childrens’ diet is a matter for parents. Sure, in the surgery, you may advise parents about their childrens’ diet if you detect a problem. However, it is not your role to seek an all-encompassing mandate. Your job is to deal with your patients – not the rest of us.
I believe that parents who smoke in cars carrying small children are committing a form of child abuse;
Then you do not deserve to be taken seriously. Child abuse is an egregious matter and not remotely comparable to smoking in the car when children are present, not least given the remarkable lack of evidence that harm is being caused.
I suppose the same people also smoke at home in front of their children.
Probably. And it is none of your business.
Evidence from the US indicates that more young children are killed by parental smoking than by all unintentional injuries combined.
Excuse me? If this evidence is so compelling, surely you would be able to cite it. That’s an awful lot of deaths caused by second-hand smoke. Or are you just making it up?
Field then goes on to point out – as I’ve heard from GPs on this matter in the past – that he sees a lot of unhealthy people in his surgery. Well, yes, I would expect nothing else. The healthy have no need to see him, therefore his view of the world is distorted.
I have no problem with him pointing out that exposure to the sun, for example increases the risk of melanoma, I have no problem with him advising pregnant mothers who consult him, to give up the weed for the sake of the foetus. That’s his job. What I object to is the lecturing the rest of us, the stupid accusations of child abuse and the desire to legislate on the basis of saving us from ourselves – and of course the chiiiillldreeen! That is not his job.
The trouble is that while individuals can (and should be able to) make their own lifestyle choices, and ruin their health if they want to, because we have socialised medicine in the UK, the rest of us end up picking up the tab. So until you introduce some mechanism for personal responsibility back into the NHS, I personally think it is legitimate for the State to try and steer people into healthier lifestyles.
If we had an insurance based system that meant individuals were liable for higher premia if they had unhealthy lifestyles (smokers/overweight/heavy drinkers etc) then I would agree, the State would have no role to play at all, and all the 5 a day & anti smoking advisors would be history.
Smokers and drinkers pay in proportionately more than those of us who do not indulge and the obese are more likely to die earlier, so that argument doesn’t hold up to scrutiny. You might want to look at what happens when the private health insurance industry deals with it. Bucko’s experience is the same as DK’s when he took out private medical insurance.
There is therefore no justification for state interference in our lifestyle choices.
“increasing levels of illness and early death”
If he believes this we can safely say that he ignorant and stupid. His favoured policies provide evidence that he is also arrogant and evil.
This is not a good combination.
‘The trouble is that while individuals can (and should be able to) make their own lifestyle choices, and ruin their health if they want to, because we have socialised medicine in the UK, the rest of us end up picking up the tab. So until you introduce some mechanism for personal responsibility back into the NHS, I personally think it is legitimate for the State to try and steer people into healthier lifestyles.’
That might be legitimate if we were able to opt-out of the enforced health service in the first place…
It has also been established that “unhealthy” people cost the NHS less over their lifetimes because they die earlier. So it isn’t really putting a burden on the rest of us.
“If we had an insurance based system that meant individuals were liable for higher premia if they had unhealthy lifestyles (smokers/overweight/heavy drinkers etc)”
Someone mentioned that smokers and drinkers are already paying way over the odds, because of the taxes levied upon them. This is also true of motorists. Perhaps the state should stop taking these exorbitant premiums off them and spending that money on something else. (And before anyone points out the difference between taxes and NI, let me point out that it’s all money, and all money is fungible.)
But let us say that in principle, our premiums should reflect the liabilities we present, according to some actuarial formulae. That means we need to know the lifetime cost, in terms of treatment, pensions, and disability benefits, of each lifestyle. And this runs the risk of telling us some rather unwelcome news. That our total cost of care is much the same. An unhealthy lifestyle may incur our end-of-life costs at an earlier age, but a healthy lifestyle will incur the same eventually, and possibly more if we outlive our ability to live independantly.
Either we have a fully comprehensive mutual support system, or we don’t. If we don’t, I want all my money back.
“Evidence from the US indicates that more young children are killed by parental smoking than by all unintentional injuries combined.”
Yet ISTR that the massive W.H.O. 1998/9 study on the effects of environmental tobacco smoke (ie “second-hand smoke”) found a lower incidence of smoking-related illnesses in later life amongst children exposed to ETS. It was, in fact, the only (even slightly) statistically significant finding in the entire study.
I’d take doctors advice so much more seriously if the places with the greatest concentration of them didn’t kill so many of us.
Excessive alcohol consumption is not new. I recall seeing it when I was a teenager.
Just seeing it?
Don’t be daft Jim. In the UK smoking and drinking are so heavily taxed that there is absolutely no need for the insanely expensive US system whereby rapacious insurers determine costs. Only the seriously deranged would ever back the US healthcare system. Most exspensive on earth and hugely underperforming.
Yes. When I started working in a pub to supplement my student grant, I’d not had the opportunity to get drunk up to that point. My exposure to drunkenness while working there horrified me enough to ensure that I never did.