Tony Blair has made a big speech on public health today and has called on people to take more responsibility for their health to relieve pressure on the NHS (BBC). Mr Blair argued that public health problems were "not, strictly speaking, public health problems at all" but were "questions of individual lifestyle - obesity, smoking, alcohol abuse, diabetes, sexually transmitted disease."
Iain Dale was unimpressed:
"I have just watched Blair's Health Speech in Nottingham on Sky. He had the usual heckler interruption which was quite entertaining, but as for the speech, well, I couldn't quite see the point he was trying to make beyond blaming the ills of the National Health Service on all these irresponsible people who dare to fall ill. If it wasn't for them, the whole thing would be running very smoothly indeed, was his implication. It is self evident that people should try to improve their health, but for their own sake, not for the benefit of a buregoning bureaucracy which is becoming unreformable."
I am more willing to be positive about the Prime Minister's message although I accept Iain's view that improved public health is no substitute for NHS reform. So many individual choices are contributing to the growth of government and anti-government fundamentalists need to overcome their opposition to publicly-funded programmes that, in the medium term, may produce more independent citizens and lower taxes. I wrote this in January:
"The road to a smaller state lies in healthier marriages, less obesity and more drug rehabilitation (among other things). It is essential that small government conservatives find ways of delivering such social goods."
And, for once, I appear to be in line with Tory policy! Andrew Lansley has welcomed Tony Blair's speech and has helpfully issued a press release comparing Blair's rhetoric today with Cameron's in January (when the Tory leader addressed the same subject). The graphic below summarises four key sections of 'Blameron' language (a subject discussed by Simon Heffer today):
Another example of New Labour stealing Tory ideas or of our Dave being the heir to Blair?
This is all hot air unless you are prepared to take the steps to make this happen. If you have a healthcare system funded solely out of general taxation, you cannot send fairly gentle signals to people, via weighted contributions, that they need to adjust their lifestyles e.g. lose weight, take exercise and stop smoking. With a social insurance system (rejected by both Blair and Cameron), you can do that without leaving people with no access to healthcare.
Posted by: Michael McGowan | July 26, 2006 at 17:54
"With a social insurance system (rejected by both Blair and Cameron), you can do that without leaving people with no access to healthcare. "
Posted by: Michael McGowan | July 26, 2006 at 17:54
Hear! Hear! It is a tory belief that individuals should take responsibility for themselves but why should the taxpayer pay entirely for conditions that are demonstrably self-inflicted?
It would not pay to talk about social insurance (which could be weighted to take account of such matters) before the next GE but by a second term perhaps the idea could be debated of hypothecating one part of NI contributions as health insurance premiums and the other part as state pension contributions.
Posted by: David Belchamber | July 26, 2006 at 18:53
To help reduce widespread obesity, first the multinationals will have to be reined in. They seem to have a deliberate policy of larding everything with suger. Anyone who has studied dietetics will know that suger is highly addictive. Nice for the profit margins. There is no way they will stop marketing breakfst cereals with an amazingly high suger content, without some sort of regulation. They throw a sop by introducing a low suger cereal, then whip it straight off again, crying it doesnt sell!! High suger content produces an insulin bounce which actually increases appetite.
Next job, is to make folk understand that obesity is a mental health problem, not a metabolic problem. Obesity is an eating disorder with as high a casualty rate as anorexia, and the sufferers are equally manipulative with their carers/health advisors. If one has got to the life threatening weight of, say 40 stones, then the only way to save that persons life is to section them, and admit to a residential unit.
Will the NHS take such a draconian measure? No.
Will the NHS create such residential units? No. the only ones are for Prader-Willi syndrome.
Will the government act against firms who put out these dangerous foods? No. There lobbies are too strong, or some one up top is sending bungs to No 10.
They appear to be just planning to obtain bigger beds, AND tellingly, BIGGER MORTUARY TROLLEYS!!!!
Is this a signal for another labour does not do???
Posted by: Annabel Herriott | July 26, 2006 at 20:23
This is never going to work unless there are incentives to good health. Penalities for bad health clearly being a total non-starter politically.
However, people who attend an annual check up with their GP and who are thereby shown to be non-smokers (by a saliva test), have a BMI less than 28 and a BP less than 140/90 (whether on treatment or not) should get a good health certificate which the GP can send to the Inland Revenue and entitle them to pay income tax at 0.5% less than the standard rates to reflect their potential lesser use of the NHS in later life.
People respond very well to quite small financial incentives and it should be quite easy to sell one about better health
Posted by: Opinicus | July 26, 2006 at 21:26
Hold on - smokers already pay far more in tobacco duty than the extra cost to the NHS of treating smoking related diseases. Plus by dying younger they help to avert a complete collapse of the pension system ...
Posted by: Denis Cooper | July 26, 2006 at 21:51
"To help reduce widespread obesity, first the multinationals will have to be reined in."
Or perhaps people should stop eating so much? The multinationals don't force people to eat their food. It is a matter of consumer choice. If people are addicted then a)they shouldn't have got addicted in the first place and b)they should shake the addiction (everyone I know who has ever smoked has successfully given up). If they make a stupid choice they will suffer the consequences.
Posted by: Richard | July 26, 2006 at 21:55
Isn't a BMI of 28 clinically obese? :-) Even sillier, most rugby players would fail that test because of muscle weight.
Anyway, as others have pointed out this is an inevitable problem for politicians in administering social medicine systems. Just another sign that the NHS is on its deathbed, although no doubt it'll thrash around in its death throes for decades - vast cash injections by both parties will keep it "alive".
Posted by: Andrew | July 27, 2006 at 00:11
Tim I completely disagree. The existence of the NHS is being used as an excuse once again, to attack our personal freedoms.
We need a health system where people pay for their own life choices, not an aggressive Nanny as Prime Minister (or leader of the opposition).
As for reining in the companies, thats another attack on our freedom of choice.
Posted by: Serf | July 27, 2006 at 07:16
The Tory/Labour debate used to be small versus big government, whereas now it seems big government has won and the two parties are simply arguing the toss over the % of private sector involvement in this big state solution.
The way to achieve personal responsibility is to change the public mindset that the state is there to help you in times of need, but it is not there to wipe your arse and to achieve that we'll take less of your money to allow you to make your own choices.
Posted by: Chad | July 27, 2006 at 08:16
I believe in a tax funded health service free at the point of use but I do think that a lot of the strain on the health service is caused by the mindset people have that if they seek healthcare wether it be with there GP or at an hospital they are getting something for nothing.
I think we need to make people realise how much of there income tax is actually spent on the health service. That`s why personally I think we should have a health tax which is ringed fenced and solely used for the health service budget.That would really make people reaise just how much the NHS is costing them and that it is not a something for nothing deal!
Posted by: Jack Stone | July 27, 2006 at 08:56
Serf/ Take a stroll along the breakfast cereal section of any supermarket/shop,and check the suger content. Only shredded wheat and porridge oats are truly sugar free.
There are perhaps two mueslis with only the dried fruit providing sweetnes. The others have either sugar in spades, or sneaky suger = "malted" "honeyed" etc. So you see, dear Serf, we do not have freedom of choice. We get what the multinational decide we can have
Richard. Your arrogance is unbelievable! I repeat. Obesity is a mental health problem. Would you mock someone with bi-polar depression? No? I repeat yet again, morbid obesity is a true psychosis, yet is still unrecognised as such. I have observed one such person, an inpatient on a (life saving) strict diet, wiping every last crumb off the plate. I was dispensing the ward medicines at the time, and paused, utterly fascinated by this eloquent demonstration of a food addiction.
These people are killing themselves with food, as surely as an anorexic kills themselves by refusing it. The catch for them, is one can choose not to have a cigarette. One cannot choose not to eat. Cold turkey is not an option.
Dennis.
A smoker? How cynical. I have also nursed people with no legs, due to a condition that is 100% smoking related. They had first one amputated, then the other. Still smoking.
People are more likely to develop cardiac conditions and die (Eric Morecambe) through nicotine, a combination of smoking and over eating with blind you, and destroy your kidneys. Still they are desperate for nicotine. I have seen a man, on his deathbed, bright yellow from liver secondaries, unoperable lung cancer, sighing that ordinary cigs made him cough, so he was on menthols.So you are saying goody goody, they dont deserve to live anyway? Save the NHS a few bob?
We spend millions on drug addiction, probably because it impinges on our own health and safety (mugging) We should be also addressing these equally fatal addictions.
Posted by: Annabel Herriott | July 27, 2006 at 09:34
If we have to pay taxes for socialist quasi-monopoly healthcare, it has to treat us.
Posted by: On Behalf of Fat People Everywhere . . . | July 27, 2006 at 11:08
How dare you tell people how to live. How dare you.
The failings of the most socialist institution in the developed world is not an excuse for health fascism
Posted by: Chris Hughes | July 27, 2006 at 13:59
Not health fascism Chris, merely a desire for people not to have to suffer the way they are at the moment, with a NHS unable to do much about it, due to mismanagement of funds, and mismanagement of priorities.
These extremes of hot weather will increase the suffering of the morbidly obese, as well as the most mobility impaired elderly in the population. How do you keep hydrated for instance, when you are incapable of getting to a cold water source by yourself?
Posted by: Annabel Herriott | July 27, 2006 at 14:16
Not health fascism Chris, merely a desire for people not to have to suffer
I'm not disputing living a healthy lifestyle is a good thing. I'm merely inquiring who made you the keeper of the nations health.
We all have to 'suffer' this marvelous weather, not just the obese, and if the obese suffer more than others surely that is there own fault for eating all the pies. Obesity is not a mental health problem or a metabolic problem, its a greed problem - at least for most people.
To help reduce widespread obesity, first the multinationals will have to be reined in.
And to instigate INGSOC now you want to rein in the free market. Damn those supermarket chains for offering tasty snacks at low prices
Posted by: Chris Hughes | July 27, 2006 at 14:48
I guess sadly, thats why there are a couple of million type 2 diabetics and rising.
You cannot accept the link between the cereal industry, and it must follow that the bulk of the population cannot either.
It was the same in 1959, when Doll reported on the link between tobacco smoking,and lung cancer. Shock! Horror! Outrage! How dare he! I remember it well. I was just starting my health visiting training at Battersea Poly. 40 odd years later, it is an accepted fact, and Doll was knighted.
Posted by: Annabel Herriott | July 27, 2006 at 23:13
"Richard. Your arrogance is unbelievable! I repeat. Obesity is a mental health problem."
I think we have to define what we mean by obesity here. I can't recall the statistics but I seem to recall that a significantly large minority of the population was considered "obese". I doubt that all these people have mental health issues. I have no doubt that a minority of them do but I am referring to people who in general eat too much and are too stupid to stop.
Posted by: Richard | July 27, 2006 at 23:17
"So you see, dear Serf, we do not have freedom of choice. We get what the multinational decide we can have"
Er, no. In capitalist society the consumer is king. Consumers decide whether or not to buy those goods. If there was no demand for them then companies wouldn't make them. Has there been a mass consumer boycott of these goods? No, which implies most people are content to put up with them. If there was serious demand for a "healthy" alternative you can bet somebody would have invented it by now.
Posted by: Richard | July 27, 2006 at 23:20
Actually, America has woken up. Low suger foods are getting big over there. I found that out when I phoned Kellogs to ask why they had taken off a no suger product that I liked. They do not sell over here as yet, because the population has not woken up yet. America has reached its tipping point, we have not. I guess we will have to have around 4 million diabetics before someone says enough already!
Posted by: Annabel Herriott | July 27, 2006 at 23:37
Richard, I was referring to morbid obesity. 20 stone and rising. They cannot stop eating. If they are bed bound, on a strict diet, they will phone for a pizza, or a curry. If they have a band fitted to their stomach, they can actually burst it with disasterous concequences, because their compulsion to eat is so great. These people can, and do, reach 50 stones. They can only be taken to hospital with the aid of the local fire brigade. When the end comes, it is so embarrasing fot their families, as there has to be a hunt for a crematorium with a big enough oven. The public titter, but it is no laughing matter.
I read in the press that crematoria are planning an increase in the size of their ovens. This is so preventable with the right support given early enough.
Posted by: Annabel Herriott | July 27, 2006 at 23:45
Chad - "The Tory/Labour debate used to be small versus big government, whereas now it seems big government has won and the two parties are simply arguing the toss over the % of private sector involvement in this big state solution."
I totally agree. What a depressing state of affairs we find ourselves in.
It might be of interest to Mr.Blair that smokers pay almost FOUR times as much on tobacco/cigarette taxes last year than on smoking related NHS treatment.
- NHS approximately £1.75 billion in 2004 due to smoking related illness.
- HM Customs and Excise, tax revenue on tobacco was over £8 billion for the tax period 2004-2005.
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