I agree, there is no excuse for being fat
Dear Andrew Lansley,
Bit of a mixed bag, I’m afraid. The article in today’s Independent on your drive towards healthier lifestyles started with such promise as you declared that people “have no excuse not to exercise, or eat their fruit and vegetables” and that blaiming biological and environmental factors for becoming obese is unacceptable. Sadly, when I read through the rest of the article, my heart sank a little as I realised that the Conservatives really aren’t going to get to the heart of the matter – at least, not until they get into government.
Your speech today will announce a raft of measures on a number of key public health issues. For example, it will cover ways to remove the “peer pressure” that you claim is responsible for teenage obesity, underage sex and binge drinking. You will also encourage firms to cut the size of ready meals and use Olympic stars as role models to encourage young people to live more healthily. Rather bizarrely, you insist that these initiatives are “not about telling people what to do” – surely that is precisely what they are intended to do? Obviously there is a difference between a wholly authoritarian route e.g. banning junk food advertising (which you won’t do) versus putting incentives and disincentives in place (which I favour) but it still sounds like a fairly top-down approach. Your claim that a future Conservative government would not “nanny” people looks a little thin (pun not intended).
In fact, not only does it sound top-down, it also sounds fairly ineffective. You intend to scrap support for “traffic light” labelling on food, which I find incredibly useful when doing my weekly shop! What are you playing at? I think the traffic light system should be expanded to all supermarket to help consumers identify the ‘good’ food from the ‘bad’. It’s non-intrusive, inexpensive and will help people stay away from potentially unhealthy food – and you’re going to scrap it. Hmmm. Your proposal for a “responsibility deal” with companies to encourage firms to cut the salt, sugar and fat content of food is similarly pointless. You’re going to scrap the traffic light labelling system which helps people see how much salt, sugar and fat is in their food, then ask companies very nicely to cut the amount of salt, sugar and fat in their food. Eh? Not very joined up thinking, Mr Lansley. Why not leave the decision about what we want to buy in the hands of the consumer instead of politely asking companies to make food healthier? Surely this is not very conservative? I also have no idea how a government intends to remove peer pressure when it comes to underage sex and drug-taking. The phrase ‘peer pressure’ makes it quite clear that the government isn’t really involved in this equation.
I’m sorry but I just don’t get it. I know that there is all this talk of ‘nudging’ people and businesses to ‘do the right thing’ in the Conservative policy unit, but this set of initiatives is all back to front. Providing good role models will only go so far. The way to tackle obesity is to educate children from a young age about healthy eating in addition to teaching them how to cook, provide people with information about the food they are buying and make them realise that the NHS is not going to pick up the tab for their obesity in future (taking obesity drugs off the NHS would be a good start). Better luck next time.
Yours sincerely,
A.Tory
“Why not leave the decision about what we want to buy in the hands of the consumer instead of politely asking companies to make food healthier? “
Because at heart, Dave’s BluLabour is no better than the current lot. Their attitude is that ‘they know what’s best, and you peasants will just have to get used to it’.
“The way to tackle obesity is to educate children from a young age about healthy eating in addition to teaching them how to cook, provide people with information about the food they are buying and make them realise that the NHS is not going to pick up the tab for their obesity in future (taking obesity drugs off the NHS would be a good start).”
Agreed. But that means expecting people to take personal responsibility for themselves. And that’s increasingly frowned upon…
That’s what I don’t get. The food labelling system allows people to take responsibility for what they buy but it’s going to be scrapped! Personal responsibility is a fundamentally conservative concept yet I see little evidence of Cameron wanting to give people control over their own lives. Very frustrating.
Lansley was responsible for the outrageous and unnecessary pledge to increase NHS spending Were he shyly suggest night follows day his lack of credibility would justifiably provoke scepticism and I was also confused about this .
Personal responsibility is associated with Conservatism I would not call it a fundamental Conservative concept though, it is more a Libertarian point . I think I prefer pressure out on food production that traffic lights because unhealthy eating has absolutely nothing to do with ignorance of what is unhealthy. And such handy hints would only be of use to those who have decided to go on a diet who do not need the help anyway.
I like your final paragraph a lot , what you need is a change of culture but I think the states ambitions can only be limited and long term. I suppse the really Libertarian answer would be to abandon free health care and let fat people try to buy Insurance .
I would be against any such idea of course .
Not sure anyone would pursue free abandoning healthcare in the modern era! Little bit too bold and very risky politically. Having said that, I still think the lack of consequences for those who are eating themselves into an early grave is astonishing. Obesity surgery on the NHS, obesity drugs on the NHS – what incentive is there for people to look after themselves?
There is a much more fundamental kind of reform to the funding of healthcare that is needed.
While there is a a very strong case for community funding of public health requirements (such as infections diseases, antisocial mental health, maternity, paediatric care, trauma, and genetic and other inherited diseases that can’t be predicted or prevented by the individual) there is a need for more individual responsibility for areas where it is the individual and not the community that is the main beneficiary of treatments.
Most people will eventually suffer from degenerative and terminal illness. While the precise illness probably can’t be predicted the approximate cost of the healthcare required can be. The amount of healthcare and when it is needed can be influenced by the lifestyle choices made by the individual.
The structural solution is to stop paying for treatments that are mainly for the benefit of the individual out of the central community fund and require individuals either to save or take risk based insurance cover to pay for the treatment.
If unhealthy life styles result in either higher costs to the individual or they have to accept that they will not get the most expensive treatments when they fall ill from avoidable causes, then they may make significant changes in their behaviour.
Robert D, you make a good point but (as you argue in relation to windfall taxes) there are significant problems in practice.
For example, some non-smokers develop lung cancer, from which we can conclude that although smoking greatly increases the risk of the condition, it is not the sole potential cause. We can surmise, therefore, that some smokers who develop lung cancer would have done so anyway, so their cancer is not caused by their smoking habit. What we can’t do is say which particular smokers this applies to.
We could of course decide to say that by smoking, you accept that the state will not pay for treatment of your lung cancer regardless of its cause. That would resolve the immediate issue, but would then create others – such as the case of a person who smoked in their 20s, stopped in their 30s, and developed lung cancer in their 50s. Should the NHS treat that?
I’m not disagreeing with you – the people who remember a time before the NHS are dying out (literally, sadly) and leaving behind generations who expect to be supported no matter what. But I’m not sure exactly how to draw the line. Where to draw the line, I’m happy with. But how … gosh that is tougher.
Is there any excuse for being unemployed more than six months?
Rob, sounds like you advocate a social insurance system – which would be great in theory but is surely too far removed from where the NHS is now to be workable within the next ten years.
Patently, my angle has always been that for diseases that are scientifically proven to be linked to certain behaviours e.g. smoking to lung cancer, I would make people pay a percentage of their treatment rather than pay the whole amount – maybe 10-20%. That would be small enough to counter criticisms of the difficulty in proving what caused an individual to develop lung cancer but would still force people to take responsibility for their own angle. People who used to smoke years ago but gave up would still be forced to pay. Obviously the list of conditions for which this applies should be small because of the need for unequivocal scientific evidence to establish a link.
Suppose the smoker in question had created a lot of wealth in his lifetime and in addition to subsiding the treasury through taxation on cigarettes had paid vastly more than the amount he would have required to buy the Insurance elsewhere. The average tax payer pays equivalent Premiums that could purchase approximately £200,000 of health care in his life, that would be £400,000 for a family. A wealthy or even middling tax payer might have purchased a lot more.
Suppose he also lived an otherwise risk averse life and considered it unreasonable for him to contribute to injuries acquired through sport, riding and /or endless other voluntary activities that add to the burden on the NHS.
What you propose, which is in effect a punitive co-insurance clause for high risk occupations cannot be levied according to the whim of this or that ‘Flint’ hearted hater of smoking . If we are going underwrite risk then lets do it , lets not pretend that there is some actuarial basis for picking on over eaters and smoker s though…( although there may be in some cases)
Some people are congenitally disposed to heart conditions- £20,000 excess?
Some people work on building sites ? 20% co-insurance?
Some people are Gay ? Drugs related and STD excess ?
Soempeople come from sick postcodes ( Glasgow has some shocking figures ) ? Why should those who do not pay for those who do?
Etc.
I am not averse to introducing Insurance concepts into the NHS and I am not against the NHS continuing in its illogical way, leaving it alone for bit is one good idea. I am, averse to it being used as weapon by the people I pay to take my rubbish out ( which they don`t) against any life style choice I make and employing some half baked gesture towards risk rating as a cover for social engineering .
So there
You have extrapolated WAY beyond what I said above. I said that for diseases and disorders that are unequivocally scientifically linked to particular behaviours, we should consider introducing some form of financial contribution from the individual.
Being gay is not a behaviour, genetic predispositions are not behaviours, dangerous sports already have insurance to cover them and are therefore not relevant, sick postcodes are not behaviours, people working on building sites presumably are covered by insurance from their employer etc etc.
This is not social engineering – this is asking people to pay towards their treatment under some limited circumstances.
Dangerous sports already have insurance to cover them
Wrong .Professionals may purchase special PA covers but no-one else does and incidentally they do so for loss of earnings not primarily for the relatively minor cost of being patched up again. Amateur Clubs and so on may purchase Liability but negligence is not usually an issue. You do not have to work on a Demolition site which is about as high risk an occupation as I can think of and in this country we have Liability not workers Comp although it is virtually strict admittedly . It is however irrefutable that many occupations can be identified with varying degrees of poor health in which negligence does not arise.
The point is this. If the Government removes, as it does, an amount that is more than enough for the health care it provides (in the case if many) , then withholds the care purchased , as you suggest , on the basis of certain life style choices , then you have to have to show that you are acting fairly to them and not simply out of malice and general bossiness.(You have, remember, removed the means by which they might make their own arrangements ). The state show they are , as a group , not behaving in ways it merely disapproves of ,but actually presenting an unreasonable burden on everyone else .In that case it is irrelevant which category of person you call “behaviour “ and which you call , whatever you call them. BTW ,what about drinking?
If the NHS was a commercial insurer and it was not just a matter of your judgement or my objection the truth is this. Yes there would be a surcharge for smokers. BUT, many many people would not be able to obtain cover at all. We would not allow the latter so pretending there is a moral of logical case for the former is all a ‘Just so’ story. Your suggestion has been made in the real world and the dreaded BMA churn out similar stuff all the time. On £250,000 pa their own habits are unlikely to be affected .
Amway basically I smoke so get you tank of my lawn LFAT…
There’s one way to solve the obesity problem – ban the private car. The number of my neighbours who hop into the car to fetch the Sunday newpaper is sad – the shop is five minutes walk away but the fat gits still have to drive because they can’t waddle that far without having a heart attack.
You were quoted in the Independent! It was on page 32.
Dead simple, everyone has to pay their own annual health insurance = method to fund NHS. Annual cost varies according to their deviation from standard weight, so fat people pay more. Unless they actually feel the financial impact during their life, no behaviour will ever change. Compulsory annual checkup will revise cost regularly, so if they lose weight they see direct impact. Insurance fees go direct to local health care provider, as they are likely to have more sick people to look after if they have lots of tele-tubbies. People on benefits have cost deducted from their weekly amount, so they see and know its impact. The power to change behaviour through simple economics.
I like it, but try telling that to Cameron.