Ramping up the Health Bill

It’s been a bad summer for the future of healthcare in the UK.  Not just because of the now-constant stream of bad news ranging from poor standards of care to staffing crises in A&E. Not just because of the continued sale of the nation’s silver – from Blood Plasma UK to healthcare data to community care services, with much more set to follow as a consequence of the so-called ‘reform’ of the NHS. But also because the government has completely failed to put in place any preventative measures that would reduce demand on our overstretched healthcare system.

Smoking, obesity and alcohol are the three most significant causes of preventable deaths in the UK. Smoking causes heart disease, lung disease, and more than a quarter of all cancers. Half of all long-term smokers will die prematurely as a consequence of smoking, on average dying 10 years earlier than non-smokers. Drinking more than moderate levels of alcohol causes accidents, heart disease, cancers, liver failure and more.

So there is a huge personal cost currently being borne by the UK’s smokers and drinkers (about 21% of the UK population smoke, and around a quarter of us drink more than moderate amounts of alcohol).  But there is also a huge cost to healthcare.  Admissions to hospital from conditions caused by drinking too much have more than doubled in ten years. And for every smoker who dies of a smoking-related disease, there are 20 people living with a smoking-related condition which they, and their health-care providers, need to manage.

The costs of dealing with these ‘lifestyle-related’ diseases have been estimated to be in the billions for healthcare alone (i.e. excluding the lost revenues from sickness absence and lost economic opportunity, and excluding the cost of policing our town-centres at night when they are overloaded with people who in turn are overloaded with cheap booze).

So how has the government responded?  Academies can ply their pupils with cheap food high in sugars and fats which doesn’t meet minimum standards for school food. Plans to introduce minimum  pricing for alcohol have been shelved. And then the ‘development’ which caused the (Tory) MP Dr Sarah Wollaston to tweet “RIP Public Health” recently: plans to introduce plain packaging for cigarettes have been ‘put on hold’ pending evidence from elsewhere.

Reducing the attractiveness and supply of tobacco is number one on the World Bank’s list of actions in their tobacco control strategy. Along with offering support to smokers to help them quit (which has been shown to work, and has immediate and long-term health benefits), reducing the likelihood that people start smoking is crucial to reducing the numbers of people smoking.

Most smokers start smoking before the age of 19, and teenagers are typically interested in branding and style, so you’d think that making packaging – and with it lifestyle images – less attractive would be a good thing.   And it’s rather hard to see any disadvantages of pursuing this approach.

Similarly, increasing the unit price of alcohol would have minimal impact on most of us as consumers (though it does disadvantage supermarkets and other retailers wishing to push alcohol sales as loss leaders, hardly a bad thing)  and sets a cultural context for talking about alcohol-related harm. That might sound boring but it is necessary, because unlike smoking, where any amount of smoking is bad, the discussion about alcohol is much more subtle: some alcohol is often a good thing, it’s just that it takes less wine or beer than we tend to think to reach harmful limits. (By the way it’s not ALL bad news –  in Ipswich there is a fantastic example of localities taking on the agenda on for themselves – off-licences in the town have entered a voluntary agreement to stop selling cheap high-alcohol drink.)

But this government appears to see things rather differently. You might think they would wish to be credited with measures which not only improve public health, but also save the public purse – not least in the face of the huge challenge our health and social care system is already experiencing from an ageing society – but it seems not.  We have plenty of effective ways of supporting people to quit smoking and to reduce alcohol consumption, just for starters (and I’m sure I’m not alone in being worried about the long-term future of early-intervention services such as these, but that’s for another day). But unfortunately we have got so caught up in arguments about what Lynton Crosby did or didn’t say (this representation by Steve Bell in yesterday’s Guardian is worth a look), that the nation is losing sight of the real prize – better public health. And the government is getting away with pursuing a free market in healthcare (no doubt funded by us as individuals through private insurance before too long) at the same time as allowing the free market in calories, alcohol and nicotine to operate untrammelled.

As a consequence, the government is ramping up the healthcare bill.  There is another possible ending to this story, so why isn’t it being heard?

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2 responses to this post.

  1. Reblogged this on nearlydead.

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