A BBC article on lifestyle related illnesses caught my eye today, ‘Illnesses associated with lifestyle cost the NHS £11bn’.
The article mentions the real health problems of type 2 diabetes and chronic obstructive pulmonary disease (COPD), both illness that are significantly related to individuals’ lifestyle choices, including diet, smoking, alcohol and exercise.
Freeport, a once prosperous fishing town in Lancashire, is used as a case study. It is the home of Fisherman’s Friends, has one of the UK’s cheapest outlet stores and still smells of fish but is economically deprived in a region that has not thrived in recent decades. The correlation between economic deprivation and poor health is well demonstrated, and causation has been demonstrated in areas where the economy suddenly deteriorates due to collapse of local industry.
One of the solutions discussed is a community project that has transformed waste ground into a community allotment run by those with learning difficulties and brain injuries (Willow Garden Project). This charity seems to be locally run and receives money from the Lottery, so, regulatory barriers to lottery startups aside, is funded from less coercive sources than central taxation. It is I believe, the right approach to improve the wellbeing, health and empowerment of those locally. National economic disincentives are also to blame, such as variable rates of housing benefit, but that is beyond the scope of this discussion.
My main concern about this article however is the headline itself. Illnesses associated with lifestyle are horrendous. Slowly suffocating in your own CO2 as your lungs deteriorated over decades is arguably as bad as an 18 month death with lung cancer. The sexual dysfunction, eye problems, kidney disease, chronic limb pain and risk of limb amputation with type 2 diabetes can be horrendous. The impact on work and independent living affects individuals and their families. Depression associated with multiple medical conditions is real.
None of this is captured in the headline however. The headline only mentions the ‘cost’ to the NHS. That NHS which is a payment and organisational / control system for healthcare in the UK. That NHS that is not a person and will not suffer the ailments listed above. The NHS that is forced (through taxation and crowding out effects) on all of us in the UK yet delivers worse outcomes than many mixed systems in Europe (OECD Health Systems at a glance 2015). The NHS that by design will always be political yet will only tend towards cheapness.
The underlying message in this headline, of which this is one example of the tone of the narrative, is that if you become ill, particularly if you are poor, it is your fault and you are not only harming yourself but the institution of the NHS itself and your fellow UK citizens.
As the NHS fails to cope with the supply/demand mismatch of an undifferentiated one size fits all system expect this narrative to continue. And as it continues expect policy to follow the narrative. A collectivised system will start to choose who is ‘eligible’ based on various lifestyle and social factors. And when individuals are forced to be in the system, through tax and crowding out, yet find the system judges them ineligible at the point of use, the net result is social division and the hardening of resulting systems to control individuals. As social and benefits records are further integrated with health records the potential for such centralised control increases dramatically.
Thus we live in a country where healthcare demand is expressed as a cost, where individual choice is demonised yet alternatives are poor for the economically marginalised. I saw an advert for a general practice role in Australia recently. The tagline was ‘high demand area’, as GPs would have lots of customers for their business. In the UK NHS however a quiet day is a victory and a queue of people waiting to be seen is a failure.
Such is the result when the state intervenes.