Monday, February 18, 2013

Doctors' attempt to tackle obesity is middle class statism

There is nothing new about the latest report from the Academy of Medical Royal Colleges calling for state intervention to prevent people getting fat.  It demonstrates the fundamental error of people who are well intentioned, and intelligent, moving beyond their core expertise of medicine, into public policy and human behaviour.

For example, virtually none of them realise that the price of food overall, including fruit, vegetables, meat, dairy products and fish would fall, if the quotas and tariffs imposed by the Common Agricultural Policy were abolished (which do not apply to highly processed sugary foods made in the EU).  However, that requires an understanding of public policy beyond health into trade.  Bear in mind the largest UK recipient of EU agricultural subsidies in recent years is sugar refiner and retailer Tate & Lyle.

The doctors also seem to have ignored the Danish fat tax failure, unless they think the problem was taxing fat, not sugar.   Danes introduced a classless fat tax, which of course meant gourmet cheeses and butter got hit the highest, and many Danes simply took to fat tax evasion trips into Germany to stock up on their favourite foods.  Doctors in the UK presumably think a sugar tax could only target the products they disapprove of (not be based on all simple sugars in products) and would avoid encouraging people to shop internationally (Northern Ireland would be home to a new black market in smuggled Coca Cola).   Policy experts? Hardly.

You see the key obesity problem is not the lack of hectoring, lack of information or lack of laws to make people do what they want, but a culture of irresponsibility and a lack of medical understanding as to why people behave in ways that make them overweight.  What is particularly galling is the implication that it is only certain foods, perceived to be "junk" consumed by the poorer classes, that are the problem.  In fact, if people predominantly ate the rich, butter intensive foods of some celebrity chefs, in particular their butter and sugar laden desserts, they would also be obese.  However, it is perceived that the people who will bother to make such foods or eat out, know how to look after themselves.  This battle against obesity is one about class.  For the wealthy man who loves steaks, Beaujolais, chocolate mousse and fine cheeses is not the target of the hectoring doctors - even though such a person equally faces a risk of heart attack as the poorer man who loves fish and chips, chocolate and beer.   Yet it is abundantly clear from the communications behind these reports that it is the latter that is targeted, presumably because the latter person is not thought to be competent, but the former "understandably enjoy delicious high fat high sugar foods".

Most of the proposals outlined reinforce a culture of irresponsibility, and the hectoring culture whereby doctors think people will do what is "right" if only they keep telling them to do so.  The implicit message is that it is only one group that is irresponsible, and it is not those doctors socialise with.

So I'll rank the proposals from least to most acceptable based on qualitative measures of promoting responsibility and preserving individual freedom.

Hospitals to adopt the same nutritional standards for the food they serve patients and staff that already apply in state schools in England, and an end to fast food outlets and vending machines selling unhealthy products on hospital premises.

It is difficult to disagree with this (although I'd emphasise this should be NHS hospitals.  Doctors can keep their sticky fingers off of controlling private hospitals).  The idea that hospitals would feed patients in ways that are not conducive to a healthy diet is simply ludicrous.  Of course having a mammoth state health service is meant to ensure this happens.  Now it seems a little churlish to remove fast food and "unhealthy" food from hospital premises, but it is good for the private businesses on the outside.

An expansion of bariatric surgery for more severe obesity, from the current total of about 8,000 NHS operations a year, to help those most at risk of dying.

I haven't become soft, but if one accepts the premise of the NHS, then there is no reason for those with severe obesity to not get surgery when it is the most effective treatment to save their lives.  Of course it would mean cutting other surgery or costs, but I am sure the doctors would pinpoint exactly who should lose out so that this expansion in surgery can occur, given what a priority it is.  In fact, they should visit those on the waiting lists personally, or perhaps work a bit harder (since they will be reducing their future workload).  If not, it can't be that important.

The NHS to spend at least £300m over the next three years to tackle the serious shortage in weight management programmes so many more patients with weight problems can be referred and helped "in a supportive and sensitive manner".

Fine, presuming the doctors specify where the money should be cut from other parts of the budget.  The concept of provide supportive and sensitive help is all well and good, and a welcome diversion from hectoring, but if it is that important then there should be a transfer.

Health visitors to advise new parents how to feed their children properly, to avoid them getting hooked on sweet or fatty foods while still very young.

It's hectoring time.  How many parents who don't know how to feed their children properly will respond to "health visitors"?  Who knows.  There is no harm in parents getting advice early on, but I'd question whether people need "health visitors" at all to nanny them.  Of course if they seek out advice, then fine to provide it.

NHS staff to routinely talk to overweight patients about their eating and exercise habits at every appointment and offer them help, under a policy of "making every contact count".

This seems cheap and innocuous, but it is hectoring par-excellence.  If someone isn't changing habits once, will that person bother coming to the doctor again and again if the key message is "you're still fat, why don't you do something about it".  Obviously if there is a health condition directly related to it, then it is worthy of discussion, but what is actually needed is some understanding of underlying causes as to why someone may be in that condition.  Is it medical (vitamin/mineral/hormonal), is it psychological (response to stress) or is it that the person simply doesn't want to do anything about it?  Yes, whilst you maintain a "free at the point of use" health service, some people will simply be content being how they are.  As counter-intuitive as it sounds, there is indeed a whole "fat pride" culture that exists.  Regardless of how you feel about that, it is meant to be a free country.  Leave them alone if they don't want your help or hectoring, as they will know the consequences of their lifestyle.

All schools to have to serve healthy food in their canteens, including academies and free schools, which the education secretary, Michael Gove, has exempted from the requirement that applies in all other state schools.

No. This is a violation of private property rights, and simply means the medical profession has decided it can't be bothered persuading schools or parents that this it the right thing to do, but wants it to be mandatory. No responsibility whatsoever.  Is it motivated well?  Of course.  However, it is very much the wrong way to go about it.  If parents don't demand healthy food at schools they choose to send their children too, then making it mandatory doesn't resolve the problem, and of course no one has demonstrated that the problem resides in free schools and academies. 

An experimental 20% tax on sugary soft drinks for at least a year, like that in operation in parts of the US, to see what effect it has on sales. The potential £1bn annual tax yield could help fund an increase in weight management programmes.

A new tax! The easy answer of statists is a sin tax, designed to "punish" people for making a "bad" choice.  Of course there would be no offsetting of other taxes (obvious one would be to remove VAT from gym membership), because the doctors want to spend more money on health!  You might ask why sugary soft drinks when fruit juices have the same proportion of sugar.  Ah of course, the middle and upper classes drink fruit juices, can't hit them can we?  What about ice cream?  What about sweets and chocolate?  What about hot chocolate, or frappucinos?  Of course it will never end, and wont be "fair" until all sugars are taxed, including sugar for baking.  Then they'll come for the fats of course.  Any such tax will affect demand, but only at the poorer end of the market, meaning it is people with the lowest disposal incomes paying for the doctors' weight management programmes.  A transfer from the poor to the rich.  It doesn't promote individual responsibility at all, but distorts market pricing.

A ban on television advertisements for foods high in salt, sugar and saturated fat before the 9pm watershed, as current restrictions to minimise children's exposure to them have not worked.

Presumably this includes Lurpak, it includes Philadelphia chocolate cream cheese it includes M & S ads with desserts in them. Oh you didn't mean the food for the middle classes, you meant fast food outlets, soft drinks, chocolate bars, ice cream and Tropicana right? Oh, not Tropicana because fructose is better than sucrose right? It isn't?  So you've decided on a key restriction in freedom of speech, on one media (the internet is fine right, because it isn't as if that isn't growing, or is it because you can't effectively regulate it), without really thinking it through.  Forget it.  These products are legal, they do no harm if consumed as part of a healthy balanced diet, and many people find the ads to be informative.

Local councils to limit the number of fast food outlets allowed to operate near schools, colleges, leisure centres and other places where children gather, to end the "paradox" of schools that try to get pupils to eat healthy lunches having their efforts undermined by council-licensed burger vans outside their gates.

This is certainly the most intrusive, anti-responsibility, anti-freedom measure of the lot.  It seeks to undermine private property rights and introduce a new level of planning restrictions, which is so widely defined to prohibit such outlets at "other places where children gather".   It would result in incumbent operators being protected, and treats all fast food as "unhealthy", when arguably plenty are not.  Outlets such as Leon and Pret are arguably fast food, but have many options that are well balanced.  Few need to be reminded of the growth of salads and other options at McDonalds.  It doesn't promote responsibility, but suggests to people that they can't help themselves eating unhealthy food and can't be trusted to choose healthy options.  Of course it also represents wealthy taxpayer employed doctors wanting to shut down marginal privately run competitive businesses.

You see, if the health profession wanted to go further it could suggest banning certain foods, it could suggest subsidising others, it could suggest rationing or other measures to restrict individual freedom.  Yet it knows it can't go that far, yet.  However, the more state intervention that happens, and fails to deliver (which this surely would do), how much more is needed?

I'd argue that if all subsidies for buses were scrapped, especially for children, then suddenly many people from poor backgrounds would walk further and lose weight, but that would be seen as being "mean" - yet taxing their drinks more is just "fine".  However, I wouldn't do it to tackle obesity, I'd do it because there is no good reason to subsidise people's particular travelling habits.

Notice my measure reduces the size of the state (by reducing taxpayer spending), but the health professionals want more government.

What drives the medical profession to do this?

Two arguments are made, one being to save us from ourselves, on the presumptive basis that most adults are simply incompetent and need other adults to push them around, tax and cajol them into behaving better.  You can decide for yourself if that is the sort of society you want to live in.  The second is the "cost to the NHS" claim.

The two are linked, because people do not face the costs of their decisions in terms of health care, they are slightly less sensitive to looking after themselves.  However, if there is to be a socialised health care service, which is based on need, then it either delivers to everyone without discrimination according to how or why someone is ill, or it isn't what it claims to be.

In other words, if your problem is some people cost the NHS more than others, then charge them or reward people through the price mechanism.  However, if "free at the point of use" is the Holy Grail (and it appears it is), then put up and shut up.

Yet if your problem is you want to save people from themselves, then get together, fund a campaign to promote it with money you raise yourselves.  Recognise that going on about obesity also exacerbates the opposite, yet similar problem of anorexia/bulimia.  However, most of all it needs to be about acknowledging that people have to make their own choices, and that some choices are easier than others.  Highly pleasurable unhealthy food is not so much about "I'd rather have this than that", but rather about getting a sensation of short term pleasure, with little apparent effect on long term outcomes.

People do this with alcohol, food, gambling, sex, shopping and in many such cases the state stands by to try to protect them from themselves, without any pointing out that these behaviours are symptoms of people needing to find help with living their own lives, not just treating the self-medicating soothing behaviour.  That goes far beyond the realm of how most doctors want to treat a physical ailment, because it is about emotional issues.  The disproportionate numbers of those from poorer backgrounds with these issues explains it - people whose lives feel hopeless use unhealthy soothing behaviours to get a little joy from life.  Hectoring them and taxing them doesn't fit that.

Perhaps if doctors both gave the time, had the understanding or at least referred people to those who can help, then they might have more success.  

They may learn from those who still smoke, as virtually everyone who has done so for some years knows how unhealthy it is.  People do it because they enjoy it.  If doctors don't understand that, then it doesn't give them carte blanche to push those people around when they are only harming themselves.

People do, fundamentally, have the right to eat, drink, smoke and idle themselves to an early grave.  People also have the right to make products and sell them to consenting adults who want to do the same.

Meanwhile, some may well ask whether associations of medical professionals might be more credible if they rather solipsistically looked as to why their professional brethren engage in behaviours which are grossly negligent leading to death.  

1 comment:

Noah Carl said...

Excellent post.