Watch this televised interview between Dr Stuart Waiton, against nannying, and Dr Andrew Fraser and Laura Williamson in favour of what they term a caring society that is willing to help people reduce their smoking and drinking.
It's always interesting to see health medics, who claim a political consensus in favour of their view, weigh in on their opponents and characterise them as rather irresponsible, selfish individuals who believe in pleasing only themselves. They claim to care for the children and society at large more than these un-community-minded free-market maniacs.
From what I know of Dr Stuart Waiton, he is no more a free-market maniac than I am. He quite reasonably rejects the notion that the health professionals hold a monopoly of wisdom about people's decisions, and rightly derides their eagerness to help people make the 'right choices'. There is an assumption that the patrician middle class has all the right answers, and anyone who disagrees puts himself (or herself) automatically in the wrong.
The two pro-establishment doctors sow the seeds of their undoing by claiming that a quarter of Scots smoke (9.29), and that people in poorer districts benefited less from the smoking ban than people in more affluent districts (10.40). Both statements reiterate the failure of tobacco control to achieve its stated aims. The smoking rate has not changed significantly since the smoking ban was introduced, the same figures (one in four Scots smoke, smoking kills 13,000 a year) have been trotted out since the millenium: a rapidly escalating tobacco control budget has done nothing to reduce the smoking rate or the alleged death rate.
Dr Williamson goes to far as to say that '[Dr Waiton's] argument for a minimal state would be okay if everybody had the same degree of freedom', but social inequalities lead to health inequalities, which it is the government's duty to correct. 'People need help, and what the government is trying to do is create this level playing field.'
She argues in favour of a system which she must acknowledge is not working. She knows the smoking ban hasn't really helped narrow the health inequalities gap. Intervention is needed to prevent 'the chronic diseases that result from smoking, obesity, alcohol consumption'.
Missing from their argument is any glimmer of interest in the socio-economic condition of patients whose interests they claim to be helping. Dr Fraser says that people know the answers but don't make the right decisions, and yet stops himself short of saying 'We love coercion'. If it is part of their faith that economic wellbeing improves health outcomes, that is where their efforts at 'levelling the playing field' should be addressed, instead of working to create countless new offences, which adversely affect people's prospects when they fall foul of the law.
More importantly, where did this idea come from that chronic diseases result only from lifestyle choices? Is it that the mega corporations are too important to politicians for their activities to be attacked on the grounds of environmental and public health damage? Note that Dr Williamson refers only to the budgets of tobacco and alcohol industries: not about the budgets of any other kind of industry, although these other industries must be even more powerful if they can avoid the government and medical establishment's hit list. Everyone knows people who have died early in spite of doing all the right things with their health: non-smokers, non-drinkers, joggers, you name it. No one is safe. [Late edit: more on this here: How working kills smokers: 'There is no question that smoking contributes to poor health. But to claim that smoking is the primary cause of preventable death and disease is one of the greatest scams in modern history.' H/tip Freedom2Choose newsletter, April 2013.]
The doctors wind up stating that we should look to a fair Scotland where we care about each other and community. And on the face of it, what's not to like? Only that the politicians and the medical establishment do far too little to campaign against economic hardship, which they know to militate against 'healthy choices', and place too much emphasis on lifestyle factors when explaining how people get ill.
5 comments:
Dr Williamson goes to far as to say that '[Dr Waiton's] argument for a minimal state would be okay if everybody had the same degree of freedom', but social inequalities lead to health inequalities, which it is the government's duty to correct. 'People need help, and what the government is trying to do is create this level playing field.'
This reminds me of the Ronnie Reagan quote... The nine most terrifying words in the English language are: 'I'm from the government and I'm here to help.'
Amazing! The (quack) Dr Frazier comes across as a Dr Mengele, and the other person (the female) seems to think that the State owns children.
No wonder that fewer and fewer ordinary people who dislike the smell of tobacco are commenting on newspaper articles about the enjoyment of tobacco - they are beginning to see how they have been tricked.
That interview clearly illustrates that the (quack) Doctors are not really interested in individuals' health - they are only interested in costs to the NHS. They seem to be unable to understand that OLD AGE is the biggest cost to the NHS, and yet they wish to prolong old age further and further.
All the money spent on Tobacco Control would be much more fruitfully spent on giving old people a purpose in life.
I haven't yet listened to the interview but you ask, Belinda, where the idea that lifestyle choices are the cause of all chronic illness comes from. I think that it might have been on Frank Davis's blog that someone (maybe Frank himself) mentioned the Nuffield Report (perhaps someone with a better memory would confirm this)and this report lays the blame squarely on lifestyle choice.
I think that the underlying problem stems from increasing powerlessness in governments to address their proper concern of the economy due to the complexity resulting from globalisation and the concomittant problem that no one government is capable of such decision-making.
jay
'Caring Society?' Health inequalities? Do they give a damn about Wealth inequalities-the real evil in society? Do they bugger all.
Sorry. That's probably not true. Such inequalities are a vital part of their patrician ideals.
I'm too young to recall the days of the deserving and undeserving poor but I do recall a time before Thatcher declared there was no such as society.
In between times, a caring society (note the absence of quotation marks in this case) created the NHS and the welfare state, raised wages and raiesd the status of the working man and woman above that of effectual serf. All this without making judgements on the choices of said workers to smoke or not to smoke.
Another excellent blog.
Thank you.
Michael.
As for health and social inequalities, certain health behaviours can acquire the form of “structurally reproductive agency”, e.g. when sedentary lifestyles and unhealthy eating habits (rooted in unequal access to capital and empirically found to be more common in the lower social classes) contribute - through habitus (see Bourdieu) - to a re-iteration of social patterns of health risks and to the reproduction of health disadvantages in lower social classes. Waiton should acknowledge that, as a sociologist.
In this respect health promotion has been rightly criticised for being vulnerable to practicing inequality re-enforcing measures, e.g. when not reaching deprived populations or when relying on interventions that are more attractive to, and effective in, certain population groups
In such cases public health action might be contributing to structural health inequalities by promoting health advantages for those already privileged thereby reinforcing class differences in health through structurally reproductive agency.
Alternative approaches might instead be focused on promoting “structurally transformative agency”. For example: new community structures that allow for citizen participation and increased autonomy in community health matters. The latter is not government nannying sub-populations of 'stupid' people and likely more palatable for those subjected to such insulting, money-wasting health promotion efforts.
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