20 July 2023

‘Preventative’ healthcare is just an excuse for meddling in peoples’ lives


Patients have always been a problem for the NHS. If it wasn’t for the burden of people needing medical assistance, the system would work fine.

The health establishment has convinced itself that there would be less pressure on the NHS if people were healthier. This is widely believed and feels almost intuitive. As the Oxford Handbook of Health Economics drily notes, ‘it is frequently argued (but not by economists) that prevention will save expenditure on future treatment’. Economists are the exception because they have looked at the evidence and understand that while premature mortality can be prevented, mortality cannot. When people live longer they consume more healthcare, most of which is needed after retirement age, when they are taking more out of the tax pot than they put it.

Nevertheless, the myth that preventative health saves money persists. It acts as a handy distraction from the failings of the NHS and the inevitable costs that come from having an ageing population. It also gives paternalists an excuse for interfering in other people’s lives. Ask not what the NHS can do for you, but what you can do for the NHS.

A report titled ‘A Covenant for Health’ was recently published by a bunch of random do-gooders, including the Nudge Unit’s David Halpern and former nightclub manager Lord Bethell. The King’s Fund, which paid for it, thinks it is an exciting plan for making the nation healthier. It isn’t. It is the same grab-bag of unimaginative and ineffective nanny state policies that the chattering classes have been talking about for years. It could have been written by ChatGPT.

What most strikes me about the report is the fervent insistence that policies that have never been tried or have already failed will definitely work. In an accompanying blog post from the King’s Fund, Richard Murray writes:

There have been major successes in the fight against many of the key drivers of ill health. For example, the regulation and taxation of tobacco, linked to support for smokers to give up, has been successful in driving down the number of people that smoke (though more still needs to be done). Scotland’s minimum unit price of alcohol has reduced deaths; the tax on sugary drinks has similarly had an impact on obesity; and the concerted efforts in other countries against the rise of obesity show that there are options. The list goes on. 

It is probably true that making cigarettes absurdly expensive and banning them from being smoked anywhere has reduced the number of smokers, but that is where the list ends. Minimum pricing has been a colossal failure and the only thing the sugar tax achieved was tanking the share price of the company that makes Irn-Bru. 

The report itself makes the preposterous claim that the sugar tax ‘led to 36,000 fewer cases of obesity in children and teenagers’. It also claims that minimum pricing ‘led to 13% fewer alcohol-specific deaths’. Both these factoids come from junk modelling studies designed to salvage something from the rubble of the policies’ manifest failure. The reality is that rates of childhood obesity rose after the sugar tax was introduced and alcohol-specific deaths in Scotland are at their highest level in over a decade. The sugar tax has cost consumers well over £1bn since it was introduced in 2018 and minimum pricing has cost Scottish drinkers more than £300m.

It is difficult to reason with someone who thinks that an increase in the number of deaths from alcohol abuse is a decline and that childhood obesity hitting a record high shows that an anti-obesity policy has worked. And these are the supposed successes! The report admits that ‘no country dramatically reduced obesity levels’, but points to Japan as a model to follow. It is true that Japan has low rates of obesity, as most Asian countries do, but does it have a ban on ‘junk food’ advertising? Does it have a tax on sugar and salt? Does it have ‘mandatory calorie reduction targets for the food industry’, as the report recommends? The answer is no, no and no again. So what, exactly, are we learning from Japan?

The policy recommendations are based on nothing but blind faith, and deep down the authors know it. Why else would have they to constantly reassure themselves? To quote from the report: 

‘We know what works’

‘We can help reduce harm from excess alcohol; we know how to do so…’ 

‘We know how to do it.’ 

‘The big message to all political parties is Just Do It. We know what needs to be done…’ 

‘There is a bunch of things that we know work…’

This reeks of insecurity, not confidence, but for Richard Murray it is only a question of political will. He argues that the Government is unnecessarily frightened of introducing policies that will be more popular than politicians think.

‘… surely all this will play badly with the public? A toxic mix of nanny state and lecturing on `healthy’ behaviours? Putting aside those who for ideological reasons think individuals should be left to sort out their own health (which is ideological given all the evidence that simply providing evidence to people on health impacts does not change their behaviours), this isn’t true.’

The word ‘ideological’ is rarely used as a compliment and it is used twice here, although not to describe Murray’s own worldview. I suppose the belief that adults should be free to eat, drink and inhale whatever they want without interference from the state is an ideological position but it also happens to be a part of living in a free society and is a fundamental value of the Enlightenment. 

And if ‘providing evidence’ doesn’t change people’s behaviour, it is because people are aware of the risks and are quite happy to continue behaving as they do. If people were systematically misinformed about the hazards of alcohol, tobacco, fast food, etc. it could justify some form of government intervention, but that doesn’t seem to be the case. Murray is so blinded by his own ideology that he doesn’t see that this makes the case for nanny state policies weaker, not stronger.

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Christopher Snowdon is the Head of Lifestyle Economics at the Institute of Economic Affairs.

Columns are the author's own opinion and do not necessarily reflect the views of CapX.