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"...public opinion deserves to be respected as well as despised" G.W.F. Hegel, 'Philosophy of Right'

the limits of health prevention « Previous | |Next »
May 9, 2008

Jeremy Sammut, a research fellow at the Centre for Independent Studies, has an op-ed in The Australian on health prevention, lifestyle illness and wellness tha tis based on his recent monographThe False Promise of GP Super Clinics, Part 1: Preventive Care He says that Australian governments have told us to quit smoking, eat moderately and exercise regularly, most memorably through the Life! Be In It campaign. We have listened, up to a point at least, and the easy prevention work has now been accomplished. He adds:

Many middle-class people are converts to the wellness cult: they have stopped smoking, improved their diet and started to exercise. But many others, particularly those on lower incomes, prefer to live for the day and have ignored the healthy lifestyle message. Recent reports on public health policy in Britain and Australia found that despite decades of spending on prevention programs, levels of physical activity have not increased and obesity levels have shot up. Obesity-related chronic disease already puts pressure on the health system and it will accentuate the challenges we face as the population ages.

Prevention hasn't worked, he says, because however intensively the health lifestyle message is pushed, it comes down to individuals to have the will, self-discipline and impulse control to change longstanding behaviours that are often pleasurable. As international studies have found, the main reason anti-obesity initiatives have failed is that many people find it difficult to sustain lifestyle modifications for long periods.

Okay, that is pretty right. So where to next? What policy options do we have to address this?

Sammut rejects government intervention as it is paternalistic and an example of the nanny state. He argues that the Rudd Government holds that it is the government, rather than the individual, that the experts deem responsible for obesity, because it has not done enough to force people to drop their hamburgers and get off the couch. Their argument is interpreted thus:

Obesity has been redefined as an epidemic, as if victims passively contract it (infected, of course, by wicked and coercive fast-food advertising). As the victims of this epidemic are concentrated in lower-income groups, obesity has also been classified as health inequality, which makes it a social problem. The failure to curb obesity demonstrates is how the system failed to provide help to turn knowledge into practice. So-called ordinary Australians therefore need Medicare-funded preventive health care, of course, because unless the government was prepared to help them, how could they be expected to take care of their own health.

He says that cheered on by the experts, the Rudd Government is determined to unfurl a new range of preventive policies to try to contain the future cost of Medicare.

The word 'force' is misleading in this context given that the health prevention has been one of persuasion. So is the idea of liberal subjects seen as passive victims of an evil fast food industry. No mention is made of fast food being an unhealthy product.

What is the alternative? Sammut turns to the individual:

But the evidence suggests the Government's policies won't work. It should let ordinary Australians be and help ordinary taxpayers instead. Millions of taxpayers' dollars are already wasted every year preaching the virtues of brown bread, wheatgrass juice and jogging to those who won't be converted.

Letting them be rather than helping them is deemed a good policy, even though they are unwell and seeking help in clinics? "Converted' is the wrong word. This implies that wellness in the form of healthy functioning is a religious cult and not a form of primary care.

| Posted by Gary Sauer-Thompson at 6:49 AM | | Comments (4)


Just say for argument's sake you could ban sugary and fatty fast food altogether, that the only take away you could get would be salads and steamed fresh vegetables.

It wouldn't make any difference. Have you been to a suburban supermarket and seen what people put in their trolleys? There are aisles of biscuits and breakfast cereals which use the minimal amount of grain required to hold the sugar and colourings together. People buy the same lard-soaked fast food crap but it counts as home cooking if you use your own oven. There are whole aisles of fizzy drinks, lollies, ice creams, cakes, chips and chip-alikes. TV dinners no better than McDonalds.

I think persuasion has gone as far as it can and there's nothing realistic that can be done about the food industry. We're just going to have to wear the cost.

Maybe there's something to be said in favour of the Biggest Loser?

Banning is not much use outside of school tuckshops. The best policy or mode of governance is shaping the conduct of free subjects.

Cigarettes is the best model--tax the junk foood so it becomes very expensive. Of course, the liberatarians at CIS will be up in arms but they have a strange notion of harm and a flawed conception of the public good.

health centres in working-class suburb see patients suffering from stress-related complaints. This includes anxiety, depression, alcoholism and drug addiction. Life for many people today is painful, in that actual sense of psycho-somatic distress. The GP cannot change the circumstances of their lives, but neither can they! Their unwellness needs to be addressed.

Talking about 'taxing the junk food' misconceives the problem. It would simply force a general increase in food prices. As Lyn points out, supermarkets are packed full of high calorie, fatty foods. To an ever-increasing extent it's pre-cooked so that people need only make a minimal investment in preparing it, meaning they are even more likely to pig out.

In other words it's not just fast food but the racks of cakes and biscuits and the whole aisle of confectionery and the pasta sauces and frozen pizzas and the soft drinks and another whole aisle of chips and the marinated meats and so on that do the damage. Making any significant inroads into obesity will require a wholesale revolution in eating habits and social tendencies. Why bother trying? People have to die of something.

BTW the idea that we can somehow rein in the exploding costs of health care is misplaced. Medical research will keep developing new and more profitable treatments to prolong life and people will keep expecting governments to make them available.