The principle of a national health service paid for though general taxation and free at the point of need is beautifully simple.
Taken as whole, the population contributes during their working lives, when they don’t need the service, and turn to it when they do – usually at either end of their lives, when very young or frail, assuming their health needs, as a whole, aren’t too great to prevent an overall contribution through taxation.
But the simplicity of that principle belies necessary complexity: some people are unlucky and suffer trauma, others develop multiple co-morbidities, some have disabilities which mean lifelong healthcare needs and prevent them from earning, hence paying taxes. And the number of people who currently are unable to work because of healthcare difficulties allied to obesity continues to increase year on year. Given we live in an obesogenic environment, where cheap, addictive and unhealthy foods are abundant and many have little choice but to form their diet around them, that should not be surprising. But the healthcare demands caused by this growing epidemic of obesity cannot be ignored, and many are prevented from working as a direct result.
Addressing this problem was no doubt behind the Health Minister’s recent suggestion that those unable to work because of obesity could be offered the latest ‘anti-obesity’ drugs (Wegovy or similar products) in an attempt to make it possible for them to take up employment as a result of improved health. On the one hand, this is a direct attempt to head off even more suffering as well as boost tax income. There is little doubt that holding down a job gives people purpose, and paying taxes means the principle of paying in to the NHS when you don’t need it is intact. The Minister has cautioned against this being seen as a substitute for trying to take control over other aspects of lifestyle. This crisis needs addressing, and it is part of government’s job to come up with ideas on how to do that.
But, as others have already noted, there are several dangers in this approach if taken indiscriminately. There is already a fog of stigma around obesity, and directed towards obese people: ‘it’s their fault’. Given the power of this assumption it would be all too easy for good intent to be swept aside by a storm of blame, in which workless obese people too easily become worthless, workless obese people: ‘it’s their fault’. Then there is the uncomfortable but undeniable reality that in many cases, losing the weight will never be enough: co-morbidity means exactly that, and tackling obesity may be only one of several problems. Again, what risk of deservedness is then likely? Overarching all of this is the danger of assuming that the jobs are there once someone loses weight. That depends on far more than someone’s BMI.
We are faced with an increasing number of chronic health issues as the UK population ages, and the obesity epidemic is arguably amongst the most serious. Political solutions will be needed, and we support the government in trying to come up with solutions that work. That’s their job. But beware the power of the stigma directed against the jobless, especially when obese.
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