Public health and the strange double life of advertising

It is not always necessary to contradict politicians; it is often better to wait until they contradict themselves. A case in point would seem to be Health Secretary Alan Johnson’s recent speech at the Royal Society of Arts.

Johnson apparently rejects the notion that people are able to make sensible choices about their health and lifestyles: “[N]ot everyone is able to defer the instant gratification of that one cigarette or glass of vodka or a meat pie too many in favour of longer term health benefits.”

The health secretary prefers a therapeutic state: “No responsible government can morally justify a retreat to the touchline. To be mere spectators as the waistline of the nation expands, lives get shorter and deprivation intensifies. …Those who cry “nanny state”, at the merest suggestion that we should change our behaviour, trivialise a debate that is critical to the future wellbeing of this country.”

Johnson recounts how, in tackling smoking, “banning advertising, restrictions on the promotion of cigarettes” have been key features of a successful strategy that saved lives. The Health Secretary then goes on to make clear that “milder” forms of government intervention into people’s behaviour, such as campaigns that merely “lecture” them about the dangers of smoking and obesity, are insufficient: “While it’s very easy to point out the pitfalls of smoking, which are now widely understood, advertising cannot promote positive behavioural change on its own.”

So hang on a minute: tobacco advertising makes people smoke and therefore it must be banned, but anti-tobacco advertising cannot be relied upon to deter people from smoking. Advertising seems to lead a double life in Alan Johnson’s world. 

In the whole speech, alternatives to government paternalism do not get a single mention. Johnson praises several “innovative” initiatives by Primary Care Trusts (PCTs) who have begun to experiment with financial rewards to promote healthy lifestyle choices. But he omits to mention that outside of the NHS, such financial reward schemes are by now commonplace. Most private health insurers in the UK offer packages including discounts on gym membership, smoking cessation and other preventive actions.

Maybe an altogether more promising approach to public health would be to leave more room for private providers and insurers, and to let them devise their own incentive schemes. But naturally, due to the way Alan Johnson formulates the agenda, this option cannot appear on the radar: “We need to consider whether we’ve done enough, whether our approach is the right one and what further action we need to take.”

Just because ‘not everybody’ is able to do something does not mean that ‘nobody’ can. Not everybody can cross the street safely. Not everybody can boil an egg. Not every MP can resist fiddling his/her expenses. So what?Those of us who have spent a working lifetime teaching know that most people can learn. One of the tasks of parents is to enable their children to learn and thus ‘grow up’into adults over time. Once again I would like to trot out Herbert Spencer’s wisdom: ‘The ultimate result of shielding men from the effects of folly is to fill the world with fools.’

But we have a National Health System which treats everyone, however irresponsible he or she may be. It is hard to see how we could introduce a system which gives a lesser standard of care to people who do not meet criteria for looking after themselves properly.

Dear Graham,
why would you want to do that? There’s actually quite a simple solution: a risk-equivalent surcharge. Implicitly, the private insurers mentioned do that already. They charge high premiums but give rebates to clients who show that they make efforts to look after their health.
The problem is, it won’t work in a monopoly system like the NHS. I’ve recently written about this, just in case anyone can decipher it: http://iuf-berlin.org/kommentare/2381.php

Of course I agree that even people who, for one reason or another, are unable to look after themselves need to be taken care of. Personally I believe that volountary charity would often suffice for this purpose. But to the extent that I am wrong, or even as an alternative safety net, I accept that the goverment may need to provide ‘coercive charity’ financed out of taxation.The point, though, is that just because some people need to be taken care of in this way does not mean that the vast majority could not be allowed to make their own arrangements on a free market, which would almost certainly provide more welfare than the present irresponsible welfare state.

Just because ‘not everybody’ is able to do something does not mean that ‘nobody’ can. Not everybody can cross the street safely. Not everybody can boil an egg. Not every MP can resist fiddling his/her expenses. So what?Those of us who have spent a working lifetime teaching know that most people can learn. One of the tasks of parents is to enable their children to learn and thus ‘grow up’into adults over time. Once again I would like to trot out Herbert Spencer’s wisdom: ‘The ultimate result of shielding men from the effects of folly is to fill the world with fools.’

But we have a National Health System which treats everyone, however irresponsible he or she may be. It is hard to see how we could introduce a system which gives a lesser standard of care to people who do not meet criteria for looking after themselves properly.

Dear Graham,
why would you want to do that? There’s actually quite a simple solution: a risk-equivalent surcharge. Implicitly, the private insurers mentioned do that already. They charge high premiums but give rebates to clients who show that they make efforts to look after their health.
The problem is, it won’t work in a monopoly system like the NHS. I’ve recently written about this, just in case anyone can decipher it: http://iuf-berlin.org/kommentare/2381.php

Of course I agree that even people who, for one reason or another, are unable to look after themselves need to be taken care of. Personally I believe that volountary charity would often suffice for this purpose. But to the extent that I am wrong, or even as an alternative safety net, I accept that the goverment may need to provide ‘coercive charity’ financed out of taxation.The point, though, is that just because some people need to be taken care of in this way does not mean that the vast majority could not be allowed to make their own arrangements on a free market, which would almost certainly provide more welfare than the present irresponsible welfare state.

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