Lifestyle Economics Blog

The NHS's healthy living delusion

Of all the attempts of NHS mandarins to blame patients for the spiralling costs of their bureaucratic leviathan, Simon Stevens’ claims yesterday were perhaps the most gratuitously misleading. According to the Telegraph, Mr Stevens, the organisation’s CEO, claimed that ‘around 40 per cent of the NHS workload is due to "modifiable health risk factors", such as excessive alcohol consumption, smoking and lack of exercise’.

The headline claim was that fatties alone cost more than the fire brigade and police force. According to the Telegraph: 'NHS England said around £16 billion a year is spent on the direct medical costs of diabetes and conditions related to being overweight or obese. They added that the fire and police services cost the British taxpayer £13.6 billion each year.'

The £16 billion cited seems to be the £6 billion that obesity is said to cost the NHS each year plus the £10 billion cost of diabetes. Having done these sums, Mr Stevens was reported to have said: 'We are now spending more on obesity-related conditions in this country than we are on the police or fire service'.

If Mr Stevens has been quoted correctly he is guilty of crude propaganda that is unworthy of a public servant. The last serious attempt to estimate the cost of obesity to the NHS arrived at a figure of £5.1 billion. As that was in 2011 we can perhaps upgrade it to £6 billion to account for inflation, but since that estimate included the cost of obesity-related diabetes it is double-counting to slap the total bill for diabetes on top of it.

In fact it is worse than double-counting. Diabetes may cost the NHS £10 billion a year but that figure includes the cost of Type 2 diabetes, which is only partially related to obesity, and Type 1 diabetes which is not at all related to obesity. If Mr Stevens thinks it is not deceitful to add the entire NHS diabetes bill to the entire obesity bill and portray the total as an unnecessary and avoidable cost of 'modifiable health risk factors' then he has been very poorly advised.

This is a standard deception. Like any cult, the NHS needs its scapegoats. Its budget has doubled in real terms since 1997 and yet it is still an under-performing, bureaucratic mess. But why blame mismanagement and an ageing population when you can blame those trusty targets of religious persecution: the gluttons, the slothful, the drunks and the tobacco fiends? Down with the obese! Persecute the drinkers! Death to the smokers!

When in doubt, blame the public. The claim is that if only we would live healthier lives, NHS costs would be 40 per cent lower and the taxpayer would save £50 billion a year. Utter nonsense. The reality is that NHS costs have risen - and will continue to rise - as a direct result of the kind of healthy living that Simon Stevens wishes to impose on us by force.

Consider some facts. In 1948, life expectancy was 66 and the NHS budget amounted to 0.5 per cent of GDP. Today, life expectancy is 81 and the NHS budget is more than seven per cent of GDP. At the start of the last century, there were two million people aged over 65. Today, there are more than ten million people of that age.

People who are not obese tend to live longer but longer lives require greater expenditure on healthcare, social care and welfare. Longer lives are associated with more, not fewer, years of illness. The annual healthcare costs of a person aged 85 or over are five times higher than those of somebody in their early 60s and ten times higher than somebody in their 40s.

After the age of 65, people pay less in tax than they claim in benefits and become - to borrow an unpleasant term that is often wrongly applied to NHS scapegoats such as smokers and the obese - a ‘drain on the taxpayer'. The diseases of old age and the costs associated with them increase as the number of old people grows. Every study that has looked at the question has found that increased longevity leads to higher costs in health care, welfare and pensions. 

It is claimed that obesity costs the NHS £6 billion a year. It is further claimed that drinking and smoking cost the NHS £3.3 billion each. These figures may be correct or they may be inflated for political effect, but even if they are correct they are gross figures, not net figures. They tell us nothing about the costs that would be incurred if people lived healthier lives and died later from different diseases. And even if they were net figures - which they assuredly are not - they would amount to only a tenth (not 40 per cent) of the total NHS budget and are covered twice over by the tax revenue brought in by alcohol and tobacco duty, not to mention the sugar tax that will come into effect in 2018.

Simon Stevens is taking us for fools if he expects us to believe that healthy living will reduce health care costs by 40 per cent. We are fools if we think it will reduce health care costs at all. If the NHS is crumbling, it is doing so under the weight of an increasingly healthy - and therefore ageing - population. As Luc Bonneux and his colleagues concluded in their study of the subject: 'There is no evidence that healthcare costs are increasing because citizens live unhealthier lives. In fact, quite the contrary would seem to be the case.’

This should be obvious. It is worrying that the man who runs the NHS does not understand the basic economics of the situation.


Read Christopher Snowdon's IEA Discussion Paper Death and Taxes here.


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