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.


Christopher Snowdon
2 February 2015
Police in London have followed the lead of their counterparts in Norwich and Loughborough by forming a partnership with nightclub owners to breathalyse customers on the door. This initiative has been...
Stephanie Lis
23 January 2015
Last night we learned that the government plans to change the law to ensure that cigarettes are sold in plain packages. The ostensible goal of reducing the number of smokers may be well-intentioned,...
Christopher Snowdon
17 December 2014
One hundred years ago today, President Woodrow Wilson approved the Harrison Narcotics Tax Act, the US’s first national legislation designed to control the manufacture, import and supply of...
Christopher Snowdon
11 December 2014
My report about pub closures was generally well received when it was published yesterday, with the notable exception of the All-Party Parliamentary Save The Pub Group, which sent out a bizarre and...
Christopher Snowdon
10 December 2014
The UK has lost 21,000 pubs since 1980, with half of these closures taking place since 2006. In Closing Time, a new IEA report, I estimate that long-term cultural changes have been responsible for...
Christopher Snowdon
1 December 2014
In December 2012, the introduction of plain packaging gave the Australian government full control over the design and appearance of cigarette packs. Tobacco branding was abolished and tobacco...
Christopher Snowdon
10 October 2014
A few weeks ago I found myself being filmed in a New Zealand supermarket searching for a healthy meal for four. The Kiwi equivalent of The One Show wanted me to help them demonstrate how much more...
Christopher Snowdon
9 October 2014
A study was published in PLoS One last year titled 'Economic Instruments for Population Diet and Physical Activity Behaviour Change: A Systematic Scoping Review'. I didn't notice it when...
Christopher Snowdon
16 September 2014
The economist Julian Simon once wrote that ‘the economic study of advertising is not deserving of great attention’, ruefully adding that ‘this is not a congenial point at which to...
Christopher Snowdon
18 August 2014
Obesity prevalence has increased sharply in Britain since the 1970s. Many public health campaigners portray Britain’s obesity ‘epidemic’ as being caused by the increased...
Christopher Snowdon
4 July 2014
The e-cigarette market in Britain has the closest thing to perfect competition that you will see in the real world. Perfect competition is a theoretical economic model but, like most economic models...
Christopher Snowdon
15 June 2014
Alcohol policy in Britain and many other countries aims to reduce per capita alcohol consumption in the belief that this will inevitably reduce heavy and harmful drinking. Campaigners cite the...
Christopher Snowdon
4 June 2014
The US Food and Drug Administration is considering making a calculation of the pleasure that people get from using e-cigarettes and tobacco products. It has suggested that financial estimates of the...
Christopher Snowdon
13 May 2014
The Economist has put a nice little chart together based on the latest World Health Organisation report on alcohol. It shows alcohol consumption per capita but also per drinker. Contrary to...
Christopher Snowdon
1 May 2014
Much of the moral panic about gambling in recent years has centred on the claim that the number of problem gamblers has "increased by 50% in three years" and that the UK has 450,000...
Christopher Snowdon
24 March 2014
The latest installment of the plain packaging saga is expected to arrive before the end of the month. After the initial public consultation found that two-thirds of those who responded were opposed...
Christopher Snowdon
19 March 2014
Today's budget was another curate's egg from the perspective of lifestyle liberty. The decision to scrap the alcohol duty escalator is very welcome, as is the freezing of spirits and cider...
Christopher Snowdon
18 March 2014
The authors of the report that claims that inequality costs the UK £39 billion a year (see yesterday’s post) say that rates of imprisonment would fall by 37 per cent in a ‘more...
Christopher Snowdon
17 March 2014
On Sunday, the Observer reported that ‘Inequality “costs Britain £39bn a year’. This is based on the belief that ‘a more equal UK would experience less crime and...
Christopher Snowdon
18 February 2014
As reported in The Guardian and elsewhere, the Alcohol Health Alliance has issued a press release in response to the ongoing campaign to bring an end to the alcohol duty escalator which, according to...

Invest in the IEA. We are the catalyst for changing consensus and influencing public debate.

Donate now

Thank you for
your support

Subscribe to