Any child of the 70s and 80s is used to being nagged by the government: don't retrieve that frisbee from a substation, look-left-look-right-look-left-again, don't get bummed by strangers, don't throw fireworks, don't kill people in your car when you're pissed, Just Say No, don't get AIDS.... It was tedious, but hey, it was sound advice and a few of us made it through to 2006. However, just when we thought we could rest easy, New Labour turns out to have found a new crusade: unhealthy lifestyles.
This week Tony Blair warned again that the NHS could be crippled by the cost of unhealthy lifestyles, particularly treating illnesses caused by obesity, alcohol abuse and smoking. He also highlighted preventable diabetes, STDs and drug abuse. He should have added a reminder to floss at least once a day, just in case Shane McGowan was listening.
What Tony had to say was undoubtedly true - no one wants to go blind from preventable diabetes, or end up with a tracheotomy because you were too daft to stop smoking. But there's still something a bit irksome about being told to be healthy by the government. Maybe it's a form of denial about our own unhealthy lifestyles, and it's certainly hard to make a case in favour of dangerously unhealthy behaviour.
When people *do*, they're forced to resort to some pretty lousy arguments, such as making dubious claims about how much tax from booze'n'fags contributes to the NHS. This is irrelevant anyway - if we take serious illness to be intrinsically bad, then moral considerations have to take precedence over financial ones. The government could earn a pretty penny by legalising and taxing heroin and crack, but they're too chickenshit.
Another, stronger, argument is that the government doesn't have any right to tell us what we should do in our personal lives. Most of us broadly agree with this, but with the exception of clearly self-destructive behaviour. Thus we can't really argue with Tony when he tells us that we need to take responsibility for our own health. However, there are a few problems with his exhortations to get healthy.
First up is the question of *how* to make people healthier. It's hard to believe that (lack of) education is the problem. Whatever your vice, there's enough information out there for you to realise it's bad for you, unless grossly obese people lumber around thinking 'Why me out of breath all time? Why me not fit through door? Big Mac make better!'
Blair's analysis of why people engage in behaviour that is harmful to themselves is rather simplistic. He argues that public health problems are 'not, strictly speaking, public health problems at all. They are questions of individual lifestyle - obesity, smoking, alcohol abuse, diabetes, sexually transmitted disease. These are not epidemics in the epidemiological sense - they are the result of millions of individual decisions, at millions of points in time.'
Yes, they're not epidemics in the sense of cholera, but it's clearly not just about choice either. The reality is probably that there is a whole spectrum of reasons causing harmful behaviour, ranging from actual psychological compulsions (e.g., alcoholism) through to general gormlessness: 'I'm actually quite full but I may as well have another piece of cake because there's nothing on the telly.'
Another way of looking at it is that people are happy to take calculated risks. Smoking and unprotected sex are good examples. Smoking would seem to be the ultimate mug's game: you spend a fortune on transient hits from tobacco, in the process turning your teeth an interesting colour and shrinking your lung capacity, and then you die. But it isn't quite this simple. Smoking doesn't kill you instantly and there is the option of giving up. Similarly, unprotected sex with a total stranger would give most of us pause for thought; unprotected sex with someone you know hasn't slept with dozens of people might not. The logic may be a bit flawed, but it's how people behave.
And although Blair has identified a problem, he's a bit short on solutions. Even if ill-health is self-inflicted, he says, 'that doesn't mean you stop treating people on the NHS who smoke, or force people to do things that they don't choose in their lifestyle'. Instead he talked about 'empowering people, setting the conditions in which they can choose responsibly'.
The upshot of all this? Unless the food industry agrees to limit junk food adverts aimed at children by 2007, there will be mandatory rules governing them. *That's* what Blair plans to do after telling us we're sitting on a public health time bomb? Restrict adverts for junk food?
There are two possibilities here: either Blair is paving the way for more controversial measures, such as somehow charging people for NHS treatment related to self-inflicted conditions, or that's really all his policy advisors could come up with: stop kids being bombarded with McDonalds ads. If so, it's like giving a chronic alcoholic a bottle of Milkthistle tablets.
There's one final aspect to the whole issue that merits a mention. When Blair talks about health being 'questions of individual lifestyle', you can't help but think it's a very specific type of lifestyle he has in mind. There's a strong sense that Blair is, basically, a bit square. You can't imagine him going out and getting shitfaced, or taking an E, or having casual sex. Despite the rock star posing of his youth, Blair comes across as someone who has fun within very prescribed limits - the sort of person who suggests going to the pub, then leaves after a pint to go to the gym.
When Blair looks at the UK, he must be genuinely puzzled. 'Why do people need to drink to enjoy themselves, Cherie? I just don't get it. Who wants to go out and get blind drunk when you could be spending time advancing your political career, playing tennis with Cliff Richard or giving God an update on how well things are going in Iraq?'
And this is the problem. Blair is quite right to say that we should have a serious think about unhealthy lifestyles. But it's one thing being told what's good for you, and quite another being told what's good for you by a *twat*.