A FEW months ago I interviewed the GP and ultra-marathon runner Andrew Murray, shortly after he had been appointed Scotland’s physical activity champion.
His brief from the Scottish Government sounded straightforward enough – get people to exercise more – but in fact his new role saw him parachuted into the middle of a bewildering ethical minefield. Murray was under no illusions about the scale of the problem: nearly two thirds of Scots, he told me, were getting less than 150 minutes of exercise per week, the minimum recommended amount. But he also seemed to know instinctively that trying to force these people to go to the gym wasn’t going to solve anything. When I asked him if he thought keeping fit, and thereby reducing your likely impact on the NHS, was a civic duty, much like paying your fair share of tax, he very sensibly sidestepped the question: “As government, and as doctors, we’re not telling folk what to do,” he said. “We’re just saying ‘here’s a bit more information for you, we think we can improve your health outcomes.’”
I was reminded of this intelligent, education-driven approach to the nation’s growing obesity problem the other day, while reading about the draconian fat-busting measures proposed by the Tory-led Westminster Council, working in conjunction with a local government think tank. The suggested scheme would see obese people on benefits who had had exercise prescribed by their GPs monitored via smartcard technology. Failure to clock up enough hours in the gym or enough lengths in the pool over a given period could result in cuts to housing or council tax benefit payments.
Setting aside for a moment the delicious irony of a room full of Tories – supposedly advocates of small government – cooking up such an archetypally Big Brother-esque scheme, let’s get to the crux of the matter: do people have the right to be fat?
In the world according to Westminster Council, the answer would seem to depend on how wealthy you are. If you require state benefits then no, sorry, you don’t get to be overweight. Onto the treadmill with you. If, on the other hand, you’re fortunate enough to be in gainful employment, don’t worry – feel free to get as lardy as you like. As long as you keep paying your taxes we promise not to demean you with any form of electronic tagging.
Clearly these proposals are monumentally unfair: an obese person having a heart attack costs the NHS the same amount of money to treat whether they happen to be on benefits or not. But what if you levelled the playing field, introducing a system whereby all citizens had to treat their bodies in accordance with strict government guidelines in order to gain access to free healthcare – eating healthily, drinking responsibly, taking plenty of exercise and so on? At least that way everyone would have to play by the same rules. You want to eat/drink/smoke yourself to death? Fine, go ahead, but don’t expect the rest of us to foot the bill. This is the logical endpoint of the Westminster Council way of thinking. Trouble is, it opens a whole can of worms about what constitutes “risky” behaviour, and leads us to a strange, paranoid place where people hardly dare to do anything at all.
We already live in a depressingly risk-averse society, but any move towards making people have to “earn the right” to healthcare through low-risk living would make things a thousand times worse. Would you forfeit your NHS privileges if you went rock climbing? Or mountain biking? Or bareback narwhal riding? Would sports like skydiving be OK, as any mishap would more-than-likely result in instant death, and therefore place no extra burden on the state? The Office of National Statistics would have to go into overdrive to help policy makers decide which activities carried unacceptable risks, and high-risk pastimes would revert to being the preserve of the very wealthy, who could afford to pay for private healthcare in the event of an accident. The Westminster councillors are teetering on the edge of a slippery slope here. They would do well to consider the example of our own Dr Murray before careering recklessly down it.