Alastair Stewart: We need healthy debate over avoidable deaths

I’ve been reminded lately of what political writer Kieron O’Hara had to say about (small c) conservatism. The philosophy – irrespective of which party brandishes the banner – must be rooted in two things.

The NHS faces increasing cost pressures from people who insist on doing what they want because they pay for it with taxes (Picture: Peter Byrne/PA Wire)
The NHS faces increasing cost pressures from people who insist on doing what they want because they pay for it with taxes (Picture: Peter Byrne/PA Wire)

First, you cannot know everything and thus don’t meddle. Second, change is inevitable – we must try to keep the best, discard the worst but not block the unavoidable.

The curious thing about this credo is it doesn’t belong to a political party. It might be described as the backbone of good governance. Yet, in the UK there’s a brewing argument over individual rights versus responsibility and health. There are those in America hostile to “socialised medicine” because it impedes their ingrained libertarianism and the right to pay for the medical consequences. The UK has never seriously placed a higher moral burden on its citizens, but is it the next social revolution?

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The UK is in the throes of what the Office for National Statistics calls “avoidable mortality”. A 2019 report found that 84 per cent of such deaths that could be avoided by public health interventions. O’Hara criticises short-term statistics in his book Conservatism. But these are generational problems, so isn’t it time to address them adequately?

We’re heading for a clash between the lightspeed ‘have it now culture’ and the NHS itself. Because it is tax-funded politicians and citizens tend to approach health from different angles. Governments of the day nearly always come round to the belief that because public money supports the health service, then more should be done to cap products that are explicitly damaging to public health. Current legislation and health policies are an inconsistent mix of laws, such as those on cigarette packaging, minimum unit pricing or sugary drink taxes.

There are curious slippages, such as banning junk food ads but not junk food itself, multi-buy price promotions or junk food deals. Across the UK, paradoxical laws seem to be the only consistent strategy to address health inequality.

Citizens, on the other hand, generally take the view their salary contributions pay for the NHS and therefore they can do as they please. The US may despise the idea of socialised medicine, but the UK has an increasingly reactionary indulgence of ‘moral hazard’ – whatever I do, there’s healthcare by rights, and no government can stop me. This is far from an argument for privatisation. The United States has singularly demonstrated that obscene health care costs do not deter poor healthy living choices.

As with most genuine policy debates, the answer seems rooted in a candid stipulation of what the country can afford, what the government is prepared to do and the responsibility of the consumer for their health. The myriad complexity around retailers, industry and the economy makes this a harder argument to measure.

The status quo is not healthy. The current debates seem to obfuscate what is possible in tackling severe avoidable deaths. Framing it like this, rather than as ‘banning junk’ or ‘better health’ might spur action to curb needless loss. Only then can we move past the status quo and have a serious discussion on better lifestyles.

Alastair Stewart is a freelance writer and public affairs consultant. Read more at and on Twitter @agjstewart