It’s hard to live a life well. You have to know yourself for a start, which is a pretty difficult and lifelong quest. You have to make continual choices; over career, finances, health and how to spend your time. It’s risk and more risk. As an imperfect human being, you will seek consolation for your inevitable mistakes. A drink? A cigarette? A big meal?
Forget it. Last week, there were more terrifying warnings from health experts about recourse to such comforts. If current trends continue, Britain will suffer an obesity epidemic within 15 years. One in three adults will be obese, reducing life expectancy and increasing the likelihood of diseases, from heart attacks to diabetes. We need to eat less and exercise more.
As for cigarettes, we knew they were killers, but now we learn they cause impotence among men and wreck foetuses in women. If men want to enjoy sex and women make healthy babies, there is no alternative to abstinence we were sternly lectured. The Government should ban smoking in public places and make tobacco warnings even more grizzly, said the British Medical Association’s Board of Science and Tobacco Control Resource Centre.
The unqualified urgency was echoed by the anti-obesity crusaders – the Royal College of Physicians, the Royal College of Paediatrics and Child Health and the Faculty of Public Health. The debate about obesity today is where the debate about cancer was 40 years ago, they warned. The nation collectively tut-tutted as it was terrorised by the unremitting and bleak statistics. Something must be done. Never had a media strategy achieved its purpose so well.
And yet. I wonder if someone somewhere in the medical establishment did not have a smidgen of concern. It’s not that rising obesity and smoking aren’t life-threatening problems. Rather, the question is proportionality and degree of risk; extrapolating the growth of obesity on the basis of the last two decades is not quite so easily justified as the report writers insist, and while to smoke is vastly to increase one’s health risks, the risk varies with consumption.
Nobody, at least in the research I have seen, argues that the health risks from smoking five cigarettes a week are equivalent to those from smoking 40 a day; it is the cumulative intake of tobacco smoke that wrecks health progressively. Yet in not one article on the report last week was this gradation of risk mentioned. We moved from a universe of non-risk to an universe of risk in just one jump, precisely because the BMA Board of Science and Education and Tobacco Control wanted to deliver an unqualified shock. Which it did.
It will argue, not unreasonably, that the case is so clear and consumption so entrenched that it has to adopt a no-holds-barred approach if it is to get any action from either smokers or the Government. The Royal Colleges will say the same about obesity – and I have a lot of sympathy for their position. But I am less convinced that we should treat the British public like children. It is creating a culture where our discussion of risk across the board is naïve, and leads to the micro-management of our lives in response. Worse, by offending common-sense judgments about risk, it undermines the authority of those who issue the terrifying warnings.
For the story is complex. On average, we are living a year longer every decade because we are getting healthier. It is true that children have more sedentary lifestyles, as do adults, and average weights are rising, but this comes against a background of a rise, not fall, in general health.
The real drama in obesity is the rise among unskilled, semi-skilled and skilled manual women, where an unskilled woman over 16 is likely to be twice as obese as her professional counterpart. Moreover, obesity is closely linked not so much to one’s current socio-economic status, but that into which you were born. If your mother is an obese unskilled worker, your chances of being obese are very high, although we don’t know whether that is because of metabolic changes caused by early deprivation or acquired behavioural traits.
But what we do know is that obesity is driven by inequality, and I suspect that the rise in inequality over the last two decades has more to do with the rise in obesity than any of the litany of causes cited last week in our media.
It’s the same story on smoking; the risks rise the more you smoke, and it is unskilled workers who smoke the most. I suspect the reason they smoke more and eat more fatty foods is that, being at the bottom of a society where social mobility and opportunity are declining and inequality is so entrenched, it is very difficult to handle psychologically.
It is hard to live a life well and doubly so at the bottom. Cynical food companies and aggressive advertising are part of the problem, but so is inequality. There was an important national conversation to be had last week, but it didn’t take place.
Instead, the health researchers went for the sensational hit with absolutist warnings about risk, aiming to set the news agenda rather than open an intelligent discourse. They are not alone, and here the contemporary media must take part of the blame; they want the terrifying headlines. Whether it’s the reaction to a rail crash, an accident at work or some disaster on a school trip, the attitude is the same – we must create a society that eliminates risk. There can be no trade-offs and no gradations.
As a result, the refurbishment of the rail network has become so expensive it can’t be achieved; children’s outdoor activity and mountaineering centres are shrinking because the regulation is so prohibitive; health-and-safety regulation has become self-defeatingly proscriptive.
It is because I believe in regulation as a means for collective improvement that I find this trend alarming. We are timid about how we regulate what really frames our lives and impacts on our happiness – financial markets, business and the world of work – because of the overhyped concerns that it might generate ‘costs’ that hurt employment and ‘wealth-generation’.
Yet we call for regulation that proscribes individual choices with no latitude. This is because there is an insistence that there should be no risk, even when the risks, as in obesity and smoking, are so differentially experienced between social classes. The real culprit – inequality – is forgotten. It’s the wrong way round, and we are diminished as a result.
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