How do we lead healthier lives?

This question is really about the NHS, but phrased to look (and be) a much worthier and better question. And of course it points to a better answer than “How can we improve the NHS?”.

There are two sides to leading a healthier life. Primarily, we can lead healthier lives primarily by taking responsibility for our health. The standard view at the moment seems to be that we should be able to do whatever we like, and then have doctors fix us when our bodies go wrong. This view has been successfully challenged with respect to tobacco, but still applies to alcohol, fat and air pollution (inasmuch as we still think it’s alright to get drunk, eat loads of burgers, and drive cars all over the place, and then expect the NHS to pick up the pieces).

Just as with pollution in general, this is stupid. Polluters should be paying, and there should be much tighter public health controls.

The conclusions aren’t obvious (or at least, my conclusions as a whole aren’t obvious!) so I’ll spell them out:

People should pay for problems they cause to their own health. Tobacco taxes (£9.3bn per year) comfortably cover the cost to the NHS (£1.5bn per year) if you believe the figures, but I don’t know if the money raised from tobacco actually goes to the treatment of the conditions it causes in the NHS. I don’t know what the situation is with alcohol; a similar taxation regime linked to treatment seems appropriate for fatty foods (though it’s more arguable, since they’re not inherently toxic; nevertheless, since the risks rise fairly directly with consumption, a straightforward tax seems reasonable and simple). In all cases, people are then directly paying for their own future care when they consume unhealthy products.
There should be far tighter controls on products that cause health problems to others. I’m basically talking about air pollution. No matter how much drivers and smokers pay for their petrol and cigarettes, they shouldn’t be able to foist their pollution on unwilling bystanders (even if they are paying for their health care too). Smoking I’m particularly against, since it serves no useful purpose to society (I don’t care about its social side, that’s replaceable, and saying jobs depend on it is like arguing for jobs making landmines or anthrax). Transport has clear benefits, but they’re not reaped primarily by those whose health is put at risk; the balance needs shifting. So: no smoking in public places (if there were any logic to the status quo, tobacco would simply be outlawed as it is toxic, addictive, and unavoidably imposed by its users on its environment; alcohol (like heroin) wins bigtime by being (at least potentially) essentially a private matter). Also, much tougher emissions laws for motorized transport. We have the technology to make cities basically free of pollution caused by motor traffic, so why not do it?

Could you be more specific about it? I thought electric cars were only just starting to be available? C

Other drugs I have much less of a problem with. Heroin doesn’t cause nearly as much misery as petrol or tobacco (or alcohol, come to that). As addictive toxins, drugs should be taxed to pay for associated health problems, and should be illegal for children (protect children from themselves and irresponsible adults). As neuro-toxins, similar legislation should apply to that covering drink driving: even if you don’t actually cause problems for anyone, you should have your ass sued off if you risk it. The trouble with this is that it should apply to far more than just alcohol (other drugs such as many medications have a deleterious effect on drivers, and diseases can do the same (including some common and hard to detect ones such as toxoplasmosis). How do you make a quick and easy test for dozens of different drugs and diseases when you stop a driver? Not obvious, but not insoluble either. Finally, decriminalize hard drugs. I can see no sense in treating alcohol as a fine thing that some sad people misuse, tobacco as a necessary evil that we have to put up with because it’s always been there, and heroin as the devil incarnate. I’m not imagining that all the problems associated with hard drugs would go away if they were decriminalized: we’d be left with the health problems, and organised crime is still interested in alcohol and tobacco. But most of the problems would go away, and I bet the framework for (legal) tobacco is cheaper than that for illegal drugs.

Last updated 2004/10/31