What divides ‘public health’ from those of us who would rather like to make our own lifestyle choices is essentially the question of what it is we want to maximise. Do we want to maximise ‘longevity’ or ‘utility’? It seems to be the unquestioned assumption of ‘healthists’ (those for whom the ‘health of the nation’ has become an ideological obsession) that longevity – length of life – is the main thing we have to consider; that all our lifestyle choices should be based on maximising the length of time we spend knocking about the planet. This explains why we have an endless stream of research papers that seek to uncover our epidemiological risk factor of premature mortality from a variety of illnesses linked to lifestyle.
A visit to the GP involves feeding all your numbers – blood pressure, cholesterol ratio, height, weight and even your postcode into a computerised, mathematical model that calculates what is termed your ‘QRisk Factor’ – your risk of heart attack or stroke in the next 20 years. You can Google a QRisk factor calculator and play around with this model if you know your ‘numbers’. I did so and discovered that my risk of heart attack or stroke was only marginally reduced even if I significantly reduced my blood pressure or my ‘bad cholesterol’. But when I altered my age from 66 years to 35, but made no other alteration to my numbers, then my risk of getting a heart attack or stroke in the next 20 years reduced dramatically – from 19.4% to 1%. In a man of my age managing epidemiological risk factors seems like an exercise in trying to hold back the tide. And we all know what happened to King Canute!
Of course, if you combine a reduction in both blood pressure and bad cholesterol then that does deliver a significant reduction in your risk of premature mortality, which is why the mission of many GPs is to get anyone over 40 medicated with drugs that reduce both these measures. And they’d also like you to stop drinking and smoking and to eat a nationally approved diet. But there is no obvious reason why longevity should be the ultimate goal of public health. What most people seek to do is maximise utility. This means they seek to live their lives in a way that maximises enjoyment, pleasure and sensory experience so as to enhance sociability and enable them to, er… enjoy life!
Longevity and utility are not mutually exclusive alternatives; this is not a zero-sum game in which you have to choose. This is about balance. Drinking yourself to death is not my idea of maximising utility, nor is chain smoking. But to live a life of abstemious self-denial elevates longevity to the status of a life principle that trumps everything else – and probably ensures that when you die, it will be of boredom. I think it is up to each individual to decide where to establish this balance, but epidemiology has been elevated almost to the status of a new religion; it is puritanism dressed in a white coat.
We are bombarded with healthist scare stories that capitalise on our fear of death, and which seek to persuade us to surrender our freedom and our right to make our own moral choices to a new priesthood: the ayatollahs of public health.
But every so often something happens that warms the cockles of my libertarian heart. One of the unintended and positive consequences of the squeeze on public spending is that cash-strapped local councils can’t waste money funding sock-puppet fake charities that peddle the healthist ideological agenda. And so it is that DrinkWise Northwest has had its state funding withdrawn. Most of their money came from local authorities, not public donations, and they used this money to campaign and lobby for changes to government policy on alcohol. This was a classic case of using public funds to campaign against public policy. Their website was full of imprecations to ‘join the movement’, ‘act now’ or ‘write to your MP’. They campaigned, anonymously at first, via an arms-length website, for alcohol advertising bans and minimum unit pricing. In relation to minimum pricing they made the ludicrous claim that it would reduce the price of some drinks.
Their campaigning falls foul of a Department for Communities and Local Government ‘anti-sock puppet clause’ that reads as follows:
“The following costs are not eligible expenditure: payments that support activity intended to influence or attempt to influence Parliament, government or political parties, or attempting to influence the awarding or renewal of contracts and grants, or attempting to influence legislative or regulatory action.”
DrinkWise North West has a counterpart called Balance North East and I can only hope they will suffer a similar fate along with Alcohol Concern, which is another fake charity which, when it isn’t pickpocketing the taxpayer, gets money from the pharmaceutical industry for endorsing products used to treat ‘mild alcoholism’.
The nanny state never sleeps, but we may be able to starve it to death.