This is the third in a short series of blogs (see below) prompted by the recent report from the highly respected Institute for Government, which argued that past governments have failed to effectively tackle rising obesity’s root causes, that politicians’ fear of the charge of nanny statism is constraining effective government action on obesity, and that a new long-term strategy is required, involving a radical shake-up in government. As we have said before, Life-Based Learning (LBL) is not overtly political, and certainly not party-political. But any discussion of principles, values and aims cannot be entirely divorced from the realm of politics. LBL is predicated on the idea that we cannot simply carry on as we are – not least in relation to health and wellbeing. We need to empower individuals and we need to harness the power, the moral authority and the immense resources of the state. These are not mutually exclusive. We need to do both.
The current approach is not working. Analysis after analysis, data dashboard after data dashboard, projection after projection, provides compelling evidence that, when it comes to obesity – and health and wellbeing more generally – we are sleepwalking towards disaster in the coming decades.
In our December 2022 review of the year we highlighted some of the troubling data on obesity and health outcomes that has been published in the last twelve months or so. For example:
These are worldwide problems, of course – not ones exclusive to the UK or to the affluent West. We blogged in September about projected health outcomes for China in the coming decades. Death rates from non-communicable diseases associated with an affluent lifestyle – and therefore previously seen in high levels primarily in the West – are likely to reach staggering levels there by 2050.
Health outcomes in other rapidly developing countries around the world are likely to follow the same trends as China as affluence levels rise. Lung cancer, linked to high rates of smoking, is high up the list of non-communicable diseases killing millions, as are diabetes and heart disease, often caused by a combination of a rich diet, low exercise levels and high blood pressure.
And yet few of our politicians are willing to seriously discuss what needs to be done to prevent this mass sleepwalk to disaster. To repeat, the current approach is not working. It cannot be left solely – or even primarily – to individual choice and tinkering around the edges of existing policies and approaches. Something more radical is required – a collective approach to obesity, led by and including an active, interventionist role for the state – if we are going to prevent a public-health disaster in the decades to come.
Last week’s blog discussed the concept of the Overton window – the range of policies voters will find acceptable – and how a fundamental rethink of a policy approach or strategy requires a shift in the Overton window, so that something that was previously deemed extreme, impossible or unthinkable becomes acceptable, doable and achievable.
Education (of adults as well as of children) is, of course, important so that people have the knowledge and skills to make informed individual choices around healthy lifestyles – what to eat, whether to exercise and so on. But it also needs a collective effort, with government doing what only it can do, driving forward significant changes in how we lead our lives and pressurising public and private organisations and actors to rethink their priorities.
How we educate our children and young people is an example, specifically the curriculum we offer in our schools. LBL is about reimagining education so that the life challenges that we all face – now and in the future – become the focus of a fully rounded, life-based approach to learning. But only government can give the green light to such a curriculum rethink.
Seizing the opportunity to reimagine education is all part of changing our common frame of reference – of shifting the Overton window – so that promotion of healthy lifestyles become an urgent priority for society. It means having difficult conversations about what is required, something that politicians are often loathe to do (hence the Institute for Government’s reference to “political squeamishness”).
Health policy is New Zealand offers an interesting test case. The Labour government passed a law in December 2022 to phase in a near-total tobacco ban. It means that anyone born after 2008 will never be able to buy cigarettes or tobacco products in New Zealand. The long-term benefits of this policy will include people living longer lives, people living healthier lives and a saving of billions of dollars in smoking-related health costs.
Despite the obvious appeal of these benefits, the new law has many critics. There is, for example, concern that it will fuel a black market in tobacco because some people will still want to smoke. There is the economic impact on small shops that make much of their money from the sale of tobacco-related products. And, of course, there is the familiar charge of governmental overreach: the opposition ACT party have referred to the new law as “nanny state prohibition”, tapping in to that feeling that the government is meddling where it shouldn’t.
These criticisms and concerns need to be taken seriously – as does the financial cost of any long-term health strategy. Any fundamental rethink, anything ambitious and radical, will not be cheap. The public finances are going to be tight for years, if not decades, to come. But to govern, it was once said, is to choose. Politicians – and society as a whole – have a stark choice. We can opt for retrenchment. Apply sticking plasters. Cut costs. Part-fund. Trim.
Or, we can do whatever it takes to meet the challenges we face.
If we don’t do it now, when will we? If it is folly to continue as we are, what sensible alternative is there to changing direction?
Image at the head of this article is by Moondance from Pixabay.