The ideology of 'public health'

A bunch of random go-dodgers wrote a report for the King's Fund recently. It was boilerplate 'public health' stuff with no new ideas, but it gave me a chance to point out that preventive health does not generally cut money and will not, except possibly in the short term, cut waiting times.

 

The health establishment has convinced itself that there would be less pressure on the NHS if people were healthier. This is widely believed and feels almost intuitive. As the Oxford Handbook of Health Economics drily notes, ‘it is frequently argued (but not by economists) that prevention will save expenditure on future treatment’. Economists are the exception because they have looked at the evidence and understand that while premature mortality can be prevented, mortality cannot. When people live longer they consume more healthcare, most of which is needed after retirement age, when they are taking more out of the tax pot than they put it.

 

And an accompanying blog post introduces the spectre of 'ideology', but only from one side.

He [Richard Murray] argues that the Government is unnecessarily frightened of introducing policies that will be more popular than politicians think.

‘… surely all this will play badly with the public? A toxic mix of nanny state and lecturing on `healthy’ behaviours? Putting aside those who for ideological reasons think individuals should be left to sort out their own health (which is ideological given all the evidence that simply providing evidence to people on health impacts does not change their behaviours), this isn’t true.’

The word ‘ideological’ is rarely used as a compliment and it is used twice here, although not to describe Murray’s own worldview. I suppose the belief that adults should be free to eat, drink and inhale whatever they want without interference from the state is an ideological position but it also happens to be a part of living in a free society and is a fundamental value of the Enlightenment. 

And if ‘providing evidence’ doesn’t change people’s behaviour, it is because people are aware of the risks and are quite happy to continue behaving as they do. If people were systematically misinformed about the hazards of alcohol, tobacco, fast food, etc. it could justify some form of government intervention, but that doesn’t seem to be the case. Murray is so blinded by his own ideology that he doesn’t see that this makes the case for nanny state policies weaker, not stronger.

 

Read the rest at Cap-X.