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Self-destruction

A far more serious weakness of the public, and an immense cost to the health service, comes from our own inability to take care of ourselves. I will pick just three types of example to show how a very large number of people are actively, consciously destroying their own health, and apparently do not care, not least as they assume someone else will eventually look after them once they fall ill (as they most certainly will).

The most obvious example is smoking. There are government health warnings on UK cigarette packets. They very clearly say that half the people who smoke will die from diseases related to smoking. This is not some new discovery, but has been in the medical literature and the public domain for a very long time (examples have existed for several centuries). Smokers will of course claim that they have the freedom to do as they wish, and are paying taxes on their tobacco products which, hopefully, contribute to the health system.

This is totally misleading as the taxes do not take care of the inflation that occurs by the time the smokers need treatments, nor do they provide sufficient new hospital facilities and staff. Mere tax money cannot cover the losses and disruptions to their families who have to look after them. It would be interesting to consider if smoking would continue at the same level if treatment of smoking-related diseases were only maintained in private healthcare. This is not an original idea, as in many nations the only healthcare is for those willing and able to pay.

Publicity and education have helped to some extent, as the percentage of the UK population that smokes has halved since 1974, and the total number of smokers has dropped. Nevertheless, smoking still accounts for about 33 per cent of respiratory deaths and 25 per cent of those who die from cancer (plus featuring in many other types of illness). Here I have cited statistics merely as percentages, and for most of us this has little emotive impact.

Therefore, I will rephrase it and say that around 100,000 (yes, 100,000) friends, relatives, and colleagues are killed by smoking each and every year in the UK. This is equivalent to a medium-size town; in terms of suffering to them and their families, it is immense. In monetary terms, it is costing the country many billions. In terms of trauma, loss, distress, and the need to care for the people associated with the diseases, the annual numbers are far worse, since the level of serious illness may typically extend over a five-year period. From this overview perspective, the number of people caused to suffer, directly and indirectly, involves close friends and family, and over a five-year period, the number of other people with lives degraded by the smokers rises to far more than a million of us at any one time. This is just in the UK.

Better health education with a much more aggressive and focussed objective is needed to really switch people’s behaviour, not just increasing the health service budget. Education is cheaper than medical treatment. The oddity is that if 50 per cent of people who smoke will die from smoking-related conditions, why do people not realize that they are at a major risk? This is a far higher risk than virtually any other activity that we encounter in our lives.

Further, the evidence is very clear that poor breathing, etc. will also lower their quality of life long before obvious diseases set in. Consider as well the fact that people suffering the consequences will invariably be saying ‘I wish I had not smoked’. This is not a problem limited to just the smoker, but it impacts on their family and friends. Help, support, and motivation to enable people to quit smoking are not just social ideology, but directly represent financial savings to the entire nation, and especially via the need for medical care. Savings, on a scale of many billions per year, whilst simultaneously reducing the strain on the medical services, are achievable realistic numbers.

The second very obvious self-inflicted set of problems comes from obesity. For the health service and cost to the UK, some estimates suggest the number is around ?6.5 billion per year. Although there are genuine medical conditions that cause obesity, including inherited genetic ones, the majority of cases of obesity are self-inflicted by excessive eating and lack of exercise. The rapid rise in obesity in children is certainly compounded by their being transported to school (instead of walking), reduction in school sports facilities, and the fact that so many children are overweight that there is no peer pressure to make an effort to change. The euphemism ‘obesity’ also implies it is a medical condition for which they are not responsible. TV and media images further imply being overweight is acceptable in terms of image, and associated illnesses receive minimal discussion.

The problem is compounded by the fact that there is a vast amount of advertising pressure to buy more food, and there are opportunities to overeat, not only nutritious food and drink, but also a plethora of junk items. These may increase waistlines and volume, but offer little true nutritional value. Similarly, products may contain substances and flavour enhancers that effectively make them addictive. If they are marketed via sports personalities, they are automatically assumed to be good for health.

Labels on the products listing the sugar, fat, or caffeine contents, etc. are probably ignored once they have been added to the list of preferred items. Junk food can appear in unexpected ways; one such is in the use of cheese substitutes on pizza. Alternative products that look and taste like cheese exist. Nutritionally, they are of minimal value, but are cheaper than cheese. The financial temptation to use them in pizza outlets means they are widely (and legally) used. Overall, the proliferation of snack and junk food items, which can become addictive, is a threat to those who wish not to be obese.

It is easy to see evidence for increasing numbers of overweight people—if we look at films and newsreels from times as recent as, say, 30 years ago, then in the UK one saw relatively few fat people, and almost no overweight children. Over this period, there has been at least a threefold increase in terms of numbers of people who are technically obese. The problem is actually far worse when assessed in terms of just how obese many people have become. Also, the presence of so many overweight people means they no longer stand out from the crowd, and so do not care about their bodies. The changes over the last few decades are self-induced, as our population is genetically the same race, so the change and increase must primarily, and almost entirely, be blamed on us. Advertising of foods is not the sole problem as obesity is not totally uniform across the UK, with the worst areas being in the north-east of England and the west Midlands. Overall, the numbers run at a quarter of adults, and, absolutely shocking, is the rise to around one in six children. This is therefore a key problem, not just for those who are obese, but for the entire nation, which allows and encourages this excess to appear in our children. The young are not just being deprived of longterm good health, but also all the pleasures of fitness and activity that we should expect as the norm. It is a total indictment of the parents who clearly have no genuine concern for the long-term well-being of their children.

Being obese has cumulative problems, as it also means children and adults are not able to exercise easily, so the children do not walk to school, they play minimal sport, and instead they sit looking at computer screens or mobile phones as their ‘exercise’. Some surveys indicate such screen watching by children can occupy more than six hours per day. This is not living. The pleasures of being fit, healthy, and agile are many, and we are stealing this from the young by cutting back on physical activities at school and failing to educate them into proper balanced and sensible eating habits. Selling school playing fields for building sites is not in the national interest. Many doctors have reported a considerable increase in young people with back problems caused by being hunched over electronic screens of phones or computers. Opticians similarly report a significant rise in young people with poor eyesight.

It also means that future adults will need more money to cope with obesity since, as for smoking, it is possible to estimate the cost to national healthcare. Obesity greatly increases conditions such as diabetes, heart diseases, strokes, cancer, mobility and joint problems, plus a very wide range of other medical conditions. In cash terms, this is ?6 or ?7 billion per year. In terms of the numbers of people, the annual estimates run at around half a million deaths from cancer and other obesity-related problems in the UK and in the USA. Further, their lack of mobility, and the strain put on all the families and carers, is immense but hard to quantify in monetary terms, but certainly it reflects a very selfish lack of consideration for these people, and an expectation that someone must look after them. Their failure to live sensibly destroys many more lives than just their own.

Numbers such as this (half a million related deaths per year) still seem to have little emotive impact, so a search for an alternative is to look at one side effect of Type 2 diabetes. Maybe we view a death as ending the problems, so they have gone away, and are no longer important. Perhaps a focus on obvious long-term factors, such as amputations, has more visible impact. It is a topic most try to ignore, so we should emphasize that in 2014, obesity-generated diabetes frequently results in major surgery and amputations. In the UK, these are running at 7,000 per year! For the young and mobile, one way they could relate to this number and appreciate the impact is to point out that it is twice the number of professional footballers in the UK. This is the current annual rate of amputations for the obese. Whilst these amputations are ongoing, they are not apparently newsworthy. Imagine the difference if the list included just one or two star footballers.

The numbers cited above are for 2014, but unfortunately the trend is downhill; current medical opinion is fairly consistent in saying that the number of people with Type 2 diabetes will rise towards 5 million within the next few years. Rephrasing this in numbers we recognize, this means roughly one person in ten of the UK population. Because the problem is regional and class-dependent (because of exercise and eating habits), the numbers may seem nearer one in six in many sections of the population! Supporting the cost of care and treatments on this scale is impossible. The problem must be addressed by a change in attitude, exercise, and diet. The root cause is a failure of many people to look after themselves.

With such a large population that is overweight, there is of course a considerable market opportunity to sell cures, fitness courses, or slimming pills that will lead back to the ideal perfect figure. As expected, these range from being excellent to extremely dubious, or even dangerous to health. Once again, technology can play a negative part in this. My particular example is that access to the Internet provides a vast range of tablets and slimming treatments. Not all advertisers are selling the products they claim, nor are they necessarily effective. TV programmes that have investigated such areas report that many of the slimming pills originate in countries where drug controls are minimal. Hence, not only may the products not contain the chemicals they claim to be using, but often the ones used instead are known to have side effects or are actively banned in the EC as being not just unsafe, but lethal.

The preceding examples reveal major problems that we, internationally, are allowing to develop, and it is easy to cite other areas such as excessive alcohol and drug use. The impact from their side effects is not always obvious as they are often hidden under an umbrella of other problems. Drunken behaviour, especially at weekends, is very obvious, but it is accepted as the norm rather than being seen as stupidity.

Looking at accident and emergency hospital admissions, the pattern of such weekend excesses is very clear. Perhaps a disincentive would be a ‘healthy’ fee to the hospitals for such emergency visits if the people are obviously drunk or drugged. A cost, such as their weekly wage, would certainly be a sobering proposal.

I am clearly of the opinion that instead of continuously pouring more money and resources into the health system, it would be far more effective, not only in terms of money, but also for the fitness, enjoyment, and pleasure of living, if there were a truly major effort to influence not just what we eat, but how we maintain our health. London was host to the 2012 Olympic Games, and the investments in sport, etc. were intended to inspire the nation to greater physical activity and fitness. By the end of 2015, surveys of over-16-year-olds suggested that the number of active participants in sport has fallen by half a million. This effort was therefore a failure, except for small numbers in about six minority sports.

I am being highly critical of the population in the UK, as I am using them as an example. The problem is actually typical of many advanced nations, but access to the costs and statistics are not always as easy. The USA certainly has parallel problems.

We need to generate a strong sense of personal responsibility for our actions, and to maintain our own condition, and enjoy and appreciate the rewards that it brings. I also think our political leaders have failed to grasp and understand the problem, so they take an easy option and keep promising ever more money and resources for a health service, in the hope of getting votes. The true problem is not that medical care needs to increase, but rather that people have lost the desire, responsibility, and ability to take care of themselves. If we regain that, then the need for hospital treatments and costs will plummet.

We also need to regenerate a sense of self-esteem and independence, because at the moment vast numbers of people assume, and expect, the state will fix all their problems, even when the problems are clearly caused by their own actions. An aggressive policy of publicity and education to help people change the way they live would therefore make immense economic sense. A fitter nation would gain far more pleasure from life; people could appreciate exercise and participate in sport (not just watch it). These are factors that would be truly valuable to society. A side effect would be a reduced need for medical services and social benefits. The only obvious losers include those selling junk foods, or unneeded pharmaceuticals, etc. I personally see this as an additional benefit.

 
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