If you get sick from coronavirus in Britain, it is your fault. Or that is at least the message the government is giving.
To add insult to injury, if you’re obese, that is also your fault. So a double whammy that will leave you with an increased likelihood of a poor Covid-19 outcome too.
In the past few weeks it has become clear that the government’s new approach to the pandemic, and health in general, is one of personal responsibility. Instead of taking responsibility themselves for steering the country towards health initiatives that will control the virus, there has been an increasing attempt to pass the buck and (pardon the complete irony here) wash their hands of any formal responsibility for mitigating the pandemic and the resulting health outcomes on our population.
Never is this clearer than in Boris Johnson’s renewed interest in obesity, ostensibly because of the links between obesity and poor coronavirus outcomes. However, instead of tackling the strong and direct links between deprivation, obesity and Covid-19 outcomes that are clear to see, the government has opted for an approach that puts all the effort (and thus all the responsibility) on the individual.
That is not to say that some responsibility does not lie with the individual. But every year I tell my students that to counsel exercise and a healthy diet to someone living in poverty is the equivalent of prescribing them a drug they cannot get here in the NHS. It is ineffective – and not great medicine.
This is because people can only make choices from what is available to them, and for many battling weight issues, these choices are not exactly extensive. Gyms aren’t free, and some areas can often be unsafe for engaging in free outdoor exercise like running or walking.
Healthy food is expensive and if you rely on food banks you get even less choice in what you eat. The zero-hour contracts and precarious shift work that often accompany those living and working in deprivation mean stability to find rhythm and routine is non-existent. And before you get on your Joe Wickes-shaped high horse, you can only workout in your home to free videos if you have the internet and ability to do so—many people have neither.
This latest move towards personal responsibility in health as a government ethos is worrying. It signals a wider mindset that health is something that only individuals need to take the initiative on, not nations. It is the opposite of both everything the NHS stands for, and the “all in it together” mentality of the past few months.
It takes the idea of caring for the health of an entire nation and pins it directly to the decisions that we the people make, instead of pinning it to the largely financial and political decisions that the government makes about where it spends its money. (Spoiler alert: it is not on British health and social care).
It is not enough to rely on (read “blame”) the common sense of the British public to maintain their health. To make good choices, there need to be better choices on offer. The public need government-funded resources to do so effectively, including meal programmes in schools, free-to-use sports and fitness programmes, accessible clinics for common illnesses like diabetes and chronic lung diseases, policies to reduce air and noise pollution, and better protection for our most vulnerable.
Without these well-funded resources in place you might as well give some people a roman candle, a roll of tape and a parliamentary-mandated mission to the moon. It is an impossible burden that cannot and should not be fulfilled by the British people on their own.
The government’s decision to take a personal responsibility approach to handling health (in the pandemic and beyond), is not the show of their good faith in the British people that they portray it to be. It is a cop-out on their own mandated responsibilities to protect us. It is libertarianism at its finest, wrapped up in a ill-judged assumption about the power of big society and the plucky British spirit of togetherness in a crisis. Keep calm and carry on blaming others.
Moving forward we need to be wary of the government’s attempt to put us in charge of our own health outcomes. If the government cannot or will not be swayed from this approach, there are still ways forward that would at least lessen the burden, while also tackling the acknowledged concerns of diseases like obesity.
For example, government-provided (and so free) masks would help protect the whole population while out and about and remove the burden of buying an effective one from those who cannot.
The “eating out” initiative could focus exclusively on health food stores and restaurants, making healthier food more accessible than it has been in years. The mandate to meet others and enjoy the outside during the pandemic could be harnessed to clean up and make safe public green areas, allowing for the development of free sports and fitness initiatives that get people moving safely, and in the long term.
Councils could be given the funding to turn short-term voluntary social support networks and initiatives that sprung up in the pandemic to help properly support their most vulnerable stay fit and healthy.
As a public, the thousands of voluntary groups that have developed over the pandemic show that we are a responsible population, but we cannot do this alone.
The government must step up to its own responsibility and help support these initiatives, and more, to ensure the healthy population that it needs for the country to thrive throughout and after the pandemic.
Dr Alexis Paton is a lecturer in social epidemiology and the sociology of health at Aston University, chair of the Committee on Ethical Issues in Medicine at the Royal College of Physicians, and a trustee of the Institute of Medical Ethics. She writes in a personal capacity