Monday, 28 July 2014

Dr Sarah Wollaston and the "duty to intervene" - how health fascism works

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Dr Wollaston MP, il capo di tutti capi of nannying fussbucketry, who chairs the House of Commons Health Select Committee has called for laws to ban 'supersized foods':

“Supersized” food and drinks should be banned by law in a bid to combat Britain’s obesity epidemic, the new head of the Commons health select committee has said.

Now in one respect this is just another judgement on a particular type of food service - one that is most popular with ordinary folk who can't afford to pig out in Michelin starred restaurants. But the most disturbing aspect of Dr Wollaston's call wasn't that she wants a ban - such is the default position of nannying fussbuckets everywhere - but rather that the government has "a duty to intervene".

For a Conservative MP to set out such an argument is quite disturbing. For sure, we've had our flirtations with the intellectual underpinnings of fascism before but this is a disturbing rationale - government must intervene to stop people making a choice that may (or may not) have a negative impact on their health. The context for this is apparently:

"You go into the cinema and someone will ask if you want to supersize for an extra 20p - we don’t need that.”

Now apart from being surprised that anything at all in a cinema is priced as cheaply as 20p, this argument presupposes that people are mere automata programmed from childhood to exclaim 'yes, please' at every piece of marketing communications. Even offers mumbled at the buyer by a food service operative in a cinema queue.

Indeed, Dr Wollaston, in an indication as to the scale of her ignorance of how marketing works, has this to say:

“The scale of the marketing towards children of unhealthy foods is wholly unacceptable in my view given the scale of the problem."

This is straight from the Naomi Klein "brands-are-evil" playbook - again an odd position for an intelligent Conservative MP to adopt. We are to believe, Dr Wollaston says, that consumers are rendered incapable of choice when presented with the question 'would you like to supersize that?' or 'would you like a large one of those?' This reflects the infantilising of society by lawmakers - people aren't fat because of their own poor decision-making but because the marketing of food 'targets' them, 'forcing' them to consume 'unhealthy' products.

All this suggests that those people - the majority of people as it happens - who remain at a healthy weight are stoical ascetics. Or else (and I'm inclined to this view) Dr Wollaston and her fellow fussbuckets are peddling nonsense about the marketing of food.

So where does this 'duty to intervene' come from? It's clear that no such duty exists so what Dr Wollaston is saying is rather that she thinks only 'tough' measures such as bans can deal with the 'obesity crisis'. As I'm inclined to kindness in these things, I could say that Dr Wollston is befuddling her duty as a doctor to advise her patients with some sort of wider duty falling on the state. However, regardless of Dr Wollaston's motives, the result of setting out a concept such as a 'duty to intervene' is to redefine the role of the state, to turn its role from guarantor of rights and provider of services to a primary role of shaping society.

Which is why the term 'health fascist' is entirely appropriate to describe Dr Wollaston's position. The central tenet of fascism is that the state has a duty to change men so they serve the wider purpose of the nation - we are subservient to the needs of that state because it understands what is necessary to build the right kind of society. So it is with the 'duty to intervene' - people ordering 'supersized' boxes of popcorn are not merely damaging themselves, they also damage society by placing a 'cost' on us all. Such practices are decadent with the sin compounded by the suggestion that someone profits from making people eat larger portions.

So to put this right government has that 'duty to intervene'. The wider interests of society - defined with the term 'obesity epidemic' - are served by banning a person from entering freely into a contract with another person because the state has decided that large servings of fizzy-pop and popcorn are unhealthy.

This rejection of choice in a free society because of associated 'health risks' or the 'normalisation' of somet proscribed behaviour represents a degree of control and a justification on the basis of wider society's 'interests' that can only be described as fascist. Yet this health fascism - the view that bans and controls are needed because of the 'cost to society' - has become ever more common. That we are weak and make poor choices is undeniable and society should help us to deal with these problems but this does not justify saying that I cannot be allowed the option of a 'poor' choice. The former is good government, that latter health fascism.

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Saturday, 26 July 2014

Taxing supermarkets won't save the high street...but it will stop the high street saving itself


The 'supermarket levy' campaign has been around for a while and, thanks to the thoughtlessness of local politicians in assorted places, has now reached the national media:

BBC News has learned that Derby City Council has called for the right to bring in a levy as a "modest" effort to ensure supermarket spending "re-circulates" in local communities.

Some 19 other local authorities back a so-called "Tesco tax" on big retailers, which could raise up to £400m a year.

The premise for this is that supermarkets and other out-of-town retailers are to blame for the decline of town centres and, when we're asked, we all say town centres are really important. Except that we don't do very much of our shopping there any more. And the reason we don't shop there is because town centre shopping - at least for every day purposes - is inconvenient, inconsistent and often expensive. We have to get into town, park (often at considerable cost) and then lug our tired bodies round assorted shots that may or may not have the things on our list.

The 'supermarket levy' is promoted by an organisation calling itself 'Local Works'. Here's something about it:

Local Works was the coalition campaign for the Sustainable Communities Bill, originally set up by the new economics foundation. The campaign was successful when the Bill became law - the Sustainable Communities Act - in October 2007. Since then Local Works, as a part of Unlock Democracy, has been promoting the Act and urging people to get involved and government to implement it properly.

What nef did was to cobble together this coalition on the manifesto of 'localism' and the Sustainable Communities Act was sold to us on the basis of positive proposals to improve town centres and local communities. It is pretty sad that the usual green left wibble about the malign affect of supermarkets has been allowed to dominate the campaign's agenda. A fine idea that local initiatives shared can prompt national action has become just a campaign for a tax on food retailing, a campaign that won't save the high street, won't make people use independent shops but will impact on food prices in the places where most people - and especially less well off people - shop.

Seeking to rescue the traditional town centre by this route merely replaces trade with subsidy. The independent retailers and town centres become dependent on the money that flows from the levy. This doesn't really make those businesses and those centres viable, it merely acts to ossify a failed model. The future for high streets - as I have said many times before - doesn't lie with mere shopping but with being places of leisure and pleasure. This probably means fewer shops and smaller centres but it also means a different approach starting from what people want - not defined by opinion polling but rather by what people actually consume.

In the widest meaning of these words, the successful town centre is about the event, about theatre and about occasion. Some of the events are grand, some might be political or campaigning or even smaller and localised. But most of the events and occasions are personal and private - Susan's 40th birthday, the end-of-season night out for the football team, a reunion of old university friends or perhaps just a walk round town with mum and dad. The best town centres are the ones that provide for these events and occasions and not the ones harking back to a time before most people had cars and fridge freezers, a time when shopping was daily and a real chore.

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Friday, 25 July 2014

Petty bans and pointless policing...nannying fussbucketry Northern Ireland style!

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The story's about the Northern Ireland cops (how times have changed) threatening a couple of skinny-dippers with being put on the sex offenders register. But tagged on the end is another bit of tin-pottism and microcosm of pointless policing:

Police in the North Down town also warned that they were on the lookout for people bringing alcohol to the beach, with officers patrolling the platform at Helen's Bay railway station. 

Yesterday Kathryn and I went up to the RHS Gardens at Harlow Carr near Harrogate to listen to a little light jazz and eat a picnic. Along with hundreds of others we sat in the sunshine drinking beer and wine without any bother, any need for dire police warnings and certainly no trouble. It's really about time we trusted people to behave sensible on a public beach and to stop this nannying and unnecessary clampdown on taking a couple of beers to drink on the beach.

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Quote of the day - on the cat ASBO

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Rocky the Ginger Tom has got himself an ASBO from Rotherham Council:

I am in receipt of several complaints regarding your cat Rocky causing alarm, distress and annoyance to other residents in the area of your property. Although I appreciate that cats do roam, I would prefer if you could take steps to keep your cat Rocky from leaving the perimeter of your garden in the future. Should further complaints be received about damage done to neighbours’ property by your pet you will be charged for the repairs. 

Well I guess the Council had to do something! However, the owners comment is priceless:

"How can a cat behave antisocially? It’s an animal, it’s a pet - he’s not going to bite your leg off, drink alcohol in the street or try and rob your phone."

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Thursday, 24 July 2014

On 'right wing fundamentalism'...

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It is commonplace to describe religious fundamentalism as 'conservative' or 'right-wing'. In one respect this is simply laziness, a sort of sloppy thought-process from left inclined folk who assume that, because they don't like what those religious folk are saying, they are 'right wing'. Here - and I'm not having a dig at Jonathan who is a sincere liberal, at least in the modern, leftist meaning of the term - is a good example:


However, this got me to thinking about whether there's a world where liberal fundamentals are considered to be the views of 'nutters'. We could argue that this was - and still is in China - the official line under communist regimes. But, it then struck me that we already live in a world where those who hold to the fundamentals of liberalism - all those things that start with the qualifier, "free" - are often considered to be slightly loopy.

As a society we have a hit and miss adherence to those things we had in our Bill of Rights and that the Americans' put in theirs - free speech, free assembly, free choice and so forth are more honoured in the breach than considered fundamental. And we allow for our legislators and our courts to limit and restrict these freedoms, these fundamentals of a liberal society.

I am reminded about the debate Bradford Council held under the helpful heading of 'Islamaphobia'. The motion put forward by Respect was a very lengthy exposition of  'islamaphobia' as a concept so as to provide a justification for new restrictions to those liberal fundamentals in the interests of a thing called 'community cohesion'. The Conservative Group, in respecting those liberal fundamentals, put down an amendment that replaced the lengthy motion with this:

"Bradford Council affirms its belief in free speech"

The amendment was defeated as Labour, Respect and Lib Dems voted against - preferring instead to support an amendment that sought to deny rights to speech where the subject was religion.

Our defending free speech was seen as 'unhelpful' rather than an assertion of principle. And we see this everywhere - in the enthusiasm for press regulation (by that mythical thing called an 'independent body'), in the locking up of people for being grossly offensive on social media and in the banning of protest and agitation. Oh and we see it in the banning of drinking outside and smoking inside.

Yet when people agitate in support of these fundamentals, especially people arguing for free speech and personal choice, terms like 'libertarian nutter' and 'right wing troll' pop up like mushrooms in a fairy ring. We say we support free speech but then join in the fray when some semi-celebrity screams about needing controls on social media. We sign petitions in favour of gagging the press because Stephen Fry doesn't want the newspapers to be nasty to his friends. And then, having done this, we call for the heads of essentially harmless Christians because they don't want to bake a cake for a gay wedding.

Another bunch of us want to stop people doing things we don't like, especially when we can claim they're bad for people's health and, worse still, cost the NHS money! So fast food shops are banned near schools, sugar taxes are proposed, smoking is forbidden almost everywhere and drinking outside is stopped. Yet we'll then proclaim our support for a 'free society' when we really means a 'free-to-do-what-we-allow-you-to-do society' which isn't the same thing at all.

I'm guessing that holding to the fundamentals of a religious faith in an essentially secular world is pretty hard work. But, if our faith is in those liberal principles written down in those bills of rights, it is just as hard. Defending free speech is easy when we agree with the speaker but a whole lot harder when that speaker is saying something unpleasant, offensive or disturbing. Speaking up for personal free choice is easy when its about the convenience of modern living but when some person makes a choice to abuse themselves it's much harder to stand by those principles.

If 'right wing' is the right term to apply to those who hold to the fundamentals of a given religious belief, it should also apply to every fundamentalist - including those strange people who are utterly consistent in defending liberal principles like free speech and free choice. And who set out their philosophy as:

"Don't hit people and don't take their stuff."  

If believing this makes you a right wing nut-job then count me in!

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Wednesday, 23 July 2014

It's poverty that reduces life expectancy not being born in a poor place

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The current debate about health 'inequalities' is not especially helpful or informed. On the face of things we are presented with what sounds like irrefutable evidence that being born in a particular place will inflict a shorter lifespan on the poor child:

Men in the most deprived part of the population across England, dubbed the "bottom decile" by statisticians, are set to die before they reach 74 years old – almost a decade earlier than those in the top decile, who can expect to live until they are 83 years old. Women share a similar fate, with those born in the bottom decile expected to die by the time they are 79 years old, seven years earlier than the most affluent at 86.

The result - as with much of this 'inequality' debate - is a load of froth and bother all wrapped in political accusation. Yet these figures don't answer a simple question: what happens when the child born in a 'bottom decile' place moves to live in a 'top decile' place? Or indeed vice versa? Does this act result in the diminution of health inequality or does that act of moving wonderfully prolong or sadly shorten the life of the person?

The truth in all this is, of course, that most of this geographical difference results from the concentration of poverty rather than the effect of that place on health. No-one is disputing that there is a pretty close link between poverty (however you want to measure poverty) and poor health. But we should remember that people are not poor because they live on Bradford's Holme Wood estate, they live on that estate because they are poor. Indeed, it would be interesting to know how many of the children born to parents living on Holme Wood actually spend their entire life living there? My guess is that this will be a pretty small proportion of those children.

It's also important for us to note that this debate isn't about the distribution of health spending. After all, health spending is disproportionately directed to people who are in poor health. Mostly this means more is spent (over three-quarters of total spending) on old people but it also means more is spent on poor people simply because those poor people are more likely to be ill. Indeed, being in chronic poor health is a pretty good start on the road to poverty itself - there are plenty of people that are poor because they're ill or disabled rather than the other way round. This might not be a good thing, indeed it probably isn't, but it is a fact.

The problem with much of this debate - we're talking about health here but we could be discussing more general issues around deprivation - is that it assumes a static population when everything we know about poor communities is that their populations are not static. And we know something about movers too:

...groups most likely to move include younger age groups (16–34); private rented sector households; recent movers; large and single-person households; residents with higher qualifications (NVQ4 or above); males; and white residents

And those moving into deprived areas (this research is for New Deal for Communities areas - all in the 'bottom decile' of multiple deprivation):

...people moving in are more likely to be younger, white (but not British), or from a black and minority ethnic (BME) background, to live in a larger households and to be accommodated in the private rented sector

While not an absolute, the tendency is for the relatively successful to move out with their place being taken by a new generation of relatively poorer people. And somewhere around 10% of the population moves out each year.

What we fail to do in discussing deprivation is to make the distinction between things that are genuinely about the place and things that reflect the demographics of the place's population. By way of example, it's a good call to say that Bradford's tight, gardenless terraces will feature higher levels of road traffic accidents and conditions (asthma, bronchitis and even lung cancer) that link to poor air quality. But to suggest that this environment leads to higher rates of smoking, obesity or diabetes rather stretches the effect of place.

It makes a lot of sense to use geography to target resources better - the use of geodemographics and other modelling systems was a good idea when we proposed it to Bradford Health Authority back in 1990 and it's now an even better idea given our ability to make even better use of data modelling these days. But this still does not mean that people in Holme Wood are more likely to be in poor health because they live in Holme Wood.

The real debate shouldn't be about 'inequality' - after all we can fix that by poisoning the water supply in Ilkey! Rather we should be talking about poverty because we know that high levels of poverty result in more ill-health and lower average life expectancy. So the very best way to improve health outcomes - and we've seen this in the UK over the past three decades - is to reduce levels of poverty and increase levels of wealth and comfort. And, although I won't be thanked for saying this, capitalism is by far the most effective way to reduce poverty and increase wealth!

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Tuesday, 22 July 2014

How Third Sector Professionals killed Big Society...and the idea of voluntary initiative

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A few years ago I attended an event organised by Julian Dobson and others that was, or rather purported to be, connected in some way with the government's Big Society idea. And, as a fan of the idea, I toddled along in what turned out to be a vain expectation of enthusiasm for thinking about civil society and the way in which voluntary social action plays a part in transforming society for the better.

What I experienced (and this was repeated again and again in my peregrinations round the voluntary sector) was quite different. Instead of people engaged in voluntary social action what we have in this visible part of the 'voluntary' sector are two sorts of people - political activists (almost exclusively from the left of politics) and what we might call 'sector professionals'. I was struck, as I am always struck at these sorts of occasion, by the almost complete absence of any genuine volunteers - people who have got up off their backside and done something for their community.

Today, various of the 'usual culprits' in "The Sector" have rounded on the Big Lottery and Cabinet Office over the manner in which they have funded a couple of organisations closely linked to the Big Society agenda. It is, we are told by these people who made it their mission to distance "The Sector" from Big Society, a terrible scandal requiring investigations and probably executions.

Yet these people - so self-righteous in their condemnation - are the very same people that spent the first year of this government undermining the idea of Big Society. They came up with different versions of it - one's untainted by the dread association. With the result that the winners in the game were new organisations - bright-eyed and bushy-tailed for sure but inexperienced and with ideas that needed work. But where were the experts? All those people from NCVO and ACEVO, all the parasitical consultants upon the multi-billion pound state funding of the 'voluntary' sector?

These self-appointed sector leaders set out to make sure Big Society failed. And they did so for one reason alone - it was an initiative from a Conservative prime minister. To these "sector professionals" (a surprising number having close links with the Labour Party) no Tory could possibly understand "The Sector" and therefore the initiative was either a smokescreen to cover up the evil neoliberal agenda of the Coalition or else a trojan horse aimed at smuggling in cackling Tory businessmen to take over voluntary action.

What these "sector professionals" and their new found activist friends fail to appreciate is that they are the problem rather than Big Society, the Coalition government or evil Tory neoliberals. It is the transforming of voluntary organisations of all sorts - whether working with a particular group people, in a particular place or on a particular issue - from organisations doing voluntary work into sub-contractors to the state that represents the single greatest wound to our civil society.

What these "sector professionals" presided over, and it accelerated under the Blair/Brown Labour government, was the de facto nationalisation of voluntary action. We got to a situation where nothing was deemed possible without government funding and without the employing of these "sector professionals". And just as importantly those professionals were recruited on the basis of their ability to attract funds fron the Labour government, from QUANGOs led by Labour supporters and regional agencies padded with Labour councillors.

So organisations - just like their funders - got stuffed full with Labour supporters. And, when the change of government arrived and with it the Big Society idea, these people were faced with two options - suck up to the evil Tory neoliberals or do what the Labour Party wanted and undermine the policy. Sadly, for the idea of volunteering and of the voluntary society, the sector's leadership chose to dismiss Big Society and campaign instead for the continuation and extension of a role for "The Sector" as sub-contractors to state agencies.

The latest round of attacks on Big Society confirms to me everything that is wrong with those "sector professionals". I see a group of well-paid, middle-class folk protecting their interests and crafting a language of entitlement to do so. Links into government at professional or operational level - along with ministerial fear of upsetting "The Sector" - has maintained the current system of funding more or less intact. New places to broker influence arose - Clinical Commissioning Groups being a fine example - and the idea of people doing something simply because they care becomes ever more distant.

Thankfully there's a whole load of voluntary action still going on and plenty of people loving the place they live and the people who live there. But these people have absolutely no connection to or links with the entitled grant-farmers that dominate the national discourse about the voluntary sector.

It saddens me that an idea such as the Big Society was killed off by a self-interested group more concerned with protecting state-funding and state contracts than with the idea of promoting and encouraging voluntary action. The idea of the state stepping out of the way and letting people do it themselves has been sacrificed so a bunch of well-connected lefties can carry on lecturing us while living off government grants.

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