Bigger-Picture

In the developed world we have come to expect good health. If we have problems, we expect them to be dealt with. In the abstract, we might recognise that a health budget cannot be unlimited, but our emotions are stirred whenever we hear about a treatment that is withheld on economic grounds. It is time we readjusted our expectations, but it is also time that the whole question of public health was re-examined.

There are some undisputed trends: we live longer; more illnesses and disabilities are treatable; and an increasing tax burden is being borne by a shrinking proportion of the population. It has been estimated that by Year 2040 there will be 55 pensioners for every 100 workers, almost double the number in Year 2000.

We recognise the high cost of medical staff and equipment, but the long, slow process of research and development of drugs is not readily apparent. Last week the UK National Health Service considered rejection of a treatment for breast cancer on grounds of cost. The marginal cost of a single dose of any drug is minute, but the drug companies have to recover their research costs by estimating the sales volume over which their research costs can be spread. Perhaps governments could help themselves by negotiating different price structures to reflect different volumes of purchasing.

Unfortunately, the complex budget structure means that savings in one area are not necessarily set against costs in other areas. This is particularly relevant when the scenario is widened to include prevention, and yet this is the key for the survival of state health systems. As always, it is illuminating to look at the bigger picture.

Last week the UK government turned down the opportunity to bring drink/driving laws more in line with Europe by reducing levels of permitted alcohol. Yet this simple step would improve road safety and reduce the burden on the health service. It has been estimated that alcohol costs the NHS £3 billion a year, twice the cost of smoking. And yet there is no attempt to subject alcohol advertising to the same restrictions applied to cigarette advertising.

An even more alarming statistic is that diabetes costs the NHS in excess of £5 billion per annum, more than alcohol and smoking combined. The biggest cause of diabetes is obesity, and the biggest cause of obesity is poor diet. Fast food is cheap and convenient, and comes with free toys for children, so this problem is going to get much worse. We need radical thinking to combat this threat, such as a ‘fat’ tax (perhaps charged when the fat content of a meal exceeds 35%), or an advertising ban, and ending free toy promotions.

There are no meaningful statistics for the health cost of pollution, but there is a real cost. So when the Government is considering the cost of subsidies for cleaner energy and more effective waste recycling, the health credit should be factored into the equation.

Ultimately we make our own choices, but the Government’s role in a democracy is to use tax and subsidy to help us through painful transitions. Education and encouragement of healthy lifestyles might just help the NHS through a transition of crisis proportions. We should expect and demand nothing less.