Fat is a local government issue

Yesterday, the LGiU published a new report on public health with Westminster City Council. Of all the recommendations in the report, which ranged from improving the supply of fresh fruit and veg to promoting use of public transport, the one that grabbed the headlines was our suggestion that local authorities could consider varying local benefit levels to reward and incentivise those people who sign up to exercise programmes.

Everyone likes the sound of incentives. The flip side, of course, is the fact that people who failed to complete an exercise programme would lose out on the additional money. It’s this issue that the press got their teeth stuck in to. Over on The Guardian, obesity campaigner Charlotte Cooper argues that we want to “withhold benefits” because of our “loathing for poor people with the wider medically sanctioned disgust of fat“.

That’s not quite where we were coming from. The suggestion that councils could think about varying benefit levels stems, rather, from a recognition that going along to a leisure centre can be expensive and that, by taking steps to improve their physical health, residents ultimately save the public sector money. The point is to remove barriers to people who want to get healthier and fitter. That’s about supporting, not loathing, poorer people.

As an organisation, we’re committed to the kind of public policy interventions that help local people take control of their own lives. That means local councils making positive, healthy behaviour as easy as possible. We need to recognise that, even in a global, modern city like London, there are communities where people struggle to access fresh fruit and vegetables and afford to pay for leisure facilities. Local councils should tackle this exclusion head-on.

Charlotte Cooper rightly draws attention to the significant risks that overweight people take to get a “normal” body. The bigger game, of course, is ensuring that people never get in to the desperate position where surgery, or even the prescription of an exercise programme, is necessary.

Surgery, and other clinical interventions, are ruinously expensive and damaging for individuals. The NHS has a lamentable record of investing in programmes, such as healthy diet and exercise, that prevent poor health.  Instead, it’s pouring £5.1 billion in to treating a largely avoidable condition. When local councils assume responsibility for public health in April, there’ll be a chance to turn this damaging approach on its head.

This blog was originally published on the Huffington Post.

    1. laura says:

      What will the lunatics in charge of the asylum think up next? Oh yes, probation services provided by the private sector and charities with payments by results – hahahahahahahahaaaaa

    2. Dear Jonathan,

      Thank you for the additional article on what proved to be an interesting report. I found much of the report stimulating in its focus on the preventative agenda and the involvement of local commissioners, who look for appropriate responses to local challenges.

      However I, as many others, do feel that the punitive nature of the financial approach is not necessarily one which will work, and has the potential to damage relationships between local bodies and citizens when their income may be compromised.

      There is a significant body of research, both within the NHS and other government departments, such as the MINDSPACE report, which promotes a more positive approach to long term behaviour change, involving supporting and trusting relationships and looking at an individuals wider situation and drivers. There has also been a number of programmes across the UK which aim to use a breadth of front line staff to support the public heath agenda and engage positively with local citizens.

      I am currently working with staff in Yorkshire and the Humber who are using the Making Every Contact Count framework approach to workforce development to train and support public and other sector staff to use interactions with the public as an opportunity to discuss their health and refer them to appropriate specialist support. The key principle behind this approach is taking individuals in their own situation, and recognising that the wider social determinants of health (such as unemployment) can be a key driver of ill health and conditions such as obesity.

      This work is not being delivered in isolation in the NHS, but is working closely with local authorities to ensure that as the responsibility moves over on April 1st, the learning and infrastructure that has been put in place is not lost, and that public health can remain everyone’s business.

      Rosie Maguire
      nef consulting (new economics foundation)

    3. Caroline Needham says:

      The truth is that as a society we have developed an unhealthy relationship with food, physical activity and weight whilst blaming individuals for the impact on their bodies. People who exercise are marketed over priced sugary drinks in leisure centres lacking healthy snack options. Women’s magazines feature ultra thin models, quick fix diets and recipes for chocalate cake. Many of us spend increasing time in offices where work is a sedentary activity and a long lunch hour a rare luxury. Women are encouraged to breastfeed but society provides little tolerance when they do so in public. We are pushing an increasing number of families into food poverty and under nourished children and adults will suffer long term damage to their health. We may spend time watching celebrity chefs cooking on tv too tired to cook or shop for a healthy meal ourselves. Stress at home, in the workplace or for a lonely older person may push us into unhealthy behaviours such smoking,drinking, substance abuse or eating ‘comfort foods’.

      Local Government has a role in providing a better life for all our citizens and working alongside them, with respect for people of all shapes and sizes, to mutually support better health in our communities. A good start would be to reject the idea of a perfect body shape and celebrate our diversity working together to kick around ideas and support and fund community based initiatives to grow vegetables, dance, walk safely, support breast feeding and ensure our staff get out to take a break at lunch time.

      1. laura says:

        My nearest pool and leisure centre, within walking distance, was closed down. My next nearest is due to close too, along with another that has the only pool with water warm enough to be tolerable to older people and those with disabilities (oh, the local hydrotherapy pool was closed down too). All of this to build an ‘olympic’ pool and sports centre on an outlying estate, inaccessible except by car, that no one can easily get to, especially not disabled and disadvantaged people, people on low incomes, people without access to a car…..

        THAT is the role that local govt is often playing in providing a ‘better life’ for their citizens, sadly. So how is that ‘working alongside us’?

    4. A Fraser says:

      Spending £5 billion on unnecessary treatment to people who could avoid getting into this condition is admirable. We need this money saved to pay off Gordon’s debt.

    5. S Foreman says:

      Surely if obese people exercising and getting healthier saves local authorities money, they should be incentivised to use their local leisure centre by increasing their benefits if they do so. Reducing the benefits of those who do not undertake fitness programmes in leisure centres will only result in their being able to afford less of the healthy eating options, and eating more cheap junk bread and biscuits. Remember in a TV documentary some years back an impoverished single mother being asked why she bought a packet of cheap biscuits instead of fruit for her children. She pointed out that the children could have a couple of biscuits each day for a couple of weeks, to help fill them up, but the one apple she could buy with the same money could not be eked out in the same way. It would only last a few days.
      I have never forgotten trying to bring up children on a benefits-level income. So that my children did get fresh vegetables and some fruit daily, I went without, eating very little indeed. I was constantly hungry for about eight years, and become properly underweight. Eventually my health completely collapsed and I was unable to work for the next five years. The costs to the NHS must have been considerable. I do not recommend this approach to anyone! I also knew someone whose income was too low to properly feed her teenage son – growing boys during those teenage years are constantly hungry. He was always ravenous, cadaverously thin. His friends’ parents used to give him food whenever they could. He used to take part-time jobs to pay for food, and his school work suffered considerably (he was very bright). It was heartbreaking, and he ended up with serious depression. Obesity often has hidden medical condition causes, and heightened appetite and powerful hunger sensations are often a side effect of medications given for conditions (such as schizophrenia). GPs do not always know about these factors. It is very unfair indeed to propose using benefits reductions to make people use leisure or fitness centre services. Far, far more should be done to educate people, and especially young children, in healthy eating – there is still huge resistance to changing dietary habits in many sectors of the population. It is also extraordinarily hypocritical of Westminster council to consider this measure. If they were to bother to integrate the report’s suggestions into all departments, such as Environmental Health, there would be far greater gains in public health and far greater savings. But it will be business as usual with regard to the shockingly polluted air in many areas in Westminster. Noise strategy and noise policy is another area that could do with revamping of aims, but instead noise teams seem to be taking noise ‘nuisance’ less and less seriously, particularly when the noise is being made by the all-powerful drinks and retail industry in the West End. Noise pollution damages health, this is why there are WHO guideline levels for noise, yet it is seen to be OK for business to keep residents awake all night long with noise above these health guideline levels. Westminster council should clean up its own house before cutting people’s benefits.

    6. Hi Jonathan.

      I am a poor person, and you speak for me. It’s like, I’m a bit thick and not so good with me words yeah, and people like you help people like me out by being cleverer and saying the things we wish we could articulate, but can’t.

      //As an organisation, we’re committed to the kind of public policy interventions that help local people take control of their own lives.//

      By taking control of our benefits, I see.

      //That means local councils making positive, healthy behaviour as easy as possible.//

      By taking control of our benefits, I see.

      //We need to recognise that, even in a global, modern city like London, there are communities where people struggle to access fresh fruit and vegetables and afford to pay for leisure facilities.//

      By taking control of our benefits, I see.

      …I could go on.

      I’m reliably informed that the medical community find your proposal to be entirely ridiculous. Do you have any evidence that mandated exercise would bear fruition in the long term? Everyone had to do P.E. in school, didn’t they? And now look around – everyone’s healthy. Because forcing sports on a person for a short amount of time in their lives, it really works.

      I lost four stone in two years whilst on benefits. I should be writing reports! Haha just kidding, we all know our place.

      1. laura says:

        Stunnigly good response, CodewordCondit. You should be writing reports!

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