Free fat jabs plan smacks of social engineering

Iwonder what John Reid, the former bombastic Labour UK health secretary, would make of the news that Scots living in the country’s poorest areas are to become guinea pigs in trialling expensive fat jabs for free in a bid to tackle the obesity epidemic.

I suspect his answer might be best summed up by his initial reaction to being given the poisoned chalice of secretary of state for health by Tony Blair over 20 years ago, no doubt speaking for many an embattled health secretary, when he said, “Oh, fuck, not health”.

I am old enough to remember Reid, then the MP for Hamilton North and Bellshill, getting pelters for what was seen as him criticising a blanket smoking ban as an attack on the poor. To paraphrase the plain-speaking politician, he said that smoking was one of the few pleasures left to the poor and was not one of the worst problems facing them.

Reid argued that, in terms of public health, people really needed help by changing the fundamental social conditions which led them to smoke. He argued that poverty and limited life opportunities made it much harder for some people to stop smoking, drinking and taking drugs, or to eat a healthy diet.

In response to his critics, he said: “We always have to remember that low incomes, single parenthood, large families, or immobility can constitute huge barriers to healthy eating for some, barriers which simply do not exist for others in more fortunate circumstances.

“And when we discuss smoking, drink or drugs, let us never fail to recognise that social deprivation or lack of affordable alternative social horizons make it much more difficult for some of us to kick the habit.”

The health secretary, who gave up a 60-a-day habit himself, said that efforts to improve the nation’s health would only prove effective if they addressed social problems such as “poverty, poor housing, lack of family support and social exclusion”.

And while I think Reid could have expressed himself more elegantly in regards to smoking, when put in context, I agreed with everything he said. And no wonder this former Northern Ireland secretary, who had worked in an area of such conflict, responded with expletives when asked to step into health because he knew better than most that there is no such thing as a quick fix.

And so, it is here that I confess I’m conflicted by the news that thousands of poor Scots, living in our most deprived areas, will be given free weight loss drugs that usually cost over £100 a month to tackle the burgeoning obesity crisis. While others appear to overwhelmingly welcome this news as a major breakthrough and hail it as yet another global first for Scotland, I feel uneasy. 

Obviously, I agree that obesity is an issue of quite literally gigantic public policy proportions, putting strain on budgets and creating a medical time-bomb in terms of diabetes and other related conditions, but I can’t help feeling that there is something in this that smacks of discriminatory social engineering. 

And if it weren’t for the overwhelming stigma of being overweight and the prejudice that comes with that, how would we feel, generally, about a political proposition to inject poor people with a chemical cocktail, with still to be tested long-term effects, as part of a population experiment to curb what could essentially be seen as a consequence of deprivation? 

Imagine for one moment this was about enforced birth control to counter the welfare bill and maybe the news wouldn’t be embraced so unquestioningly.

I recognise this is a prickly one. On the one hand, obesity is a massive drain on the public purse and it disproportionately affects poor people who don’t have the luxury of a good diet and access to a plush gym, or may even be lacking in a basic education, or there’s a generational legacy which leaves them not knowing how to cook healthy food – so why shouldn’t they be afforded the same access to these appetite-suppressing drugs as the wealthy? I get that.

But on the other hand, this is a complex issue that doesn’t fit with a band-aid solution. The underlying issues that have helped swell the numbers of obese Scots to well over 50 per cent of the poorest cannot simply be wiped out by a shot in the stomach. They need systemic change and being offered the inducement of a free miracle drug by big pharma doesn’t even touch the sides.

‘Prevention’ is the buzz word on the lips of every health secretary across these islands. It has been for decades, and yet the clamour to accept the panacea of a quick-fix drug runs completely counter to all of that. Indeed, it’s an acknowledgement that that horse has already bolted.

And while I couldn’t agree with John Reid’s Marie Antoinette-style moment in relation to smoking, I absolutely agreed with him on the fundamentals that a ban on smoking was never going to be the silver bullet to tackle the travails of the poor. And here we are, 20-plus years on from Reid’s plea to deal with the underlying causes of health inequalities, and all the while the poor have got sicker, fatter, and are dying younger.

I am sure that so-called fat-busting drugs do have their place. Indeed, I walk around Westminster and see the evidence in the hollowed-out faces of previously fat politicians now looking too small for their shoulder pads. But it is temporary and without other longer-term interventions, education, and wrap-around care, poor fat people will still be poor even when they are thin.

And on that, I agree with Reid. Until we tackle the fundamental reasons for health inequalities, then nothing will change. You might eat less because the drugs make you feel full, but your diet won’t have improved, your home won’t miraculously be damp-free, the local shops won’t suddenly be stocked with affordable fresh produce, you won’t be off the breadline or in your dream job, and those drugs won’t push you into education or onto the treadmill but might push you into malnutrition. I’m all for health improvement but let’s be honest, this trial isn’t a moment to celebrate success. This is about dealing with decades of failure in tackling poverty and its consequent ill-health in any meaningful way. And that is something to properly chew over.