So, what is really going on here? A review group on health matters is reported to be proposing that people should be asked about their diet, alcohol intake and other habits whenever they see a health professional – even if the reason for the conversation has nothing to do with how fat or boozy they might be. The Guardian reports as follows:

Patients should be asked about their diet, smoking and drinking habits every time they see a health professional according to radical proposals from the government’s NHS advisers to tackle soaring rates of obesity, cancer and alcohol misuse. The NHS Future Forum wants health staff to routinely talk to patients about their lifestyles, even when they are suffering an unrelated illness, and offer them advice and help to become healthier.

So far, so reasonable. After all, part of the social contract involved in a welfare state is that we own up to a mutual responsibility to the service. If my lifestyle choices are costing others, then I can have no objection to being asked questions. And again, after all, the questions are aimed at my better health and best interests, aren’t they? 

The statistics almost beggar belief:

  • The number of people in the UK with diabetes has risen by almost 130,000 to 2.9 million in the last year. That is up by almost 50% in just four years (2006-7 to 2009-10). Some 90% of these 2.9 million have Type 2 diabetes, which almost always develops in people who are very overweight. 
  • The Lancet medical journal has conservatively estimated that, on present trends, by 2030 obesity in the UK will have produced 5.45m cases of diabetes, 330,000 more people with coronary heart disease and stroke and 87,000 extra cases of cancer, which together will mean a loss of 2.2m quality-adjusted life years in the population, and costing the NHS another £2.2bn a year on top of the existing huge price of tackling obesity-related illness.

Yet, the Guardian report continues:

But some medical leaders last night voiced fears that such interventions might stop some patients from seeking medical help in case they were asked questions they found uncomfortable, and the Patients Association said it was “overkill”.


Of course the questions are ‘uncomfortable’. Isn’t that the whole point? They are supposed to be uncomfortable if they call into question the effects and consequences of our choices or habits. But 

that is no argument for not asking the questions. The guy leading for the government on this gave an example:

… A podiatrist who’s looking after the feet of a diabetic patient has an absolute responsibility to talk to the patient about their smoking, because smoking makes diabetes worse and means the patient is more likely to have a foot amputated.


Now, anyone who has ever been phoned by a journalist knows the sorts of games that might be being played here. However sensible the substance of the story, someone has to be found who will object. (A bishop says the sky is blue and the National Secular Society is called to object…) And it is often the case that the person being called is told a rather biased story to which the desired response can readily be given and the ‘story’ is then complete and ready for publication. I have no idea, therefore, how the ‘objections’ to the proposals above were elicited, but I do want to be wary about taking them at face value (and would be interested to know if those quoted feel that they have been quoted justly).

Why this interest? Well, simply that what really interested me about the story was the choice of words used by those who aren’t so keen on the proposals. Try this for starters: 

But Dr Clare Gerada, chair of the Royal College of GPs, said the policy was “muddled” and some patients might be put off by what they saw as intrusive questioning. “Young men pluck up the courage to go and see their GP, maybe about a sexually-transmitted infection, and would not want to be lectured. So we have to be careful that we don’t impose our agenda on to the patients and don’t inadvertently frighten patients who are coming in to see the doctor and who fear that they might be preached at,” said Gerada.

Er… ‘preached at’?’ ‘Lectured’?
Why these words to describe questions that need to be asked precisely because they are uncomfortable? The patient doesn’t have to answer them. As any doctor will tell you, you can double the figure any patient gives you when asked about weekly alcohol intake. But, since when has the asking of relevant health questions been synonymous with ‘lecturing’ and ‘preaching at’?

The economic price, as measured in lost productivity, welfare payments and the cost to the NHS, are already mind-boggling. Diabetes costs £10bn – almost a tenth of the entire health budget. That includes £725m spent on drugs for diabetics, and the cost of hospital beds – one in seven is occupied by someone with the condition. Yet every expert believes that, without a major change in human behaviour (which no one expects), these costs will only rise. These lifestyle diseases have been increasing at the same time as the risks of unhealthy behaviours have received unprecedented attention. Everyone knows that cigarettes are ruinous, but one in five still smoke.

… Professor Steve Field who chairs the forum admits: “Not enough people take enough responsibility for their own health, despite the amount of information that’s available.”

But, if this challenge to individual, personal responsibility needs to be heard loudly and clearly, so does the warning to society generally need to be heeded:

Katherine Murphy, chief executive of the Patients Association, said it agreed that patients needed more advice on living more healthily and help to do so. “But the underlying factors causing unhealthy lifestyles, for example poverty, also need to be addressed.”

So, happy new year to you! And my advice to myself and everyone else? Drink less alcohol, eat less, get more exercise, … and welcome ‘intrusive questioning’ about all three. It might make the difference between a healthy and a miserable 2012.