It transpires that in Vale of York, access to some NHS treatments may be restricted on the basis of BMI – people deemed “obese” (a BMI of over 30) will find themselves no longer covered by the universality of the NHS. Jemima @ Sometimes It’s Just A Cigar writes eloquently and passionately on the topic, and her critique is probably the best I’ve read.
All the same, I’d like to add a few thoughts of my own about this, because it affects me directly. My BMI is in the region of 40. I am, for want of a better term, a tubby B-word.
One common objection to the BMI calculation, and its association with “bad life choices” and “ill health” is that BMI is a poor indicator: many very fit and healthy athletes in various sports (American football, weightlifting, etc) easily score well over 30. For myself, I am not so bad on fitness, although I judge myself harshly on some scores.
But that’s basically only to excuse those who are actually fit. It’s the wrong argument – like advocating gay rights for those whose homosexuality is the right sort, or legalising (as opposed to decriminalising) sex work, on the basis of “escorts are okay, whores are not” or whatever. It’s still about making judgements about people that should not be the basis of whether you treat them as humans.
I’m not bad on fitness. But I am also not “healthy”. Most notably, and clearly, linked with my obesity is my gout. This is currently treated preventatively on the NHS by a regular prescription. I used to have prescription painkillers to handle the disease. All of this was on the NHS, and because I was unemployed for much of that time, I got the prescriptions for free (I have to pay now, since I have a proper job again).
I suffer from depression.
(Interestingly, depression has been linked in recent research with inflammation and trials of anti-inflammatory drugs seem to show that they can be used to treat depression. Gout, or “metabolic arthritis”, is a form of inflammation and I have certainly suffered less from depression since my gout has been controlled properly.)
I suffer from depression, and have done for a long time. One of my ways of coping was to eat. On a deep, primal level, somewhere in the lizard-brain, there must be some kind of evolutionary logic that if I have a full belly, I am doing well, I am in less peril. Eating made me feel better, and eating high-calorie stuff made me feel best of all.
There has also been a lot of financial insecurity in my life (remember, being unemployed, and before that, I was struggling to make ends meet on a student loan). There was a subtle imperative to eat while I could, because I never knew for sure if I’d be able to afford food later. Free food was an opportunity to stock up while I could. That obviously keys into that evolutionary lizard-brain imperative.
This added up to a significant eating disorder of comfort-eating that required a lot of mental toughness to break even enough to get to where I am today. Between ages 18 and 28, I increased in weight by about 50% (yes, that’s not a typo – I added half as much again to my body weight) and really only stopped gaining weight a few years after that. The key events were defeating my most serious bout of depression (aged 28) and then having to go on gout medication.
In that time, I only rarely had any kind of financial security. My obesity can be linked quite closely with the worry, stress, and depression associated with trying to survive on the pittance that Tony Blair’s, Gordon Brown’s, and David Cameron’s governments begrudged me as an unemployed person.
But it’s also linked to bad choices. Yes, it is. You see, when I was diagnosed with gout, I was told that certain foods and drinks are high-risk, and that I should probably reduce my intake. I don’t drink alcohol, or rather, only rarely. I was okay there. But red meat and caffeine… I drink cola like an addict (probably, I am addicted *shrug*) and I like my beef burgers and pork and so on. And because I am weak, although I have managed to reduce my intake, I do not have the willpower or inclination to use it, that I would need to cut them out completely. And to be fair, they are pleasurable and the gain is not certain to follow.
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There’s a really big problem when you start to decide who is deserving and who should not be helped, based on the idea that they have “brought it on themselves”.
The problem is simply that we all make bad choices. No one lives a perfect life, no one manages to follow perfectly all the rules that the latest research says we should in order to stay perfectly safe, perfectly healthy, perfectly “good” and “deserving”.
Do I think it’s fair that a lifelong 40-a-day smoker should take up so much public money for treating the diseases their smoking has caused? Not really. But then, I know that someone else can (and it seems, has) say the same about me and my cola, and my enjoyment of “bad” foods. Do I think it’s fair that people should risk their lives to save people who went fell walking in shorts and t-shirts and got themselves into trouble? Probably not, but at the same time, there but for the grace of God go I. And, no matter how careful you are, there’s always something more you might have done to prevent this or that disaster befalling you. If you’d cut services to obese people, then perhaps we should also say that the police need not attend if it turns out you “accidentally” left a window open or your door unlocked when your car was stolen or your house burgled? Perhaps you’ll agree that that time you pulled out without looking both ways, if another car had hit yours, then you should not have received any medical care for the injuries you might have suffered?
Emergency services, the Welfare State, health care provision, and so on: these things cannot be based on “deserving”. Because no one is “deserving”. No one lives a perfect life.
If this sounds familiar, then you’re probably a Christian. It’s the same basic principle as the concept of Grace, that none of us are deserving of God’s forgiveness and no one is untainted by sin. But regardless of that, God extends the possibility of forgiveness. As long as there is the will to do better, then forgiveness is offered and we can be restored, whether or not we deserve it. However badly we don’t deserve it.
You don’t need to be a believer or a Christian to understand the point, though. You just need to see other people as people: flawed and doing the best they can, just the same as you are. You just need to feel that another’s suffering, regardless of the cause, regardless of their own complicity in it, is something to be alleviated, to help them out.
When your friend starts dating someone you know is bad news, who’ll use them and hurt them, you might try to talk them out of it but in the end, you know they’ll make that bad choice anyway. Do you then refuse to help when your friend is dumped, hurting, maybe the arsehole they dated ripped them off, maybe kicked them out of a shared home? After all, you warned them this would happen! They brought this on themselves by not listening to you, didn’t they?
You know – instinctively, I hope – that the right thing to do is to help in any way you can, however much your friend was complicit in creating their own current misery. To make sure that, despite their bad choices, whatever they may have been, their suffering and misfortune do not destroy them or lay them low.
The NHS, the Welfare State, the emergency services, and so on, all work the same way. If you would not wish they come to the help of everyone, just try for a moment to imagine that they wouldn’t come for you when you are in need. Because, believe me, whoever you are there’s bound to be some reason why people might feel it’s “unfair” if they do.
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Edit to add: see also Stavvers: Blocking fat people and smokers from accessing healthcare hits our most scapegoated punchbags