No one can doubt the sincerity of Dame Sally Davies’s parting shot as Chief Medical Officer. Her report on child obesity crackles with frustration and fear at the horrendous cost of the problem to individuals, families and the wider country. But her proposed solution reveals much that is wrong with our healthcare system and the people at its apex.
Every one of Dame Sally’s ten principles for change urges government, corporations and public sector leaders to make incremental shifts in regulation, policy or practice. You will look in vain for any call for a fundamentally more preventative approach to healthcare based on collaboration with and empowerment of communities. In that sense, it bears a striking similarity to the disappointing Long Term Plan published by the NHS in January.
This is particularly apparent where Dame Sally raises the alarm about the much higher levels of obesity within poorer, marginalised communities. The report metaphorically scratches its head about the issue leaving its recommendations with nothing to say about the policy shifts that might actually address the conditions of poverty and marginalisation themselves. This is silo thinking of a heroic scale.
It leaves the report fatally weak on two fronts.
Firstly, any attempt to reduce obesity that does not root what is essentially a hard personal battle for lifestyle change in the context of highly supportive networks and communities will struggle for impact. This was the insight of the famous Oklahoma City “This City is Going on a Diet” initiative which Dame Sally, of course, does not reference. An approach now endorsed by a wave of research on the link between strong communities, health and well-being.
Secondly, if our solution to any major health crisis is always to outsource solutions to legislators to force us to change, then we never build the community resilience and social conditions to stop new crises emerging. Some years ago, it was smoking that had to be resolved by regulation. Now it is obesity. It will undoubtedly be something else in the future.
Each time a crisis is allowed to emerge, cause misery and then be retrospectively legislated away. We should surely instead be creating a society where these pathologies fail to gain a grip in the first place. That, however, would require the vast resource and effort currently poured into acute response to instead go into prevention through community empowerment and economic inclusivity. And the desire for that in the NHS and government is currently little more than rhetorical.
Much of response to the report has predictably been shaped by the tramline ideologues of market and state paradigms with dull clichés about the ‘nanny state’ versus ‘corporate irresponsibility’ abounding. As usual, both sides in this hackneyed row miss the point. The power to change rests not with government agencies nor with atomised individuals. It can only be found reliably in stronger communities confident in their own ability to support each other and find positive, health-giving solutions to their challenges.
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