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Overweight or unhealthy people who fail to attend exercise sessions should have their benefits cut, the Local Government Information Unit proposed. Such a measure, included in a report produced with Westminster Council, would be unjust and do more harm than good.
Councils in England are taking over key responsibility for public health, though the NHS will still have an important role. A Dose of Localism: The Role of Councils in Public Health contains various proposals, some more practical than others. The most controversial – and likely to backfire – is about “Linking welfare measures to behaviours that promote public health”.
Obesity can indeed increase the risk of various diseases. It is more common among people on low incomes, people with mental health problems (sometimes linked to their medication), people with learning disabilities and survivors of child abuse.
As the NHS Choices website explains, GPs can help people to lose weight in various ways, including “exercise on prescription” and other physical activity opportunities. In addition “Many GP surgeries across the country prescribe exercise as a treatment for a range of conditions, including depression”. People with a family history of heart disease, at risk of osteoporosis, with diabetes, high blood pressure, arthritis or who have had a stroke are among those who can benefit.
A Dose of Localism recommends punishing those on such schemes who do not turn up to exercise sessions: “Relocalisation of council tax benefit and housing benefit combined with new technologies provide an opportunity for councils to embed financial incentives for behaviours that promote public health. The increasing use of smart cards for access to leisure facilities, for instance, provides councils with a significant amount of data on usage patterns. Where an exercise package is prescribed to a resident, housing and council tax benefit payments could be varied to reward or incentivise residents.”
For a start, such a scheme would be immoral (and of doubtful lawfulness) because disabled people would be particularly likely to be affected. In addition, some might fail to attend exercise sessions for reasons connected with their disability, or because they were carers. Overall, it would be those most disadvantaged who would have most to lose, which would be unjust.
It could also be counter-productive. Some people might be pressured into exercising more. But if, say, someone missed a couple of sessions because they were too depressed, or heart disease made them too faint or dizzy to exercise, cutting their income so that they could not afford to heat their home would hardly be likely to improve their health. Other members of their household too might suffer. Probably some doctors, to avoid harming the patients they wished to help, would stop prescribing exercise, except for those well-off enough not to be seriously affected by financial penalties.
The proposal has now been criticised by Stephen Dorrell, chair of the Commons health committee (http://www.standard.co.uk/news/london/westminster-councils-bid-to-slash-...).
This proposal should be ditched, and a less prejudiced and more evidence-based approach to public health taken. This includes tackling social conditions such as poverty and homelessness that increase the risk of ill health.
(c) Savitri Hensman is a regular commentator on politics, religion, social affairs and theological issues. She is an Ekklesia associate.Tweet