Disadvantaged worst hit if obesity, drug or alcohol problems are punished

People unable to work because of obesity, drug or alcohol problems may have their social security payments cut if they do not undergo treatment, UK prime minister David Cameron has threatened. He has asked Professor Dame Carol Black, an adviser to the Department of Health, to carry out a review.

Reportedly around 2,000 people receive Employment and Support Allowance because of obesity, 56,000 people for alcoholism and 34,000 for drug dependency. Some have already tried numerous health programmes unsuccessfully or may struggle to cope with attending medical appointments.

This follows a government pattern of targeting those most disadvantaged while shifting wealth to the super-rich. This includes leaving tax loopholes open and usually not prosecuting the richest evaders.

In May 2014, the Sunday Times revealed that the combined fortune of Britain’s richest 1,000 people has reached a new high of £519 billion, twice as much as five years before. Meanwhile those struggling to get by have been badly hit. This proposal would increase inequality still more.

According to Cameron, “It is not fair to ask hardworking taxpayers to fund the benefits of people who refuse to accept the support and treatment that could help them get back to a life of work.”

But the causes of obesity and drug and alcohol misuse are complex. And those already facing disadvantage and discrimination are most commonly affected. Some will have worked for decades, until this is no longer possible because of ill health.

As the NHS National Obesity Observatory stated in 2012, “for women, obesity prevalence increases with increasing levels of deprivation.” For men, those in lower-status jobs and with fewer qualifications are more likely to be obese.

Public Health England explained in 2013 that being disabled can increase the risk of obesity: “Physical inactivity and muscle atrophy, as well as secondary conditions (such as depression, chronic pain, mobility problems and arthritis) have all been found to contribute to the development of obesity among people with physical disabilities.”

In addition, “For those with learning disabilities, obesity is linked to lower levels of physical activity, poor diet and the side-effects of medication.”

Other medical care too can lead people to become obese, e.g. some cancer treatments and anti-psychotic medication. So someone might survive a life-threatening illness but be left with an ongoing health problem which might not respond easily to treatment.

Findings from the 2007 Adult Psychiatric Morbidity Survey of England, published in the journal Psychological Medicine in 2011, found that alcohol and drug misuse were far more common among survivors of child sexual abuse than other adults.

Other adverse childhood experiences (ACEs) such as physical abuse, exposure to domestic violence or having a parent in prison can also result in health-harming behaviours, a national survey by Liverpool John Moores University and other researchers found.

According to a 2014 article in BMC Medicine, “Modeling suggested that 11.9 per cent of binge drinking, 13.6 per cent of poor diet,” and “58.7 per cent of heroin/crack cocaine use… could be attributed to ACEs.”

So the proposed crackdown would disproportionately hit people who had been in low-income jobs and with few qualifications, disabled people and cancer survivors and people who had been physically and sexually abused in childhood. This would be cruel and unjust.

There is much that could be done to improve the health of those already experiencing hardship and exclusion. This includes reducing stress and childhood deprivation and better access to healthy living support. In some cases, those too unwell to work might be able to do so.

But threatening yet more people with destitution, many of whom have already suffered deeply, is unfair and unhelpful.

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