Sick society

The Tyranny of Health: doctors and the regulation of lifestyle

Michael Fitzpatrick <em>Routledge,

When did it become the business of a Labour government to spend millions advertising the virtues of virginity (sorry, "abstinence")? Why has the government invented a minister for public health to run such crackpot propaganda schemes? And how did it decide that two previously happy singletons, sex and health, should be forced into a miserable marriage to promote something called "sexual health" (message: sex makes you sick)?

In The Tyranny of Health, Michael Fitzpatrick gives the booming health-promotion industry a rigorous examination, and does not like what he finds. Fitzpatrick is a working east London GP with a surgery full of fit young men demanding check-ups and scans in response to the latest high-profile health scare, while the elderly and infirm queue for treatment for their real, but less fashionable, illnesses.

Over the past two decades, first under the Tories and now under new Labour, the health-promotion industry has re-educated the nation around its "Big Four" injunctions: stop smoking, eat a low-fat diet, drink alcohol in moderation and take regular exercise. Many who now suffer from Bridget Jones syndrome, slavishly counting their daily cigarettes, calories and units of alcohol, might need a stiff drink when they discover that giving up smoking is the only one of the four proven to have significant health effects. And even here, there are major doubts about the real risk of passive smoking, the prime target of the tobacco wars of today.

Yet, despite the inability of an army of researchers to find hard evidence to support many of its claims, the health-promotion industry has won broad support from the political parties and from the public. This paradox, says Fitzpatrick, suggests that the doctrine of health promotion has become a contemporary article of faith: where once we had to do battle with the seven deadly sins to save our souls, we must now strive to meet the four targets for health promotion. As he points out, unlike old-time religion, the new cult of healthy eating, abstinence and exercise does not even offer the prospect of salvation. At best, its disciples are promised that, if they abandon bacon sandwiches, watching the game and having a Bud, their joyless and possibly flatulent fruit-and-fibre lifestyle might be prolonged by a few short weeks.

The government-led approach has redefined health not in terms of treating disease, but "in terms of the ways in which we live our lives", and Fitzpatrick details many of the symptoms. Look, for example, at how many social and psychological phenomena are labelled as health problems or syndromes, blurring the distinction between the sick and the well. Thus, definitions of addiction and dependency have been expanded to cover everything from shopping to sex, leading to the conclusion that more and more people (as in the ubiquitous phrase "one in four are victims of . . . ") need medical or therapeutic intervention to get by.

Fitzpatrick spells out the distinctly unhealthy results of all this. It has enabled the government to pursue a "programme of social control packaged as health promotion", and made doctors turn their attention "away from the care and treatment of patients towards the regulation of behaviour and the rationing of resources". Explaining how doctors have been pressed to prescribe methadone for heroin-users, in a programme designed not to get them off drugs, but to stop them stealing to buy illegal substances, he asks: "Is it my job as a GP to cut crime?"

Fitzpatrick's conclusion is that the policies of public health promotion should best be abandoned. Governments should stay out of the surgery, while doctors should concentrate on treating the sick and leave the well alone. This is a brave act of heresy, given society's morbid obsession with these issues today, and he acknowledges that some might think the conclusion "perverse". His book should be kept by the bed as an indispensable second opinion, and an antidote to health panics past, present and future.

The Tyranny of Health raises certain broader political questions that are beyond its scope to answer fully. Why did so many on the left abandon trying to change society in favour of trying to change our eating habits? How was the goal of sexual equality dumbed down to mean radical men demanding screening for testicular as well as cervical cancer? Perhaps most important of all, how did we reach the point where, "in a society of low expectations, the goal of human existence is redefined as the quest to prolong its duration"?

Mick Hume, a former editor of LM, is editor of the new online publication spiked