Dr Phil Hammond, GP and broadcaster

Nearly 25 years on from the Black Report, we still live in a very unequal society. A boy born in Dorset will live on average almost a decade longer than a boy born in Manchester. Take the tube east from Westminster station to Canning Town and, according to the London Health Observatory, life expectancy is reduced by a year for each station passed.

Successive governments have been unwilling or unable to tackle the thorny issue of health inequality. However, unless they do, there seems little point in pouring money into the NHS.

Tony Blair may believe we live in a classless society but, if so, the top of the class is very much richer than the bottom.

The income gap brings with it huge differences in lifestyle and behaviour. I live in a pleasant Somerset village, just 6 miles away from Bristol. For my daughter’s birthday party, we hired a magician who was used to doing parties in the city centre.

The climax of his balloon modelling act was a balloon containing lots of little lottery balls. The audience was completely nonplussed. "Oh come on!" he shouted. "What do your parents do on a Saturday afternoon? The National ...?" A girl put her hand up and shouted "Trust!"

There are lots of reasons public health is in a bad way. The neverending glut of cheap, bad food is a price we pay for capitalism. When the deep-fried, salted, sugared, reconstituted but very tasty ‘food’ costs less than the packaging, you may as well offer seven portions for the price of one. Humans are genetically programmed to eat, some more so than others, because a famine may be just around the corner.

We consume fewer calories than we did in the 1950s, but do a fraction of the physical activity. No-one walks to school any more for fear of being knocked down by those who drive.

And with a health service that’s free at the front door, there’s no financial incentive to get yourself fitter and make fewer demands on the service.

I’m not convinced that punishment and fat taxes are the way forward. Health is as much a psychological issue as a physical one, more about the gap between our aspirations and achievements than the state of our waistlines.

If you feel good about yourself and your lot, it’s far easier to keep your body in shape. Conversely, if you’ve got no job, no future and no self-esteem, you’re unlikely to pop down to the supermarket for some oily fish and a packet of sun-dried tomatoes.

If we want the nation to have better physical health, we need to sort out its mental health. According to The Sainsbury Centre for Mental Health, in England alone mental ill health costs the economy £77.4 billion each year, when you add up the bills for care and lost productivity.

My belief is that one of the reasons we’re degenerating into a nation of risk-taking, alcoholic, smoking, junk-eating lard buckets is because we pay so little attention to psychological health. We don’t need more doctors, we need more friends and grannies and fun. Then we’ll feel like getting in shape.

Guidelines in Practice, April 2004, Volume 7(4)
© 2004 MGP Ltd
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