Mention “healthy eating” to many people and the first thing they might think of is an ‘expensive fadish salad, with quinoa’. Some others will consider “healthy eating” is principally about people taking responsibility for their own health, and is the best way to prevent diseases, such as obesity, heart disease, diabetes. This is certainly the line that Matt Hancock, Secretary of State for Health and Social Care has taken: “Prevention is also about ensuring that people take greater responsibility for managing their own health. It’s about people choosing to look after themselves better, staying active and stopping smoking. Making better choices by limiting alcohol, sugar, salt and fat.” It is though nowhere near as simple as any of this would suggest.
Matt Hancock will ‘outline his 21st century vision today which aims to predict disease and pinpoint those at risk before they fall ill using digital apps to analyse personal data.’ reports The Sun. This approach to government health policy causes several concerns. It is one thing when a Doctor refers an individual to a dietitian, it’s quite another when this is set out as an app to complete a ’21st Century vision’ by a minister for whole nations. There are concerns on a number of levels. Using a digital app for such a purpose raises many questions about privacy, security and the sharing of such information, especially to the likes of insurance companies, or even to the NHS with justifiable worries about health rationing. Beyond the data concerns are further questions about why a Government Minister should find this particular approach appropriate.
Take the idea of individuals taking responsibility for their own health, that the Secretary of State is promoting. This is far too simplistic, it does not consider the environment a person is living in nor their genetic inheritance or their levels of wealth and income. The Government has been repeatedly taken to court over levels of air pollution which could cause up to 36,000 deaths in the UK per year, according to a report by the Kings Fund, ‘poor housing conditions have a detrimental impact on health, costing the NHS at least £600 million per year’ according to a report in the House of Commons, which could be as much as £1.4bn. The support for public green spaces, that can help ameliorate poor environments, has mainly fallen to Local Authorities, most of whom are cutting support, ‘Warwickshire County Council, which slashed its parks and green spaces budget by 87% in just one year, reducing spending from £108,268 in 2016/17 to £14,184 in 2017/18.’
Genetic inheritance too, particularly for conditions such as obesity, which can lead to cardiovascular and pulmonary diseases (such as sleep apnoea), metabolic diseases (such as diabetes) can not be taken into account in such a simple app, unless it was to become even more intrusive of personal data.
The other area that has significant impacts on health, which is not merely a matter of personal responsibility is income. The Joseph Rowntree Foundation report into how money influences health concluded: “A wide range of pathways link people’s income with their health. No specific mechanism dominates. They all interlink to form a complex network that interacts across people’s lives in ways that influence their health. The theories put forward in research into this topic therefore tend to suggest a need for wide-ranging policies to address health inequalities.”
It is then a matter of concern too that the newly launched The Eatwell Guide, the Government’s official guidance on a diet that meets nutrient needs (Public Health England, 2016) would cost £5.99 a day per adult or £41.93 a week, if its guidance was followed, which equates to the poorest fifth of homes with children having to spend 42% of their disposable income (after housing costs). When, as the Food Foundation’s research suggests, up to 3.7 million UK children live in homes struggling to afford enough meat, fruit and vegetables to meet healthy eating advice, it’s clear that the Secretary for Health and Social Care is going to struggle to improve the nation’s health. This comes at a time when ‘90% of councils‘ have cut smoking, sexual health, weight management services’, the very preventative approaches this app seems to want to replicate.
Update: “So, I see social prescribing as fundamental to prevention. And I see prevention as fundamental to the future of the NHS.” – Matt Hancock, Secretary of State for Health and Social Care, speaking to the Kings Fund.