“Take responsibility for your own health”: naivety or convenient excuse?

When Matt Hancock got his new post as health and social care secretary, he delivered a speech in which he described ​‘preventing ill health’ as one of his main priorities. To make the most of the extra £20 billion promised by the government for the health service, he argued that ​“we must take a holistic approach to prevention”.

It is encouraging to hear prevention endorsed from the top. We do need to be better at preventing ill health in this country, rather than just treating it. However, the devil is in the detail and there was very little of that in this first speech.

With the exception of a few scattergun references to social prescribing schemes as well as investment in primary care and community pharmacies, it wasn’t immediately clear exactly how the health and social care secretary aims to prevent ill health or what he understands prevention to mean. Maybe this was understandable, given he was only a week or two into his new post.

On Monday morning, however, Matt Hancock gave some more insight into his intentions. It wasn’t promising. ​“Prevention”, argued the health secretary, is ​“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 seems that, by prevention, the health and social care secretary means individuals should take more responsibility for their own behaviour – by making more healthy choices, and less unhealthy ones. In order to encourage such healthy choices, one of the measures is to make genome sequencing more readily available, so that people can adapt their diet to account for certain biological deficiencies. ​“For instance, if you get your genome partially sequenced you can find out if you have a deficiency in a particular vitamin,” he said. ​“A vitamin B12 deficiency leads to a higher instance of dementia but can be prevented by eating broccoli”.

The problem

Matt Hancock says he hopes to increase life expectancy to increase by five years and to close of the vast health gap between rich and poor in the UK.

But decades of research shows that health is not determined by our personal choices, but rather the conditions in which we are born, grow, live, work and age. Our access to these conditions is dependent upon our place in society. The poorer you are, and the poorer the area in which you live, the less likely you are to have a stable job and control at work, a decent home, or an income to afford a healthy diet. All of these affect your health, either by restricting the healthy choices available to you, by leaving you in poor environmental circumstances (damp or cold housing affecting your respiratory health, for instance) or by affecting your psychosocial state (such as insecurity in work or a low position in the social hierarchy affecting your mental health).

Evidence has even shown that approaches that try to change individual behaviour may even make health inequalities worse, since those who take up the behaviour changes are those who are most able to – those higher up the socioeconomic ladder, who already have better health.

To improve life expectancy and narrow the gap between rich and poor, we need policies that nurture the conditions of a healthy life, like quality employment, adequate incomes and good housing. Broccoli isn’t the issue.

Naivety or political convenience?

Governments of all stripes have struggled to take these wider determinants of health seriously. Often, they pay lip service to things like housing or poverty, but action is predominantly targeted at individual behaviours. This has been so prevalent over recent years, academics came up with a term to describe it: ​‘lifestyle drift’. Matt Hancock seems to have gone one step further and ignored these determinants altogether.

Commenting in the Guardian, Professor Simon Capewell accused him of naivety. But is this approach naive, or is it politically convenient given the dire health trends that the government has presided over?

Over the last few months, official statistics have revealed worrying health patterns in the UK. Average life expectancy appears to be showing signs of grinding to a standstill from 2010. This is very unusual, as life expectancy has improved at an almost consistent rate for over a century. And inequalities in life expectancy are widening, after a period of narrowing up until 2010. Some groups in less advantaged areas of the UK have even seen life expectancy decline. More concerning news about the state of the nation’s health seem to be appearing by the week.

The jury is currently out on the causes, as more data is gathered and analysis rolls on. However, most are pointing towards the pernicious effects of austerity, as cuts to social care, social security and local government have taken hold. Austerity is making us sick. 

Last week’s Budget could make things worse. Combining extra money for the NHS with tax cuts means less for other areas with key roles to play in promoting the conditions for a healthy life, from education to public health. Whilst money for the NHS was clearly needed, doing so at the expense of other areas of public spending may ironically result in more sickness, meaning increased demand and yet more need for more NHS money. It’s a downward spiral.

After almost a decade of policy choices making it increasingly challenging to live a healthy live, Matt Hancock is blaming individuals for their poor health. The health secretary’s focus on individual responsibility lets the government off the hook for its awful record on health inequality, and absolves them of responsibility for doing anything about it in the future.