There is a problem in the NHS. There are too many sick people in the UK. The number of times people see a GP a year is, for example, increasing, and the number of frequent attenders seeing a GP often is rising dramatically. Either people really are ore sick, or they think they are, and that comes down to much the same thing at the end of the day: demand for the NHS is rising inexorably.
In that case, the obvious need is to improve people's health. That's not just to save cost in the NHS. It is also to improve people's well-being. There is little that Labour could do that would be more effective.
And so, its big idea is to ban smoking outside pubs.
I despair. Fewer than 10% of people in the UK now smoke. Many of them will not do so outside pubs. And the risk of getting cancer as a result of them doing so is very small, even if anyone could identify a figure at all. I am assured that the causes of cancer are not that identifiable.
So why is Labour doing this? Because it looks like it is going to something, however meaningless it might be.
And it is ignoring the fact that this might do harm. Pubs are places of social contact for many. Take that away for smokers, and their rate of other illnesses may well rise.
This, then, is performative at best and harmful at worst.
So, what should Labour do? If it wants to tackle obesity, diabetes, heart disease, depression and more, it has to tackle the excess consumption of fructose in our society. It is as simple as that. Take on big sugar (and the big pharma companies that thrive on treating the conditions the big sugar companies create) and we have a plan for cutting NHS costs and making people better in vast numbers of ways.
So, the question is, why won't Labour do that? It could. It could require a reduction in sugar in food. It could reduce the amount in fast food. It could change packaging, as happened with tobacco, and which worked. And it could make the country vastly better.
If it won't, Labour is not seriously trying to solve health issues, or the problems in the NHS. Only tackling sugar can now do both those things. And I expect nothing to happen.
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I saw this and it’s just a bone tossed to us from the top table to those of us who will never sit at the top table.
They’ll do anything other than what is really important.
They think they are so clever.
When in fact they are so dumb.
They have begun their own end.
But perhaps, that is what they signed up to anyway?
Starmer, Reeves, Streeting – these are all people who have agreed (been groomed even) to have power, status and a promise to be ‘looked after’ when its all over as long as the ‘project’ to destroy anything that remotely looks like socialism is destroyed.
Imagine what it is like to be paid to say and do stupid things? I mean look at Andrew Bailey?
Broadly, I agree that banning smoking in outdoor places around pubs is a fairly modest and perhaps slightly performative step (if the leaks do become policy). There are indeed many other drivers of public poor health, including sugar, poverty, stress etc.
However, “the risk of getting cancer as a result are very small” and “I am assured that the causes of cancer are not identifiable” is conspiracy theory territory. Please don’t go there. Sure, the causes of cancer are complex, and the causes of any specific case may be uncertain, but there are decades of serious medical research showing both the correlation and physiological mechanisms by which smoking causes cancer. Current stats are that smoking causes 3 in 20 cancer cases, and 6 in 20 cancer deaths in the UK.
Of course smoking causes cancer. I am not disputing that for a moment. No sane person would. I am saying it is far from proven that smoking outside a pub makes an iota of difference to either the smoker or anyone else. Sorry if that was not clear.
I think covid should get a mention here too! I can say from personal experience that in the 6 months after having covid, I had more NHS appointments than in the 6 years before. Covid set off an irregular heartbeat which meant an echocardiagram, a “wear the little box overnight” & on one occasion a precautionary visit to A&E. And I had POTS-type dysautonomia for 8 months, which I did see the GP about even though they offered nothing and what actually helped more was info from POTS UK. (I’m a lot better now luckily for me, but not everyone is so lucky)
Accepted
Both the UK and the USA has an aging population. As a person ages, they need to see the doctor more and the doctor needs to see them to monitor for problems and catch the problems at an early stage when the treatment outcome is better and less expensive.
My husband (now in his 70s) has four to five medical appointments (with different doctors) a month. When he was 45-65 he only had one appointment a month for the purpose of monitoring erratic high blood pressure. Yes! Sugar and diet cause problems which are easily solvable and could diminish net consumption of NHS services. The sugar problem needs to be addressed then solved or contained.
However, IMAO, with people living longer net consumption of NHS services will steadily increase.
Accepted
So, is living longer a problem , or a success, for an individual or for society as a whole?
Ann, it’s all about the quality of that extra life. Health and wellbeing are key.
I agree about sugar. As far as smoking goes its far more important to ban VAPES apart from those issue on prescription to help existing smokers stop.
It always amazed me how many VAPE shops were set up immediately it was agreed that VAPES were legal – wonder where all the money came from to do that.
Now vapes are being adulterated with all sorts including SPICE its imperative to make them illegal. We have already groomed millions of kids into smoking Time to also find out what the people who gave the approval were doing and who was paying them.
https://www.bbc.co.uk/news/articles/c897qw8ddp9o Virtually no noise made about this very brief item – I would have expected it to be headline news it is so appalling.
I suspect vape shops, like nail bars, American sweet shops and Turkish barbers, are largely fronts for money laundering, modern slavery and other illegal activities.
It is not simply sugar, it is the industrial food processing industry in general, and ultra processed food in particular. If Trump were to win, and I think it is 50-50, it will be interesting to seek what RF Kennedy Jr is able to do on that front. He even argues that it would be cheaper for the US to subsidise organic food for its people rather than pay for Ozempic to tackle the obesity epidemic.
As for smoking in public spaces, there is nothing worse these days to me, than walking along a pavement behind someone vaping and getting a face full of their fumes.
@ JohnA
‘Nothing worse’ than vape fumes. What a sheltered life you lead.
You never wallk along a street then? You must have a very sheltered life to be ferried everywhere by car.
We have seen it all before – from Harold WIlson’s ‘white heat of the technological revolution’ and now Blair’s love affair with innovation and technology .
Such magic bullets are so much cleaner than distasteful issues like raising money from the rich and reducing inequality down to Finland levels . Its so messy to talk about paying doctors and nurses properly and filling teh 100,000 vacancies in the NHS
Why on earth would they tackle sugar or ultra processed food – when they have been paid – ‘donated’ – not to do so? Starmer did say they would clean up politics – but he obviously will not get corrupt money out of politics – after his Labour party ‘revolution’ was to replace members and their subscriptions with huge slugs of private money from private healthcare, pharma – fossil fuel interests albeit disguised and indirect – via Labour Together etc.
We are deluged with public advertising and messagin persuading us to eat and drink more and more of teh wrong things – while public health messaging has been abandoned.
Its probably good to ban smoking from outdoor eating places like pub gardens – but as you say Richard, in the grand scheme of things – he is using it as a useful distraction – ‘look I’m doing something’.
Unless they share with the public the understanding that 14 years of ‘short term’ belt tightening has wrecked public services and also the economy and has to be reversed, they are doomed, and so are we.
But the last thing Labour wants is to ‘engage’ – and discuss – about the economy , about sars2 covid – about Europe, about anything .
I agree with your comment about we should be tackling the sugar industry before banning outdoors smoking. I would go further and include the alcohol industry. The effects of alcohol are catastrophic on the body, and society, and we could at least start with generic packaging, and a ban on advertising. It is an addictive drug, agressively pushed by drug dealers in suits, just like tobacco.
I would argue that fructose in and of itself is not harmful.
To the contrary, berries and apples are some of the most nutritious foods you can eat and one probably should include them in their diet if they do not already. And yet all the calories you get from them are from fructose.
Demonising fructose will not help as turning people on to more fibrous fruits to supplant the junk they eat currently would be a huge positive for the nation’s physical health.
The key is having balance in a diet and eschewing foods that have almost no nutritional value whatsoever.
Then you don’t undertsand fructose….
And fresh fruit is not that good for you
@ Brian Lynch,
Scroll down to the post by Matthew T Hoare and click on the embedded link:
https://www.taxresearch.org.uk/Blog/2024/07/25/we-need-to-end-our-addiction-to-sugar/
The NHS and World Health Organisation disagree with you…
https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-england-additional-analyses/ethnicity-and-health-2011-2019-experimental-statistics/fruit-and-vegetable-consumption
Old surveys
We now know a lot more
This was 2019. Have the NHS and World Health organisation backtracked on this since? I cannot see anything to suggest they have.
Their suggestion appears to be too general
Most petiole think for example that fruit juice = fruit = a good thing
The fructose is only useful from fruit if the fruit is eaten whole, you can absorb vastly less fructose as a result.
It is very common knowledge that fruit juice isolates the sugar and isn’t great. That is not the same as saying fresh fruit is bad for you. It simply isn’t, quite the reverse. And the article in question just talks about fresh fruit not fruit juice.
Ok
Accepted
I am amazed to read this exchange that no one mentions the Black Report of the 90s. Smoking undoubtedly causes lung cancer and is a factor in many others as is alcohol. Diabetes is not caused by sugar but an inability to process it. Obesity is main cause. The main determinants of poor health are social ie poverty,poor nutrition, poor housing,unemployment, stress, poor mental health, drug addiction. These are societal and political problems that NHS can palliate but not prevent. It is no coincidence that the last decade and half has witnessed a decline in life expectancy for the first time in the modern era. The new labour government has not a clue about this merely replicating it’s predecessor’s policies.This will prevail until Richard Murphy’s economic theory becomes the accepted practice.
And they requires on the ground changes, like reduced sugar consumption.
“if they (politicians) were truly intelligent and clever, they’d be doing something else”.
This was said to me decades ago, and nothing has happened in the intervening years to falsify this statement.
I see this proposed measure as a “fig-leaf”.
There are many reasons why the NHS is under strain; one is simply demographics. The problems now in the NHS were predictable 50 years ago. It should have been planned for properly. But no, short-termism has ruled.
I remember reading a report, published in the late 60/early 70s, that predicted that, in the year 2000, we would need all females born to enter the nursing profession. Of course nothing was done and the labour shortage was solved by using immigrants to fill the gaps in as nurses.
But, yes, we do need to look after ourselves better. Understanding the linkage between lifestyle and health is key and is best tackled young and then throughout our school years. But there’s the real issue. For that families need adequate income to feed themselves properly on decent food.
Thank you and well said, Richard.
I echo what you say about sugar. Declaration: My family has been involved with the industry since the mid-18th century. Lonrho, then run by Tiny Rowland, offered me a job before I left school, but I wanted to go to university and keep options open.
Richard: “So why is Labour doing this? Because it looks like it is going to something, however meaningless it might be.” UK diplomat turned French lecturer, training French and other aspiring officials, Aurelien often writes about the need to be seen to be doing something, often inappropriate, and then institutional inertia, factionalism etc. kick to prevent a change of course.
Thanks
Encouraging more people to quit or cut down on smoking is positive and a lot of people will welcome not having their pub lunch spoiled by smoke blown from a neighbouring table, and venue workers will value less mess.
I agree other public health measures are important but continuing to put pressure on smoking is also important. Labour would be best proposing this in a package of public health measures but they don’t really know what they are doing… but it’s a good move on its own merits in my view.
University of Colorado research has shown that consumption of fructose is forty times as much as we did in the 1700s – about twelve generations:
https://www.progressivepulse.org/society/innocent-drinks-not-so-innocent-after-all
And fruit has been bred to enhance the flesh and reduce the seed(s). See an old fashioned peach where the stone was much larger or the sweet and seedless Cavendish banana, which only really came pervasive in the 1950s and is the world’s most widely consumed fruit.
Thanks Peter
I welcome any initiative to improve individuals’ health; smoking, sugar… or anything else.
However, if you think this will save the NHS you will be disappointed. It might give us some breathing space to marshal the increased resources we need for healthcare… but it is only breathing room.
An ex-smoker that does not get lung cancer at 60 will need other treatment at 70 or 80 instead.
Ultra processed foods, that the food industry lays on us is an urgent target for Govt to encourage a reduced consumption.
Common dietary emulsifiers inter alia in processed foods can strip the gut mucus layer (recent Nature paper [1]) thus disrupting the work of gut bacteria. There is a high exposure to the population of these additives, many included so that the shelf life is exceedingly long (think coffee shop chain cakes’ etc).
[1] https://doi.org/10.1038/s42003-024-06224-3
As well as disincentivising the consumption of junk food, sugar, etc., the government should also focus on vastly improving walking and cycling infrastructure, reducing car dependency and encouraging exercise. They need to be bold and not listen to a loud minority of local protestors, reforming towns and cities. There are proven direct economic benefits to this on top of the indirect benefits from improvements in health. Again, though, it needs vision and the ability not to be kowtowed by vocal groups with vested interests.
Walking is vital…..
Marc writes “Encouraging more people to quit or cut down on smoking is positive and a lot of people will welcome not having their pub lunch spoiled by smoke blown from a neighbouring table, and venue workers will value less mess”.
Just to be clear about this, indoor smoking in pubs, clubs, restaurants, public transport has been prohibited in Scotland since March 2006. So having one’s “pub lunch spoiled by smoke blown from a neighbouring table” simply cannot happen here. Some pubs provide outdoor “smoking gardens”, but when they don’t, customers wishing to smoke gather outside on the pavement and frequently dump their fag-ends on it.
“Some pubs provide outdoor “smoking gardens”, but when they don’t, customers wishing to smoke gather outside on the pavement and frequently dump their fag-ends on it.”
It is the same in the USA.
I am talking about the outdoors proposal. Smoke doesn’t magically disappear outdoors and there can be confined spaces in pub gardens.
There are also spaces such as bus shelters where it is antisocial to smoke to say the least.
The question is why are we banning smoking
The answer is to protect workers health so if there is evidence to suggest smoking in beer gardens is a hazard to staff or customers then why hasn’t it been banned already
There may of course be a consumer protection issue in which case a ban may also be in order
There are two other areas where a smoking ban may be appropriate
Firstly smoking is banned in Red Square in Moscow and has been for decades because of the litter it creates so I suggest that there’s a case for band in some area’s eg outside pubs for this reason.
Secondly as the former Daily Telegraph motoring writer Honest John pointed out why do we tolerate drivers having a lighted cigarette in their hands when they are supposed to be in proper control of a vehicle so I propose a smoking ban for drivers as they are not in proper control of a vehicle with a little cigarette in their hands.
Along with excess sugar and ultra refined foods, sedentary lifestyles and air pollution (largely from transport) are also big contributors to illness, disease and premature death.
We need to build a society that as well as consuming less sugar, is consuming less ultra processed food and is less reliant on private motorised transport.
People need to be encouraged and feel safe travelling short distances on foot, by bicycle or by mobility scooter.
I am sure the measures to achieve these aims would be much more effective than extending the smoking ban, if indeed the goal is to reduce the NHS burden.
However, a minority still smoke. A majority drive.
And in all honesty, this is another dead cat. Hence it was leaked and Starmer was briefed and ready to comment on it.
Dare I say it nothing about a minimum unit price for alcohol or the ban on super strength lagers that some homeless charities have called for
My first thought on hearing this was:
1) How much demand is placed on the NHS through cold-induced illnesses each winter?
2) how much demand is placed on the NHS through malnourished children?
3) how much demand is placed on the NHS through Covid and long Covid?
4) how much demand is placed on the NHS through stress?
I abhor the idea of effective altruism, but if you are going to justify things through a cost-benefit analysis at least make sure you’ve done your homework, and show your workings!
I like your thinking
25,000 deaths from underheating a year. More than smoking. But get rid of winter fuel allowance.
The broader issue is that Labour has over invested in the “prevention will save the NHS loads of money” meme.
They are now forced to act as though this were true and that such acts as banning smoking will justify their policy of cuts in the NHS.
None of it is true; but that’s not the point.
Many people really believe if you prevent disease that it will save money. What premature deaths do is save money. Sickness and disease are symptoms of a sick society plagued by inequality, poverty, unemployment, poor housing, poor diets , poor living and working conditions, stress and bad , toxic environments.
Britain already spends more on preventative medicine than all other European countries.
Banning smoking outside pubs is neither going to save any money or save many lives. But it makes it look like they are making hard choices.
The harder choice would be to increase taxes on rich people and increase spending on the NHS and Social care.
For those that think the policy of the Labour Party is not to cut the NHS; go to the website of your local Integrated Care System. Most are committed to making 5% cuts in spending , while increasing activity by 5%.
Admittedly this was the policy before Labour took over but they seem little inclined to change direction.
Good public health does undoubtedly save money
But, as I keep pointing ouit, that requires that the government take on big pharma and big sugar and it will not do that
Good public health is a good thing and requires public investment but it costs more in the short term; and takes a long time to pay back, if at all.
This article is worth reading for the cost drivers in NHS spending :https://bjgplife.com/why-perpetuate-nhs-funding-gaps/
Deferring death can push back costs but only that.
And deaths are expected to soar in coming years.