Which came first, the chicken shop or the desire for deep-fried chicken? New research by Public Health England (PHE) last week showed that of the 50,000 or so fast food outlets in England, just under half are to be found in the poorest 30 per cent of wards.
With obesity and diabetes exerting a growing strain on the health service, it’s naturally a public policy goal to encourage people, particularly children, to have healthier diets. To this end, PHE sees an obvious solution: curb the proliferation of unhealthy eating options in low-income neighbourhoods.
“It’s not surprising some children find it difficult to resist the lure of fast-food outlets when many neighbourhoods are saturated with them,” argues Dr Alison Tedstone, the quango’s chief nutritionist.
“Local authorities have the power to help shape our environment and support people in making healthier choices. They need to question whether these fast food hotspots are compatible with their work to help families and young children live healthier lives.”
But could this be a classic reverse-causation error? Do poor people often eat unhealthily because they are surrounded by fast food shops? Or do they eat unhealthily because they are poor (and thus attract fast food outlets)?
George Orwell famously described this supposed tendency in the 1930s. “The less money you have, the less inclined you feel to spend it on wholesome food,” he wrote in The Road to Wigan Pier. “A millionaire may enjoy breakfasting off orange juice and Ryvita biscuits; an unemployed man doesn’t …
When you are unemployed, which is to say when you are underfed, harassed, bored, and miserable, you don’t want to eat dull wholesome food. You want something a little bit ‘tasty’. There is always some cheaply pleasant thing to tempt you.”
And there is some more recent evidence that the stress of poverty leads people to behave in a short-sighted way, particularly in relation to their own health.
A related critique is that attacking the pleasures of the poor is the peak of hypocritical, middle class condescension. Jamie Oliver’s epic healthy eating crusade has drawn criticism from some on this basis.
Even attempts to discourage smoking have drawn complaints that they risk being a form of class-based discrimination. “What enjoyment does a 21-year-old single mother of three living in a council sink estate get?” asked the then health secretary John Reid in 2004. “The only enjoyment sometimes they have is to have a cigarette.”
The fact that such interventions often seem to “work” does not really settle the debate.
The ban on smoking in pubs, which Reid was objecting to 14 years ago, was introduced by Tony Blair’s government in 2007. There was a spike in demand for NHS stop-smoking services after its introduction.
Survey results show 14 per cent of ex-smokers credit the ban with helping them to quit. And 20 per cent of smokers say it has helped them to cut down on their consumption.
Recent research from the Institute for Fiscal Studies on the likely effects of the tax on high-sugar soft drinks also suggests it is a “well targeted” intervention if the goal is to discourage consumption among the young.
In truth there’s something slightly specious about the “middle class nanny state” objections, given that those who make the complaints are often thoroughly middle class themselves. One could argue that it’s not them and their children who have to run a gauntlet of fast food shops when they step out of their front door. And is it not just as patronising of a cabinet minister like John Reid to suggest the “only enjoyment” available to a single mother is, or can ever be, a cigarette? And in relation to the correlation-causation conundrum on unhealthy eating among the less well-off, it’s notable that anti-nanny state libertarians tend not to be proponents of more fiscal redistribution or higher public spending.
Yet it would be wrong to brush off the tradeoffs. However successful recent interventions have been, there has been collateral damage as well.
The smoking bans seems to have helped speed the decline of pubs, arguably reducing the social bonds of communities. The IFS research suggests middle age builders, whose demand for high-sugar soft drinks is insensitive to price, will be made financially worse off by the soda tax.
And one does not need to be a rabid libertarian to worry about the danger of excessive state interference in people’s free choices.
In the end, how an intervention is done matters as much as what is done. Balancing welfare considerations is inherently a political choice. Decisions cannot and should not be left to technocrats and health experts like Public Health England.
Elected politicians need to take clear ownership of the decisions, as the Labour government did on the smoking ban and as the Conservatives, to their credit, have on the soda tax.
This is especially important as politicians, unlike technocrats, are in a position to take action to influence all those other relevant factors, from the availability of local economic opportunities, to the funding of local community institutions, to the raw reality of how much money people have in their pockets.