Saturday, 11 December 2010

Fat is a class issue

There seems to be a backlash against people who are obese as evidenced by articles that have appeared nationally in national and local on the number of people who are taking stomach-shrinking surgery.
Issued by the NHS Information Centre, new figures show the number of people having stomach shrinking surgery to help them lose weight soared from 480 in 2004 to 4,246 in 2009, costing the state an estimated £29 million.

Matthew Sinclair, research director at the Tax Payers' Alliance, is quoted recently criticising the increase, saying: "So much is being spent on surgery for the obese instead of on treatment for unavoidable diseases."
Alan Kaminski from Abbey Hulton who had the operation is featured in the Sentinel deploring what he considers to be an attack on the obese and indicating that for a number of other health reasons such as diabetes and his weight that exercise and other methods proved unsuccessful

Three years ago, Alan found himself in an appalling position when health bodies haggled about who should carry out his treatment and he found himself having to spend 200 days in the UHNS whilst the arguments were sorted out.

Now I know Alan Kaminski who lived in Eaveswood Road in Abbey Hulton when I was growing up. I don’t want to embarrass him but Alan is a highly intelligent and extremely capable man. For some years he was a worker at Hanley CAB I would think that he would make an excellent Councillor for the Abbey.
But there is an issue over the increase in obesity. You only have to look around the public places of North Staffordshire to prove this claim.

I am a fan of the Mitchell and Kenyon series of documentaries of film on lives of people in Edwardian England based on film discovered in Blackburn about a decade ago. I was watching a clip of working people parading around Blackpool in 1904. Not one of the people in the film was overweight. Fat in the context of 1904 was a rich man’s disease characterised by the bulky presence of King Edward VII described by Kipling as a “corpulent voluptuary” which probably explains why Kipling never got a knighthood.
But the film evidence is there. Obviously hard manual work, diet and access to food and skills in cooking are all part of the problem. But it always seems to come down to a culture of blame and the fat are usually labelled as lazy, stupid and lacking control which is why I mention Alan Kaminski who clearly is not stupid or lacking in focus.

A couple of years ago I heard Judith Bell, Public Health Director of North Staffs Primary Care Trust on BBC Radio 4 on a programme in a series on the 60th anniversary of the NHS justifying the conditions imposed on patients who drink, smoke or who are overweight before they can access procedures such as surgery. The radio programme gave examples of the sort of protocols that are currently in place for those patients who for example have a body mass index of over 30.

I would imagine that these policies would have been accepted at board level.

They certainly raised comments from members of the panel who were debating the issue there was talk of “management diktat” and a “black and white approach” adopted by North Staffs PCT. Perhaps the sharpest comment came from a spokeswoman from the Patient Association who was scornful of the consequences of such moralistic decisions on people in poverty and that it was“easy for skinny rich people who make these decisions, much harder if you are having a tough life”.

She was supported by a Rotherham GP on the programme who gave an example of a patient whose knee injury restricted her ability to tackle her obesity which she dearly wanted to do. He regarded the approach as unethical. All the critics of the restricting or denying access approach suggested too much of a “stick” approach, they felt that to make changes requires time, energy and money factors as well as support which can be lacking.

To cite my own experiences of health services in Leek I have found it very difficulty to access the exercise on prescription scheme which eventually proved insurmountable or discovering that the weight control clinic at my practice I use has had funding removed by North Staffs PCT. It therefore seems paradoxical to demand changes by individuals and not provide the opportunities for self help or support within primary care.
But my main objections fall into two main categories. As David Edgar the distinguished playwright suggested that by denying treatments it means that you are denying treatment to people who may have been paying taxes and National Insurance contributions for many years. Where would be the fairness in that as well as being against the ethos of the NHS! Similarly, if it a question of punishing or checking unhealthy behaviour then the logic would also mean that you would also restrict access to services, for example, for those who did not practice safe sex or those individuals who engaged in sports or activities which have high risks of injury.

Secondly, the whole issue smacks of a patrician, top down attitude to health and social care. It invokes the 19th century attitude to the poor and of deserving and undeserving cases. In short, it is more to do with morality than health. It reminded me of a quote by an eminent figure from that century the great philosopher and social reformer JS Mill in his essay “On Liberty” who captured this attitude which has never gone away, “Wherever there is an ascendant class a large part of the morality emanates from its class interests and its class feelings of superiority”. No doubt these feelings of moral censoriousness in authority existed before he was writing in the 1850s, but certainly they exist now as evidenced by North Staffs Primary Care Trust in 2008.

As one Dorset GP explained in the last minutes of the programme the approach being applied by North Staffs PCT was entirely the wrong approach, the impact of social deprivation should be directed upwards towards Government’s whose actions are seeing an increase in poverty rather than in downwards in chivvying the patient to make changes that they will find difficult.