Can you choose | to be healthy?

Science tells us what it means to be healthy but still many people smoke, drink alcohol and have weight problems. But that’s their choice isn’t it? Should the government and other health professional get involved? What about factors out of your control e.g. where you live, family finances?

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What does it mean to be healthy: test your knowledge!

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Should smoking be illegal?

What's the value of free will when it comes to smoking? Research has shown that it doesn’t offer much benefit to a person’s health, and the resulting diseases place big pressures on our medical services. But should the government place restrictions to try to stop people smoking, should they offer support or simply let people do as they wish? 
 

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Analysing the reasons behind people’s lifestyle choices is a tricky business since it involves a complex mix of: a person’s personal preferences, their home environment and available resources, their existing knowledge and education, and the influence of others around them. Psychology often comes into it too as sometimes people turn to things like smoking to gain pleasure or to help cope with the stresses of everyday life. The role of the government and other (health/education) professionals in shaping (and controlling) people’s health choices is a hotly debated topic. Smoking is a particularly interesting case as public perception has changed over time as we have gained more and more understanding (through medical research) of the health risks it presents. Such research has led to changes in UK law. In 1991 all tobacco TV advertising and sponsorship was banned, and this was extended in 2005 to ban all forms of media advertising (including the internet, radio and at sports events like Formula One racing). Smoking was also banned in all enclosed work places in 2007 to protect employees from the health risks of breathing in other people’s smoke (passive smoking).

Smoking

But what can the government actually do to help? Is there a right answer? 

In short, no. Especially since many people think the government shouldn’t get involved in the first place. After all, it’s our life and isn’t it up to us to live it as we wish? But others think it’s the responsibility of those in power and who have relevant expertise (e.g. doctors, health charities, teachers) to educate, and give guidance and support to enable people to make the best lifestyle choices possible. Helping us to live long and healthy lives. Here's a few steps that can be taken- but which one do you think is best (if any)? 

  1. Bans - so an extreme measure would be to ban cigarettes altogether. That way, people wouldn’t be able to (easily) get hold of them and cause themselves harm. In philosophy, we call this a consequential argument- where you’re not interested in someone’s reasons and motives for doing something (i.e. smoking) just the outcome of taking another action (i.e. a ban would in theory lead to a healthier population with less smoking-related deaths). But in doing so, aren’t you just pushing people to make different and sometimes worse choices? Will they be tempted to buy cigarettes illegally instead - products which might not have been quality-checked and could be unsafe?
  2. Increased taxes - another option is to tax people more on buying cigarettes. This might put some people off and help their health improve but many people don’t like being told what to do. So – like with banning things- an increased tax may force some people to look for cheaper and perhaps worse alternatives. For example, many people in the UK have turned to vaping (e-cigarettes) which although doesn’t contain the same poisonous chemicals as traditional smoking, there's currently very little research to indicate the long-term effects of this type of smoking. 
  3. Nudges - This is another word for actions aimed to make it harder for people to make unhealthy decisions, or offering support to encourage them to make better choices. For example, changing a supermarket layout so that the healthier foods are seen more easily by more people with the naughtier foods tucked away. But what about if people aren’t made aware of these interventions? Some argue that by hiding an intervention, you’re restricting people’s freedom and preventing them from being themselves. One study at the University of Oxford has taken a slightly different approach by giving participants health recommendations based on an analysis of what they recently bought at the supermarket. The researchers highlight to participants their top three fattiest food purchases and suggest healthier alternatives. When it comes to smoking, a lot of work has been done to try to put people off buying cigarettes by placing unappealing wrappers on cigarette packs. These either give details about medical risks or show gruesome images of body parts destroyed by smoking. Do you think this is enough to change people’s minds about smoking? 

So these are a few of the strategies the government can take but many health professionals believe that the most worthwhile thing you can do is to give patients real choices. A large part of this is about offering honest explanations, and realistic and achievable ways to improve their situation. Say for example a patient is struggling with obesity and requests to have a gastric band operation (where an adjustable ring is placed around the top of the stomach making a person eat less and feel full quicker). This is major, life-changing surgery which may affect their ability to eat normally forever more. Some argue that if a doctor didn't share this information and simply followed the patient’s request, this wouldn’t be respecting them fully. It’s better to offer honest explanations (where they are told about the long-term issues) and some alternative possibilities to change their lifestyle before heading to an extreme option such as surgery.

Choice vs. Desire 

Another thing to consider is how many of our choices are determined by our motivations and desires, and how sensibly/clearly people can actually think when they're addicted to something like the nicotine in smoking. Plus, how much are these choices shaped by our thoughts about the short term v.s. the long term consequences of our actions? Say for example, you see a delicious-looking but fattening chocolate cake in a shop window, there are several ways of thinking which may or may not lead you to eating it: 

First order desire: I want it so I will buy it and eat it now. 
Second order desire: I won’t eat it as I will ruin my appetite for later.
Third order desire:  I won’t eat it as I want to staying looking good.

Chocolate cake

But where does staying healthy fit into all this? A particular concern when it comes to children is that they tend to be led by first order desires and so would often benefit from the guidance of a supportive adult. And more generally, people have been shown with things like smoking to give more weight to immediate benefits (i.e. stress relief, enjoying social smoking with friends) rather than looking towards the future health risks.  

This is clearly a sensitive topic with no easy answer. But what do you think? Should the government take some responsibility in helping us make better health choices? Or should this be left down to us? Should you have to live with the consequences of your actions? 

This article was written in discussion with Dr Andrew Papanikitas (Nuffield Department of Primary Health Care Sciences) and Tena Thau (Department of Philosophy) - both based at the University of Oxford. 
 

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Should you have to pay more for your fizz?

Should there be a sugar tax on soft drinks? Would this reduce childhood obesity? That's what TV chef and health campaigner, Jamie Oliver argues in this interview with Evan Davis.

https://www.youtube.com/watch?v=s3k1BFjq2UA

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Do you truly have a choice if you're born in the developing world?

Young Lives is an international study of childhood poverty led by the University of Oxford. It has followed the lives of 12,000 children in Ethiopia, India, Peru and Vietnam over 15 years. Here Gudeta (aged 15, from Ethiopia) talks about how poverty affects local children's diet and education. 

https://www.youtube.com/watch?v=ijD9lMZ6EpU

Populations in Western Africa have some of the healthiest diets in the world but a lack of good health care means life expectancy remains much lower than the global average.  

Populations in Western Africa have some of the healthiest diets in the world but a lack of good health care means life expectancy remains much lower than the global average.  

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But does more money and resources mean people make better choices?

This short animation by the Guardian newspaper considers how our modern lifestyle in the West (i.e. US, UK and some parts of Europe)has led to many people suffering with weight problems. The rise of cheap fast food, less active jobs, and less time to prepare food has all played a part in this trend.

https://www.youtube.com/watch?v=GeWIEyTQsis

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What shapes your health?

For children and teenagers, keeping healthy is not straightforward. There are several things that are out of your control. Here are some examples but can you think of any others? 

  1. Where you live
    1. Where we live can have a huge impact on how healthy we are, and this varies massively around the UK – from the 10% of us who live in the countryside to the 20% of children who have never set foot on a farm. Even within a city, quality of life and health can vary. We know, for example, that exposure to air pollution increases the risk of diseases that affect our lungs and hearts, and this is more common in urban areas. We also know, however, that living in rural areas can be linked with longer distances to travel to school (meaning potentially less exercise), and isolation from healthcare services. Research has shown that many people’s diets are influenced by what shops and restaurants are nearby and the type of food they sell. Plus, if your parents work long hours, this choice is restricted even more by what stores are open at the times when they can shop. In general, the healthiest lifestyle has a balance – spending time outside and ideally free from pollution is good for our mental and physical health (including topping up on vitamin D we get from the sun), and being able to access specialist healthcare and healthy food to keep our bodies in check. 

  2. Family finances
    1. We live in a society where a healthy lifestyle comes at a cost, literally. Looking at diet, for example, a 2012 study from the University of Cambridge found that healthy foods were three times more expensive per calorie than less healthy foods. The rise of fast food chains has made it easier and cheaper for families to eat out but at the expense of health with many meals containing high levels of fat and salt. Even within fast food restaurants the price difference between healthier options and unhealthy ones are clear- with around £3.69 for a McDonalds' salad compared to £2.99 for a Big Mac!  Beyond what we eat, family income can also affect how we exercise determining whether it’s possible to afford specialist equipment or training, or even the cost of travel to go to it if it’s far from home. This highlights how it’s never just one thing that determines how healthy we are, but the whole mixture of how we live our lives.
  3. Family knowledge
    1. In the UK, we’re lucky to live in a country where, in theory, there’s enough food to go around for everyone and we have some choice over what we eat. This choice opens up a world of potential for companies to try to sell us their products through advertising. It can be difficult for families to find the healthiest choices which are also within budget. This is especially because the majority of foods found in promotion deals in supermarkets are classed as unhealthy, and on television and digital media we’re surrounded by adverts for products high in sugar, salt and preservatives. The UK government has developed a few health apps to support families such as the Sugar Smart App to help parents see the amount of sugar contained in products as they shop (you can simply scan any barcode with a smart phone). Families eating together, preparing healthy meals and understanding the importance of exercise are considered important in maintaining a healthy lifestyle. But in reality, this is not always easy when many parents have to work long hours and take it in turn to look after the kids- leaving little or no time to prepare food and eat together. Some say that cooking should be studied at school by all children, to take the pressure off learning from their parents alone. What do you think?

  4. Religious practices and personal beliefs 
    1. In 2017, around 1/3 of people in Britain said that they’re religious. In the UK, people follow a wide range of faiths, with Christianity and Islam being the most common. While most religions are followed as a general way of life and outlook, there are some religious beliefs that influence the things people eat and how they act. This can include fasting, like the holy month of Ramadan in Islam, or food restrictions like those observed by Jewish people e.g. not eating pork. And since children tend to follow the same religion as their parents, these practices are often beyond their personal control. Other personal beliefs can affect people’s health. This includes being a vegetarian or a vegan (a non meat, non-dairy diet). Effects on life expectancy aren’t yet clear for these lifestyle choices but there are known links between eating certain types of meat and diseases such as cancer, as well as connections between a non-meat diet and a lower body mass index. Would you make a big diet choice like that if you knew it would make you healthier?

  5. Family and school culture
    1. We get a lot from our parents – our hair, our eye colour – but it’s not just their genetics that make us who we are. While our genes account for around 30% of the variation in how long we live, it turns out that how healthy our parents are and what they teach us is one of the biggest factors affecting young people’s health. Take smoking for example… studies have shown that the longer teenagers are exposed to a parent smoking, the more likely they’re to begin smoking and become regular smokers in the future. Similar is the case for fruit and vegetables- the more our parents eat, the more we’re likely to eat. Our school lives can affect how we eat and stay active too. Currently, in England, the number of children who are obese doubles during their time at primary school so there is clearly a need to help kids get healthier at this age. Government- backed programmes are being developed to reduce these stats by giving young people a healthier environment to grow up in. For example, the charity ‘Fit for Sport’ offers a free digital tool to help schools track, monitor and evaluate how active students are whilst at school.