Tom Sutcliffe: Should I be bribed to stay healthy?

Social Studies: Anyone who requires an incentive to persuade them not to eat themselves to death is, by definition, not sufficiently committed to changing their health behaviours
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The Independent Online

It has the feel of a classroom exercise from a moral philosophy primer. Should grossly unhealthy people be offered a financial incentive to mend their ways – if that proves less expensive to the state in the long-run than their continued ill health? The National Institute for Health and Clinical Excellence's citizens' council thinks that they should, and so the idea has now been floated so that the wider public can comment.

Some, no doubt, will approach the matter in the same pragmatic spirit as the council, arguing that the end justifies the means. Others will probably say – as John Humphrys did in an animated interview with NICE's chairman, Sir Michael Rawlins, on yesterday's Today programme – that "bribing" the feckless to reduce the burden they impose on the feckful may be going about things in the wrong way. Would this not look very much like a reward for self-indulgence rather than a form of treatment?

Today's discussion of the issue was slightly fogged by their illustration – the case of an overweight woman who'd had her gym membership subsidised by the NHS. That was straightforward, surely. Giving them money or supermarket vouchers, on the other hand, would be a very different matter.

The citizens' council acknowledged as much by adding conditions to their suggestion. Incentives should never be exchangeable for tobacco or alcohol, they've specified, (or, one would have thought, pork pies or Krispy Kreme donuts either).

That was a bit of a no-brainer really, even if the ingenuity of the self-destructive suggests that it would take about five minutes for a secondary black market in NHS reward vouchers to be set up. But their other conditions only took you deeper into the problems of the scheme.

One insisted that such incentives would only be offered to "people who are committed to changing their health behaviours" while another cautioned that "cash incentives should only be offered as a last resort". I would have thought that anyone who requires a cash incentive to persuade them not to eat themselves to death is, by definition, not sufficiently committed to changing their health behaviours. More dangerously – for those who want to maintain this as a purely clinical affair, unsullied by questions of personal culpability – the belief that an incentive will work at all exposes the fact that the problem is a matter of individual choice, not a helpless subjection to genes or metabolism. And once you've made that link it's not inconceivable that someone else will eventually come along and say perhaps the wilfully obese should be paying the NHS for their treatment rather than the other way round.

As a taxpayer I might vote for the proposal – as a short cut to lower costs. But if I was grossly overweight I'd be a bit wary about signing up to a scheme which takes it as read that I have a choice about it.



Bad acting can often mean bad directing



Sir Ian McKellen reportedly blames the erosion of amateur dramatics and the old rep system for falling standards of stage performance in British theatres. I don't know whether he's right, in part because it's virtually impossible to know who to blame when productions fall below par. Let me give a very specific example. The Crucible Sheffield's new Hamlet opens, as all Hamlets do, with Francisco and Bernardo on the battlements at Elsinore. As Bernardo enters he says: "Who's there?", and Francisco answers: "Nay, answer me: stand and unfold yourself". But why does he say "Nay" first, rather than simply answering?

You can think of a number of reasons. He may have been dozing on the job and has woken embarrassed (the "Nay" is a belated excess of zeal). He might be standing on his dignity as the officer on watch (it's his job to ask "who goes there", after all). Or he might be saying it with a tremor of real fear in his voice (you tell me first so that I can be sure it's safe to answer). Whichever way, the point is surely that Shakespeare knew that unexpected word would contribute something to the mood of jittery uncertainty.

On the night I saw the production, though, the "Nay" sailed past as if it was simply there to fill out the poetic metre. But was the actor to blame for that, or the director, Paul Miller? I'm inclined to think that some of the blame, at least, should rest higher up the pay scale, and that it may do in other cases as well.







It's time our bishops embraced a bit of Lycra



The correlation between pious homophobia and secret homosexual yearnings isn't exactly a scientifically proven fact, but you'd have to admit that evidence favours the hypothesis that where you find one you're quite likely to find the other. The most recent case involves "Bishop" Eddie Long, the flamboyant leader of an Atlanta church who has done very well out of denouncing the sins of others (unlike many Church of England bishops, he runs a Bentley and travels by private jet). It's been alleged that Bishop Eddie coerced young men into having sex with him – an allegation he denies, although his protestations of innocence have been undermined by photographs he took on his iPhone and sent to one of the young men in question, which depict him posing in un-episcopal Lycra.

They are wonderfully and purely farcical in their own right, not conclusive evidence that the Bishop is a sexual exploiter, exactly, but surely a sign that, despite all those muscles, he's losing the battle against vanity and pride. What is most delicious though is the explanation tendered by one of the Bishop's supporters for this unusual form of ministry. He's suggested that all he was trying to do was encourage a healthy lifestyle and a better exercise regime.

Why are our own churchman so unimaginative when it comes to initiatives like this? Time, I think, for a few Anglican bishops to get out their gym shorts and singlets and show our increasingly obese youngsters what muscular Christianity really looks like.



For further reading: 'Obesity: The Biography' by Sander L Gilman

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