Physician, heal thyself
Following the smoking bans imposed in Ireland and, earlier this year, Italy, it looks like England is the next place where fags will be banned in pubs. The Scottish Executive has already announced a total ban in Scotland to start next year (although who's going to enforce it in some of the howffs on Sauchiehall Street is another thing - best break out the riot gear, boys) and Wales is also on its way, so it's a racing cert than England will follow suit. The NuLabor regime talks of a "consultation" and only banning smoking in pubs where there's "prepared food", but it's nailed on that there'll be a ban in all pubs.
Personally, I'm not too bothered. I do smoke, but only 4 or 5 a day, usually only 3 if I stay in of a night, and I can live without a fag with my pint and go outside for a puff. Hell, it might even help me pull - in Ireland, the ban's led to the phenomenon known as 'smirting' where smokers chat each other up outside bars. Neither do I think it's a major imposition on 'personal freedom' - in our 24/7 surveillance society there are far greater dangers to freedom than not being able to puff on a coffin nail, and I rather wish the pro-smoking zealots would address themselves to these.
What does gripe me, other than the sheer smirking patrician middle-class moralism of this whole 'debate', are two things:
1. The pot calling the kettle black. It's the BMA that's forever calling for a ban on smoking (amongst many other activities) and punitive increases in the price of booze, yet doctors are notorious drug abusers. As the old joke goes, an alcoholic is someone who drinks more than their doctor. Quacks drink like fishes and smoke a fair old bit too, and if that wasn't enough they often self-prescribe opiates. I can't say I blame them, given the stresses of the job and the sheer temptation of the prescription pad, and if they want to get off their heads then fair play to them, but it's awful rich for them to then tell the rest of us how to live healthy lives.
2. A complete ignoring of the major factor behind reduced life expectancy and lifestyle disease - capitalism. The sheer stress involved in wage-slavery, particularly at the bottom of the heap, shortens your life - it's known and quantified that those of us in the 'lower social classes' (aka working class oiks and riff-raff) live many years less than our 'betters' higher up the rung [1], and suffer worse and more chronic health problems. Not to mention the environmental degradation that's an integral part of capitalism - polluted air and water, food laden with chemical toxins, destruction of habitat and open spaces, more roads and cars and thus more fumes and particulates for us to inhale (the nobs, of course, live in the country away from all that 'unpleasantness'), poor housing, and of course drastic climate change. All the dangerous activities, such as smoking and drinking, that quacks want to ban or control, are but minor 'risk factors' compared to the greatest risk factor of all - living in capitalist society. Banning smoking whilst ignoring capitalism is like stopping a pub fight and ignoring a city-wide riot, yet you never hear a peep about the inherent health and life threats of capitalism from middle-class quacks. Perish the thought.
Trouble is, not mentioning the mother of all risk factors behind poor health and reduced life expectancy is ignoring the elephant in the room, and leads to good old middle-class liberal victim-blaming. The plebs are ill because we smoke and drink and eat fatty and sugary foods and don't go to the gym twice a week, and although some liberals might pity us - poor dears, they know not what they do - in the end it's all our fault, in their eyes.
As liberalism is the dominant ideology of capitalism that's hardly surprising, I suppose, but in practice it leads to increasing restrictions on our life choices, and to cutbacks and privatisation in the NHS. Why? Because the middle classes increasingly ask "why should I pay for the care of someone who smokes/drinks/eats the wrong foods/doesn't exercise enough?", and the simple logic of that rhetorical question leads inexorably to private healthcare. If the principle is that the cost of the healthcare of those who take 'unnecessary risks' with their health should not be borne by those who 'live healthy lifestyles', then plainly those who willingly take such risks should pay for their own healthcare. The Daily Mail-reading middle classes would nod their heads vigorously when you're talking about the lifestyle risks that we plebs take, such as as smoking and drinking, but what then about people who go sailing, or mountaineering, or hillwalking, or skydiving, or hang-gliding, or play rugby, or take part in any activity riskier than a walk in the park? Surely they should pay for any care they might need as a result of their activity? If I break a leg whilst out on the hills and the mountain rescue come for me, why should other taxpayers who don't hillwalk pay for my stay in hospital and out-patient care?
The simplistic, economically-individualistic answer to those rhetorical questions is: everyone should pay for their own healthcare. The NHS is based on the principle that care is given on the basis of clinical need, regardless of ability to pay, funded by general taxation, but that means that, by definition, we all subsidise the healthcare of others, regardless of how 'clean' our own lifestyle is. Which seems fair enough to me, in the same way as it's only right that education should be free and universal. As a childless bloke, I could ask the rhetorical question: "Why should I pay for the education of kids when I don't have any myself?", to which most folk would tell me not to be such a selfish bastard, and rightly so. Yet we allow the "why should I pay for XXXX?" questions of the selfish middle classes to dominate debates on health service provision, even though anyone with half a brain can see the logical end result of such 'policies'. As the middle classes are forever professing their faith in the NHS then presumably they don't want fully privatised healthcare, so the only other conclusion to draw, if the Nigels and Sarahs want to retain the NHS yet not pay for the care of wilful risk-takers, is that they want to use the "why should I pay?" argument as a stick to bash the heads of the plebs with, and to enforce control over personal aspects of our lives that they find distasteful.
That's what burns me about the whole smoking ban issue. If it was just about the health of workers in pubs and public places then there'd be no problem, but that's plainly a tissue-thin figleaf of a rationale for since when has the State, particularly the right-wing neo-liberalist State we've had since 1979, given a toss about the health of workers? No, it's the sheer hypocrisy of quacks, and their wilful ignoring of the destructive nature of capitalism, that really gets my goat.
Why do doctors drink so much? BBC Magazine, 14/6/05
Smoking ban consultation to start. BBC News, 20/6/05
England smoke ban plans unveiled. BBC News, 20/6/05
[1] National Statistics Online - reports on life expectancy in the UK. See in particular Trends in life expectancy by social class 1972 - 2001
Personally, I'm not too bothered. I do smoke, but only 4 or 5 a day, usually only 3 if I stay in of a night, and I can live without a fag with my pint and go outside for a puff. Hell, it might even help me pull - in Ireland, the ban's led to the phenomenon known as 'smirting' where smokers chat each other up outside bars. Neither do I think it's a major imposition on 'personal freedom' - in our 24/7 surveillance society there are far greater dangers to freedom than not being able to puff on a coffin nail, and I rather wish the pro-smoking zealots would address themselves to these.
What does gripe me, other than the sheer smirking patrician middle-class moralism of this whole 'debate', are two things:
1. The pot calling the kettle black. It's the BMA that's forever calling for a ban on smoking (amongst many other activities) and punitive increases in the price of booze, yet doctors are notorious drug abusers. As the old joke goes, an alcoholic is someone who drinks more than their doctor. Quacks drink like fishes and smoke a fair old bit too, and if that wasn't enough they often self-prescribe opiates. I can't say I blame them, given the stresses of the job and the sheer temptation of the prescription pad, and if they want to get off their heads then fair play to them, but it's awful rich for them to then tell the rest of us how to live healthy lives.
2. A complete ignoring of the major factor behind reduced life expectancy and lifestyle disease - capitalism. The sheer stress involved in wage-slavery, particularly at the bottom of the heap, shortens your life - it's known and quantified that those of us in the 'lower social classes' (aka working class oiks and riff-raff) live many years less than our 'betters' higher up the rung [1], and suffer worse and more chronic health problems. Not to mention the environmental degradation that's an integral part of capitalism - polluted air and water, food laden with chemical toxins, destruction of habitat and open spaces, more roads and cars and thus more fumes and particulates for us to inhale (the nobs, of course, live in the country away from all that 'unpleasantness'), poor housing, and of course drastic climate change. All the dangerous activities, such as smoking and drinking, that quacks want to ban or control, are but minor 'risk factors' compared to the greatest risk factor of all - living in capitalist society. Banning smoking whilst ignoring capitalism is like stopping a pub fight and ignoring a city-wide riot, yet you never hear a peep about the inherent health and life threats of capitalism from middle-class quacks. Perish the thought.
Trouble is, not mentioning the mother of all risk factors behind poor health and reduced life expectancy is ignoring the elephant in the room, and leads to good old middle-class liberal victim-blaming. The plebs are ill because we smoke and drink and eat fatty and sugary foods and don't go to the gym twice a week, and although some liberals might pity us - poor dears, they know not what they do - in the end it's all our fault, in their eyes.
As liberalism is the dominant ideology of capitalism that's hardly surprising, I suppose, but in practice it leads to increasing restrictions on our life choices, and to cutbacks and privatisation in the NHS. Why? Because the middle classes increasingly ask "why should I pay for the care of someone who smokes/drinks/eats the wrong foods/doesn't exercise enough?", and the simple logic of that rhetorical question leads inexorably to private healthcare. If the principle is that the cost of the healthcare of those who take 'unnecessary risks' with their health should not be borne by those who 'live healthy lifestyles', then plainly those who willingly take such risks should pay for their own healthcare. The Daily Mail-reading middle classes would nod their heads vigorously when you're talking about the lifestyle risks that we plebs take, such as as smoking and drinking, but what then about people who go sailing, or mountaineering, or hillwalking, or skydiving, or hang-gliding, or play rugby, or take part in any activity riskier than a walk in the park? Surely they should pay for any care they might need as a result of their activity? If I break a leg whilst out on the hills and the mountain rescue come for me, why should other taxpayers who don't hillwalk pay for my stay in hospital and out-patient care?
The simplistic, economically-individualistic answer to those rhetorical questions is: everyone should pay for their own healthcare. The NHS is based on the principle that care is given on the basis of clinical need, regardless of ability to pay, funded by general taxation, but that means that, by definition, we all subsidise the healthcare of others, regardless of how 'clean' our own lifestyle is. Which seems fair enough to me, in the same way as it's only right that education should be free and universal. As a childless bloke, I could ask the rhetorical question: "Why should I pay for the education of kids when I don't have any myself?", to which most folk would tell me not to be such a selfish bastard, and rightly so. Yet we allow the "why should I pay for XXXX?" questions of the selfish middle classes to dominate debates on health service provision, even though anyone with half a brain can see the logical end result of such 'policies'. As the middle classes are forever professing their faith in the NHS then presumably they don't want fully privatised healthcare, so the only other conclusion to draw, if the Nigels and Sarahs want to retain the NHS yet not pay for the care of wilful risk-takers, is that they want to use the "why should I pay?" argument as a stick to bash the heads of the plebs with, and to enforce control over personal aspects of our lives that they find distasteful.
That's what burns me about the whole smoking ban issue. If it was just about the health of workers in pubs and public places then there'd be no problem, but that's plainly a tissue-thin figleaf of a rationale for since when has the State, particularly the right-wing neo-liberalist State we've had since 1979, given a toss about the health of workers? No, it's the sheer hypocrisy of quacks, and their wilful ignoring of the destructive nature of capitalism, that really gets my goat.
Articles
Why do doctors drink so much? BBC Magazine, 14/6/05
Smoking ban consultation to start. BBC News, 20/6/05
England smoke ban plans unveiled. BBC News, 20/6/05
References
[1] National Statistics Online - reports on life expectancy in the UK. See in particular Trends in life expectancy by social class 1972 - 2001
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