David Mitchell col­umn

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Why spend a for­tune on hos­pi­tals for peo­ple to die in when they could as eas­ily get run over by buses?

“In the UK, we are spend­ing £97bn of pub­lic money on treat­ing dis­ease and only £8bn pre­vent­ing it,” the health sec­re­tary Matt Han­cock said last week. “You don’t have to be an econ­o­mist to see those num­bers don’t stack up.” But Matt Han­cock ac­tu­ally is an econ­o­mist, so how does he know? I sup­pose he might have can­vassed the views of some non-econ­o­mists, but I’m scep­ti­cal about how rig­or­ous that sur­vey can have been.

“Hi Chris, Linda…” (good to get a gen­der bal­ance) “… have you got a sec­ond?” Han­cock may have asked his aides. “Of course, min­is­ter.” “You did clas­sics and his­tory re­spec­tively, right?” “That’s right.” (Chris is do­ing all the talk­ing – come on, Linda!) “Great, so we’re spend­ing £97bn on treat­ing dis­ease and only £8bn pre­vent­ing it. Can you see that those num­bers don’t stack up?” “Oh yes, ab­so­lutely,” says Chris. “Yes in­deed, min­is­ter,” adds Linda.

It is pos­si­ble that on such flimsy ev­i­dence rests the sec­re­tary of state’s claim that “you don’t have to be an econ­o­mist to see those num­bers don’t stack up”. And ob­vi­ously they do stack up. As in, you could stack them up – you could add them to­gether. They prob­a­bly are stacked up in var­i­ous sum­maries of govern­ment spend­ing: stacked up un­der the head­ing “Health”. You don’t have to be an econ­o­mist to see that if you stacked them up, that would make £105bn.

I don’t think he means that, though. I think maybe he means that £97bn is much more than £8bn. His point may sim­ply be that you don’t have to be an econ­o­mist to see that 97 is a larger num­ber than eight. If so, I heartily agree and my only quib­ble is why, even with Bri­tain’s ris­ing life ex­pectancy, for which Matt Han­cock is doubt­less keen to take credit, he con­sid­ered that as­ser­tion worth the time it took to ex­press.

To be fair, I think what he’s get­ting at is that, if we spent more than £8bn on pre­vent­ing ill­ness, maybe we wouldn’t need to spend as much as £97bn treat­ing it. Un­for­tu­nately, though, you don’t have to be an econ­o­mist to know whether that con­tention stacks up. In fact, you have to be some­thing else. You need a com­pletely dif­fer­ent type of ex­per­tise.

And, in an ideal world you’d want ev­ery ex­tra pound spent on pre­ven­tion to save more than a pound spent on treat­ment – oth­er­wise you’re just swap­ping money about. Matt Han­cock clearly reck­ons it would, and it seems plau­si­ble up to a point, but it’s not as ob­vi­ous as know­ing that 97 is more than eight and the naughty man is try­ing to make us think it is.

What I don’t be­lieve, by the way, is that, if you spent £97bn on pre­ven­tion, you’d hardly have to spend any­thing at all on treat­ment. And, even if that did hap­pen, it would be a disas­ter be­cause it would quickly be­come im­pos­si­ble to de­fend the £97bn. It would look like it was be­ing frit­tered away on noth­ing. Peo­ple hate spend­ing a for­tune on fire pre­ven­tion un­less they can see that lots of things are on fire.

This is a prob­lem con­stantly faced by those who seek to jus­tify counter-ter­ror­ism spend­ing. If they foil all the plots, no one ap­pre­ci­ates them. So they keep the alert level scary and bang on about how many plots they’re foil­ing. I’m sure they’re telling the truth (by which I mean: they may be telling the truth), but there’s no doubt that it’s fail­ing to foil ter­ror­ist plots, rather than foil­ing them, that has the great­est govern­ment purs­es­tring loos­en­ing ef­fect.

This isn’t a prob­lem for Matt Han­cock be­cause I don’t think jus­ti­fy­ing greater health spend­ing is his pri­mary aim. So what is his aim? The con­text for his re­marks was the launch of a Depart­ment of Health “vi­sion doc­u­ment” en­ti­tled Pre­ven­tion Is Bet­ter Than Cure. No one could ar­gue with that idea. But when politi­cians go around say­ing some­thing with which no one could pos­si­bly dis­agree, there’s usu­ally some­thing with which mil­lions ab­so­lutely would lurk­ing be­neath it. And so it proved.

“For too long, the NHS has seen it­self es­sen­tially as the Na­tional Hos­pi­tal Ser­vice,” he told the To­day pro­gramme. He reck­ons that’s wrong be­cause only “a fifth of the de­ter­mi­nants of the length of your healthy life­span are caused by what goes on in hos­pi­tals”. A fifth! And yet the hos­pi­tals cost so much! The ma­jor­ity of the coun­try’s health bud­get is be­ing lav­ished on in­sti­tu­tions that af­fect a mere fifth of the… you know… the de­ter­mi­nants of the healthy thing. That’s ridicu­lous! Why spend a for­tune on hos­pi­tals for peo­ple to die in when they could just as eas­ily get run over by buses? Why waste money on in­ten­sive care units when, for the same money, you could print a seem­ingly in­fi­nite num­ber of leaflets warn­ing about salt?

Not leaflets though! I’m such a Lud­dite! Han­cock is talk­ing about “pre­dic­tive pre­ven­tion”, which, ac­cord­ing to the de­part­men­tal doc­u­ment “will trans­form pub­lic health by har­ness­ing dig­i­tal tech­nol­ogy and per­sonal data”. Just as peo­ple get tar­geted mar­ket­ing from Ama­zon or Face­book, this will be “tar­geted health ad­vice – specif­i­cally de­signed for their de­mo­graphic and their lo­ca­tion”.

This is such a Tory idea. Let’s learn from the pri­vate sec­tor! We can re­place those pricey hos­pi­tals with al­go­rithms! That way, a com­puter can pre­cisely in­struct peo­ple on how not to get ill – and the fact that there will hardly be any hos­pi­tals will be an added in­cen­tive!

By all means, let’s en­cour­age healthy life­styles. It also makes sense (a bet­ter idea in the doc­u­ment) to of­fer ge­netic anal­y­sis so pa­tients can be warned about health risks spe­cific to their DNA. But the com­mer­cial tech­nique of ex­ploit­ing per­sonal data to tar­get ad­ver­tis­ing is a trick and a govern­ment depart­ment shouldn’t aspire to trick peo­ple even if it thinks it’s for their own good.

The health ed­u­ca­tion the state pro­vides should be the ob­jec­tive sci­en­tific truth about the causes of ill­ness. It should be widely ac­ces­si­ble, but not mar­keted, nor ex­pressed dif­fer­ently ac­cord­ing to what type of cit­i­zen a com­puter reck­ons will read it. That ap­proach would be as con­temp­tu­ous of the pub­lic as a cor­po­ra­tion is of its cus­tomers and an­other way by which in­con­ve­nient truths are trans­formed in peo­ple’s minds into fake news.

Il­lus­tra­tion by David Fold­vari

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