Macchiavelli, that well-known advocate of public health once wrote to the effect that those who want change has as enemies all those who do well under the current conditions and only (at best) luke-warm support of those who may do well under the new’. I was thinking about this as I spent part of my rock and roll weekend pottering around the supermarket. So, no offence to them, their job is to make money but part of mine is not to spend it so here goes:
Entering such haven of consumerism and I am confronted by tins of quality street piled 2m high (bargain if you buy two). Next fruit and veg (getting the first items in the basket is the hardest, after that Bob’s your uncle). Items with most profit at eye-level (eye-level is buy-level) and basics of what you need are spread out across the store so that you see everything as you wonder around looking for it. Pesto in on offer but right next to the pasta so I’ll buy more whilst I am here. Bakery at the back to waft the smell of freshly bread throughout and yes, I have bought more.
If supermarkets have teams of very clever people changing what’s around you to get all us individuals to do the same thing (buy more) the same can be said of everyday life. Want people to have a workplace pension make it opt out rather than opt in. Want them to eat more healthily put fruit and veg first in the canteen. Most famously want blokes to pay attention when they are peeing put a target in the urinal.
I could go on but the point is that there is never a neutral choice. Planned or not it is always easier to one thing than another. And the effort to one thing or another changes; some 50% of Uber journeys were once walked, the Government is thinking about banning the online sale of knives. Smartphone apps are expected to help takeaway spend to exceed £8 billion a year and in The Netherlands people cycle because it’s the easiest thing to do.
For PH the dilemma is (usually) that people prefer instant gratification to long-term gain (e.g. health). Do I have piece of cake now or do I reduce my risk of weight gain later? Do I watch the TV now or do I go out for a run so that I don’t spend my 60’s on medication? Do I smoke now and fit in with the ‘cool crowd’ or do I expect to walk up the stairs unaided when I am as old as my Dad (and who can even think that far ahead)?
The difficulty to this dilemma is then what to do about it? How much do people want / expect / can put up with Granny restricting their choice. No-one chooses to be overweight but supermarkets (and much else) wants you to buy more of what you probably don’t need. Two case studies may be indicative; pre-2008 we were told that the world would stop spinning if people were stopped from smoking in the workplace. Remarkably we’re still here. We were told that no-one would eat at the Civic café if we changed the menus away from stodge; evidently that was not true.
To update our 15th century philosopher then (Machiavelli) the other problematic for PH is that no-one make money from a healthy lifestyle. The individual who is healthy by default will not be buying cigarettes, slimming aids, fitness apps or alcohol. No-one wants to stop people enjoying themselves (that is obviously a good thing) but the next time someone objects to something because it will reduce ‘choice’ think about what is being chosen and in whose interest is the objection