An opinion piece by Adrian Bailey who is a volunteer with The Machine Zone CIC
If we want to we can eat junk, smoke, take drugs like alcohol, gamble, and to hell with ‘health warnings’ or ‘health education’. We’re free to have a big say in risking our health (and if we get sick we have every right to demand free treatment). We’re free to increase risks of shortening our lives. You only live once. Seize the day.
That freedom is guaranteed in law. Public health and schools educate about health risks so people are informed about risks in patterns of behaviour and consumption. Some things are tightly regulated. For instance heroin is illegal. Tobacco consumption is illegal in public spaces, and there are annual tax and other smoking disincentives; advertising is banned. Voluntary agreements with food industries see reductions in salt and sugar content, for instance.
Personal experience suggests for many of us that we don’t usually live life based on cold rational principles or facts. While many not realise associated harm risks, among those of us who do we may prefer unhealthy ‘comfort food’ over minimising health risks: we’d rather be comforted now than think beyond the moment. Similarly, while we may have every intention of eating healthily, cutting down on the booze, giving up smoking, ‘soon’, we’re too frazzled to think about it just now. That’s OK. That’s one way we humans are.
The UK government set up a Behavioural Insights Team (BIT) in 2011. It’s more popularly known as the ‘Nudge’ initiative designed to gently nudge us towards more satisfactory states, including health. Now fully independent of the government BIT has recently turned its attention to gambling behaviour. The idea of gently ‘nudging’ over dogmatic instructing is common to all health education. It should be noted that all attempts to ‘nudge’ and educate through things like BIT, public health, campaigners etc. are seen by some as an affront to personal liberty. ‘Stop treating us like children’ is a common mantra. There’s a significant population of people who are ‘libertarians’ and, roughly, believe we should be free to live without others telling us how to live our lives provided we don’t harm others. This is a respectable viewpoint (given here in a very compressed form that doesn’t do it justice), and in a democracy as essential to be heard as any other population sector such as right wing, centrist, liberal, left wing, individual, environmental, spiritual, religious, conservative, ameliorist or whatever other crude label chosen to represent the vast number of points of view which in our political lives interact in dynamic fluxes too complex to be simplified. We disagree, we lobby, we campaign, we oppose, we compromise, we reach agreement, we fail to satisfy everybody, we may support the status quo by operating within it, or we may be radicals striking at the roots of the status quo. A special mention to the emergence of issues based political involvement. There has always been such as in the abolition of slavery for instance, or pacifism, and now increasingly gender politics, environmentalism, human rights, lgbt and queer politics, radical mental health movements such as anti-psychiatry and countless more issues. Grassroots and third sector work is usually issue based such as around mental health, addiction, housing, poverty, neighbourhood enhancement, transport, energy, As Aristotle said, we are ‘political animals’. To adopt a stance of ‘not being political’ is also a political act especially by virtue of its contribution to the continuation of the woes of the world in general and our immediate neighbours in particular. So it goes.
Smoking is one of the few pleasures for poor people. We should not make them suffer with draconian regulation. So claimed then Labour Health Secretary, John Reid, back in 2004 when government began considering legislation to reduce tobacco harms. An ex-smoker himself, he said adults should be able to make up their own minds about risky health behaviours. His views were the same as those of the tobacco industry, and Forest, ‘the voice and friend of smokers.’
This ‘freedom and responsibility’ of the individual narrative is one which runs through contemporary debates about gambling harms. It’s worth spending a few minutes thinking about it.
Reid was a formidable politician, known as ‘Tony Blair’s rottweiler’. He was raised in a Bellshill working class family. He lived a working class culture based which included smoking, gambling and drinking as regular parts of life. That, and a masculinity of hardness and ‘don’t mess with me’ view of the world.
He was right to identify a sentimental middle class patronising of the poor working class, those constructed not just as poor materially but poor in intellect, good manners, moral agency, and containing other such ‘deficiencies’.
Culture is a flow of many different cultures, streaming together, affecting each other, shifting and changing. It certainly isn’t limited to a night at the opera. Within working class cultures, there have always been efforts to escape the negative aspects such as male violence. A matriarchal working class has frequently dedicated itself to seeing children enjoy a better quality of life, rising through the ranks as it were. Also, in earlier times, there have been powerful working class campaigns to mitigate the damages from gambling and drink. Many streams flow into the river that we, for convenience, label working class culture. Among them must be included the educational and intellectual streams, a long history of mutual co-operatives of worker education organised and led by workers. Hundreds of years ago, Scottish weavers were at the vanguard of such education. The rise of ‘the respectable working class’ from the late nineteenth century onwards, the growing clerical class answering the bureaucratic needs of rapidly expanding commerce and business, are another stream.
Working class solidarity led to demands, actualised in unions, to mitigate low wages and harsh working conditions. From this emerged concerns with wider social and political issues and a recognition from the needs of the most downtrodden in Glasgow to the unjust exploitation of workers in foreign lands. Many working class people today continue the long tradition of thinkers and activists. Others, of course, promote actions by which children born into poverty can ‘move up’ the social ladder. ‘Education, education, education’ was a mantra Tony Blair, for instance. (Since the current education system results in a quarter of the Scottish population’s being functionally illiterate, there may be some ways to go here).
Cultural reproduction (learning peer, family and community values and behaviours) occurs in all classes. With regard to health, members of every class, since they are unique individuals not inevitably made into robots determined by environments, develop healthy and unhealthy lifestyle habits. Doctors are among a large occupational population which exhibits dangerous alcohol behaviours. The cultural learning of sectors of the working class population reproduces unhealthy habits like smoking, unhealthy eating, use of alcohol and other hard drugs. This is, an absolutely essential point, at a population level only. The majority of people, like the majority of doctors, demonstrate lifestyle factors on a continuum: many individuals and families prioritise healthy behaviours; community organisations, led by community members, exist in their thousands to promote and support good health, and to especially provide non-judgmental community support to those who wish to become healthier, particularly with regard to what is referred to as ‘mental health’.
Human beings share most basic aspects of living. There may be, reading this, an overweight or clinically obese consultant doctor who enjoys her cigarettes and daily doses of alcohol. She would not take at all kindly to being told to change her ways. She knows, more than most, the risks she is taking with her health. The stressed-out A&E junior doctor wouldn’t need telling that their amphetamine use to stay awake, their ‘downers’ after a long shift, is a dangerous issue for themselves and others. Being human, many of us act today and tomorrow is a future that we’d prefer not to think about.
Middle class people actually consume more alcohol than those in deprived communities. They can afford it (and it should be noted here that there is a thriving illegal spirits business filling two lite bottles of ‘vodka’ at three quid a bottle for the poor who want it|). Middle class people by and large are protected by a reasonably healthy diet which to some extent limits alcohol physical health damage; they may smoke heroin with less harm too. By no means are all individuals in a designated ‘deprived community’ the same. In terms of deprivation, for example, it’s not an opinion but a fact that people here give proportionally more to charity, support each other in fundamentally human relationships, and represent the least deprived of compassion compared with those of the leafy suburbs. All gross generalisations, of course, and that’s the point. As a point of absolute moral or any other consideration, we should not ‘see’ a person in terms of class, gender or any other abstract data profiles. Though that ‘should’, of course, is itself a moral judgment.
On this website we are engaged with raising red flags and unashamedly campaigning for achievable political (governmental) strategies to mitigate health and social damages, specifically those due to gambling. Rightly or wrongly, our approach mainly employs a rhetoric of extremes. Were we to engage directly with the many relevant institutional stakeholders, we’d obviously seek to employ ‘appropriate discourses’. To a limited extent we are already doing the latter. When our future work in the community commences, when we engage with individuals, we are looking forward to relaxing into that lovely discourse of being with real, unique humans like us. At this point the skills, experience, training and knowledge bases of the volunteers involved here will continue their many decades of practical one to one and group mutual support.
There’s a lot of teaching granny to suck eggs here. We know, respect and celebrate the enormous experience and sensitivity of the people working in community settings, their total and unquestioned human focus. You can’t change somebody’s life by pumping ‘knowledge’ and facts and dire warnings into them (and anybody who makes this their goal is not only silly, they may be dangerous). Imagine a doctor telling her patient that she’s grossly overweight and could drop dead on the way out of the surgery versus a doctor who suggests the patient may benefit from losing a few pounds. Imagine a doctor whose approach to somebody experiencing devastation from addiction saying that they won’t treat them until they stop using alcohol or other hard drugs or gambling versus a doctor who says she knows and understands and is going to do everything in her power to help.
Coming into contact with ‘the human touch’ may be down to chance and maybe it’s impossible for research to demonstrate its crucial power. Among the great work going on there is, sadly, also a strand of well-meaning folk who lack experience and wisdom, and use encounters to push ‘advice’ that may be at best useless and at worst harmful. Listening to is more important than talking at. The words on this page are empty vapours and have no relevance or importance to human contact, human touch.
John Reid’s instincts were right, even if his thinking wasn’t. The changes to tobacco legislation mooted in 2004 and now fully implemented have resulted in very significant reductions in tobacco damages. His instinct to be repelled by ‘them up there’ constricting the agency and freedom of the great unwashed is spot on. By and large, from doctors to policy and strategy designers, work has been sensitive and realistic. It has recognised massive structural issues such as inequality (often working to alleviate them). It has realistic and moral humility. It priorities this unique individual who may need, support, advice here and now.
There isn’t, or shouldn’t be, the slightest whiff of prohibitionism in tackling gambling harms. People will continue to gamble, drink, indulge in all sorts of unhealthy behaviours. What we can do is reduce the pernicious value of profit before people which so often exploits our nature and our behaviours. None of us are rational machines. Those who think we are such biological computers are wrong.