Sir Julian Brazier is a former Defence Minister, and was MP for Canterbury from 1987-2017
As the Party searches for the long path back to power, one question will be at the heart of much of the debate on our core values, whoever is leader: what do we mean by liberty?
More specifically, how should we balance the desire for liberty most Conservatives feel in their hearts with other important goods, such as security, fiscal probity and community well-being?
One place to start is public health.
The NHS is in the top three public concerns in almost every opinion poll. Some on the libertarian wing of our party, including our former prime minister Liz Truss, have rejected attempts to promote public health by taxing sugary foods and drinks as “nanny state measures”. David Frost speaks for many when he denounces the ‘collectivist mentality’ in his customary punchy style:
“This collectivist mentality is everywhere once you spot it. It even applies to your property in your own body. Are you happy enough with being a bit overweight and the risks that come with that? You need to think about the burden on the NHS and slim down a bit. “
More surprisingly, Fraser Nelson, who has been forthright in exposing the epidemic of people claiming illness and disability benefits, takes a similar line:
“If you let go of the principle of freedom, including the freedom to make bad health choices, it’s hard to see where it all stops.” The emphasis is mine.
Most of us struggle at times to keep out of the fridge and stop our clothes from shrinking around the waist, but much of society is now loudly proclaiming the right to be unhealthy; the human rights lobby denounces ‘fat-shaming’ even in the Army and the Police.
I am with Frost and Nelson in deploring the growth of legal restrictions and the growing dominance of lawyers in our public life. Bad legislation, often rooted in Human Rights and Equalities, is corroding the ability of organisations to achieve good purposes. I also share the view of most Conservatives that recent proposals to ban smoking in pub gardens were disproportionate and would risk bringing the Law into disrepute through widespread breaches.
Nevertheless, there is an important trade-off when it comes to public health. There are two issues we need to weigh against the libertarian case. One is controlling public spending and the other involves wider public goods. Most Conservatives, rightly, believe that the state should do less and do it well. Unfortunately, the rapid growth in state spending is now dominated by two runaway departmental budgets, Health and Work and Pensions.
Conservatives have plenty of ideas for reform of the NHS and social care – from pruning expensive bureaucrats and tackling GP contracts, to moving towards an insurance-based system. Yet there is one way we could reduce NHS spending dramatically and improve productivity in the economy: by persuading millions of obese people to lose weight and get more exercise. Britain’s obesity is the worst in Europe (apart from tiny Malta). A range of illnesses from cardiovascular conditions to arthritis to diabetes are made both more likely and more dangerous by obesity – exacerbating pressures on the NHS.
Indeed the growing number of people with more than one health condition (a condition called co-morbidity) not only is driving up costs but is also making the gathering of statistics to provide a basis for health policy harder; the same treatment for any one condition usually requires more doctors’ time and resource if another condition is also present in the patient. This means that the large rise in co-morbidity, much of it driven by obesity, ensures that each individual procedure requires, on average, more doctors’ time and/or bed occupancy, drugs etc than a decade ago.
Productivity statistics based on the number of procedures carried out year by year, over a generation when co-morbidity has been rising, may seriously distort the true picture, and always in the same direction.
The second major area of spending growth comes from welfare.
Part of this is driven by the growing number of pensioners. But the other major cause is the rapid growth in the number of people on disability benefits. It is hard to avoid concluding that the taxpayer is picking up the bill for people’s lifestyle choices.
Yet, the financial cost to the taxpayer of an increasingly unfit nation is not the only price Britain pays for the increasingly poor health of many of its citizens. There are wider public interest concerns. Many of us were horrified by some of the measures adopted in the Covid crisis. But, the blunt truth was that the UK faced intensive care facilities on the very brink of breakdown, simply because they were overflowing. Statistical analysis confirmed what doctors anecdotally said – that obese people were more likely to be admitted to hospital, spent longer in hospital and – critically when so much of intensive care was on the brink – were disproportionately admitted to intensive care.
Scandinavian countries adopted a wide range of contrasting approaches to Covid but, with their much fitter populations, all suffered far lower rates of Covid deaths, and, critically, lower pressures on their health systems. Sadly, had we tried the Swedish approach here, allowing a temporary surge in cases, many extra people would have died, as intensive care facilities collapsed and had to turn away desperately ill people and accident victims.
Discussing some of the close calls in London hospitals with doctors who had to cope with the crisis left me convinced that the impact on intensive care of obesity was a key factor in boxing the Government into imposing lockdown onto the rest of us.
It is wider than that. A society where more people are willing to take responsibility for keeping themselves fit is one where the state needs to intervene less, outside emergencies too. A parent who takes care of their own fitness is more likely to foster fitness in a child. Because of the link between physical and mental health, a child growing up without sensible levels of eating and exercise is more likely to have mental health problems. Exercise is of course important for mental health – as is limiting time on social media – another ‘Nanny state’ proposal criticised by some libertarians.
Yet growing numbers of mentally ill children increase the strain on teachers, many of whom are leaving teaching because of stress. It also impacts the ability of teachers to deliver a good education for all the other children.
Edmund Burke famously said: “Men are qualified for civil liberty in exact proportion to their disposition to put moral chains upon their own appetites.”
Conservatives should reaffirm our belief in liberty but also in fiscal restraint and, above all, fostering personal responsibility.
