If the government believes in ‘levelling up’, stop blaming individuals for making the ‘wrong choices'

Lifestyle factors such as smoking, drinking and poor diet do play a part in health, but they don’t have anywhere near the impact that social determinants do

There’s good reason why Boris Johnson has made it his main mission to ensure schools re-open, he knows the importance of education for young people’s life chances. 

Education is just one of many environmental factors that determine how long you live and how many of those years you’ll have good health. Where you are born, where you live and the type of job, if you have one, are other environmental factors that influence life expectancy and good health.

The government knows this and regularly refers to their ambition to “level up”, a term describing their aim of reducing inequalities. So, it is odd that they continue to blame individuals for making poor lifestyle choices. Take your pick. 

Multiple groups have been shamed recently: the overweight, smokers, drinkers and those that don’t exercise. Of course, all these factors do play a part in health, but they don’t have anywhere near the impact that social determinants do.

For 200 years we’ve known that where you live is more important than how active you are in shaping health. Contrast the prospects of a child born in Kensington today to the child born in Liverpool, they will suffer two decades more of ill-health and die a decade before their London counterpart. These are not marginal differences, but stark differences and a clear indicator that inequality is thriving in modern Britain.

Despite this we are collectively obsessed with symptoms rather than causes, the billions spent on the NHS compared to the few million spent on prevention pay testimony to that. The meagre funds spent on prevention through public health campaigns have been ineffective. The National Audit Office called out the failure of the government strategy aimed at reducing childhood obesity, saying there was no evidence that any campaign or intervention had worked. If anything, the number of overweight children has been rising. But this rise is not spread equally. As with so many aspects of inequality, the greatest number are to be found in the poorest parts of the country.

Weight, or more specifically being overweight, doesn’t just matter during the Covid-19 pandemic, it has a significant impact on health at any time. But weight is a symptom not a cause. Poverty is a causal factor, poor people live in food deserts, where fast food is more readily available than fresh fruit and vegetables. Even if poorer people had more access to healthy food, their income is unlikely to allow these foods to feature regularly on their table.

Lifestyle choices that influence health are shaped by how secure you feel and whether you have hope. It’s much easier to exercise, eat well and moderate alcohol intake when you live in a well-heated house that’s located in a safe area. Not worrying about money and having employment, particularly permanent work, all foster motivation and provide real choices in life.

As rates of antidepressant and opiate prescribing continue to rise, particularly in the most deprived communities, we are inadvertently sedating whole communities that lack hope. Pills won’t build the houses they need or provide secure employment, what they do instead is help people survive environmental factors over which they have no control.

There is no political appetite to address these root causes of inequality, instead the emphasis and blame is on the individual for making the “wrong choices”, even though these choices are severely limited. This shameless attempt to distract from structural societal problems simply compounds the shame, lack of hope and control that these individuals have. Blaming individuals neatly absolves the government from their own choices, past and present, which so far have nurtured inequality and sabotaged nearly a century of rising life expectancy.  

These environmental and social factors can be easily improved by investing in housing and secure employment, for example. So far our government has no appetite to do this, ironically those with the greatest privilege continue to blame those with the least for their own poor choices.