Health like Education.

Health and it’s monopoly industry that shares many circumstances with education. It is essentially politically managed by the same group of people, with forces from society and the stakeholders are similar. This leads to similar issues of low performance in absolute terms for a rich economy. The choosing of public issues and operation is for others benefits. It is not in the best interests of the state. It is for those running the state and those working in the industry and others. Of course there is a name and theory for this; The Principle-agent theory. Here the principle is the member of the public but all the decisions and actions are by others the agents. These agents have many wants and desires that are not part of the agents health (or education etc.) they are other and can be opposite to the principles interests. A big problem in both heath and education is that the member of public whether child or adult has many decisions made for them that are of questionable value for the person themselves. As they are both monopolies (I’m sure another label would be preferred but the effect is the same) little choice is available. Also the person who suffers the failure is not the one who makes the decision. It is important to take responsibility for one’s own health (and education) it is too important to leave to others. From the opposite perspective the governance must encourage people to take responsibility for their actions. This must be the individual but also organisations and people who affect others. All together the wrong questions are asked and the wrong solutions attempted so that even amazing results have little value. The main questions for the individual are what is best for my health and education. Then what is best for my dependents and what is best for the country and humanity.

If you ask what’s the best thing for the state? Then one component would be economic. The simple truth is prevention is better than cure. Doctors and their administration are the expensive least effective end of health. They are doctors of medicine not health they have sometimes amazing knowledge and skills with personal genius (if this is not managed out at an early stage – not to standard!). They are well paid and over managed often by people of little understanding. Getting productive people who could and would work or contribute needs to be a priority.

Doctors have their specialisms and even the junior doctors role is full on in technical knowledge, skills and time. The courses are said to be half out of date by the time they finish, as new research is carried out in such quantity world wide. But the problem in the UK is it’s called the NHS; the ‘h’ standing for health not medicine. Yet very little of the budget goes to prevention and results are poor. The irony is of course that large numbers of illness and issues (mental and physical) are preventable. That is not to say there will be no Diabetes (almost 10% of NHS budget) with a little prevention. The numbers are huge just in the NHS bill but also the knock on effects of less work output of the individual and others around them as they deal with the issues created. If they leave work then there are welfare costs. A recent outcry over doctors overtime pay being over £13K a year per consultant, was met with claims of not enough doctors but the obvious problem is too many patients, in too poor health. Could the over £100K pay (plus training and equipment) of a consultant be better spent? How many social workers who work in an emergency capacity all the time could it pay for so that more problems could be identified earlier and cheaper. Or any number of workers whether fitness instructors or activity leaders, could have a better result, admittedly early on in the process not when an operation is needed, that’s still best left to the appropriate consultants

Of course the elephant in the room is the big three lifestyle factors are sleep, diet and exercise. These are health, not medicine, they are cheap, well known and have low performance indicators. The big scandal is the absence of any action. During recent times the health service was kind of protected but leisure was not. Sports and exercise facilities closed but the health service got protected. The Health service has practically no incentives to prevent health problems they are not responsible for leisure and measured on their success (maybe it’s hidden where no one looks!). All the incentives are to headline medical conditions. Health must have a role here. Funding based on health not treatment.

Obviously health has many factors. There must be facilities and provision to make it easy to participate for all ages. This must be nationally backed but also independents should be supported. As they are actually saving medical costs compared to no exercise/activity. Currently they have to pay for facilities, dodge danger, fill out paper work and then tell the tax office. Education must improve standards of participation, learning and support. Work places must pay the costs of preventing workers being active. People of course have to be incentivised to exercise both to encourage participation and reduce the costs for not participating.

Many businesses and industries profit from unhealthy options that they do not pay the bill for. The food industry has to be regulated or pay the obesity costs as the alcohol industry and retailers should pay the price too. As the results of smoking policy have reduced smoking levels to below 20% smoking from over 50%. Similar approaches must be made towards Obesity and Alcohol. As well as affecting the negatives the positives have to be made easier. Then ultimately the wrong doer must be made to take pay the costs, and the right doer must benefit from their decisions and actions.

Unhealthy work patterns that prevent organised activity should pay the premium to cover the cost. Limiting healthy opportunities of their staff must be addressed. Much research shows that poor working conditions and practices reduce the productivity of the workers. Unhealthy staff do less work through slower rates, more breaks and higher absenteeism. Just as badly maintained machines do not function as well and brake down.

There has to be joined up thinking and actions that get results. It is not a moral service to be ineffective as a health service. Working stupidly hard is still stupid when the less stupid way is to prevent. Improving Activity (including exercise), improving diets and improving sleep patterns, will improve productivity and actually be cheaper and less pain, making it more humane and the morally better approach. With the separation of government organisations they often save money in one area which increases the cost in another and overall. Without a holistic approach between government departments and organisations with legislation, results will not happen.