Anyone still observing dry January may be on to something: last week the Big Issue’s founder, John Bird, launched the magazine’s “NHS pledge”: a request for readers and supporters to “volunteer for the NHS by staying healthy” and not become “a drain” on its time and resources. The depiction of individual people as a drain on resources understandably left many of us bridling – as it fits the narrative promoted by the government and its supporters that the key problem facing our healthcare system is too much demand, rather than too little funding.
Yes, we could all do more to take responsibility for our own health. But health and the decisions we make about health are complex, as any doctor will tell you, and poverty is a crucial factor. Such admonishments about personal responsibility are invariably directed at the poor, so that the deserving/undeserving poor become deserving/undeserving patients. Eating habits in particular are endlessly scrutinised, with the “let them eat gruel” trope regularly trotted out. Why on earth do poor people go hungry, wonder rich people, when porridge is so cheap?
Here’s why people don’t live on oats and water: if you’re cash poor, you’re likely also time poor, and speed is of the essence when your job starts at the same time as your children’s day at school. Cooking requires time, effort and fuel: increasing numbers of people I’ve visited can’t even afford to turn on the kettle for a cup of tea as they eke out every penny to feed their extortionate gas and electric meters.
Porridge might be cheap, but fresh fruit and vegetables aren’t. If you haven’t performed the mental gymnastics necessary to figure out how to feed yourself and your family for the longest possible time on the fewest possible coins, this may be hard to imagine. So let me help you. First comes the calculation of bulk: how many calories can you find for the lowest cost? Then there’s the exact monetary calculation to avoid reaching the checkout and feeling your face burn as you jettison an item that turned out to be not on offer after all. For years I avoided loose fruit and veg – an absolute minefield – simply because it was impossible to tell how much they would come to at the till.
The mental baggage involved in attempting to feed yourself when poor is immense. Being able to go into a supermarket and buy what you both need and want is incredibly freeing, but it’s a luxury not appreciated by anyone who hasn’t experienced longterm hardship.
Then there’s simply the fact that, for a lot of people, food is a cheap form of enjoyment. Junk food is filling and cheering, and sometimes when you feel miserable, spending a quid on a burger is a brief mental palliative. A Marks & Spencer ready meal and bottle of sauvignon blanc achieves the same effect, but at 15 times the price, and with none of the class-based opprobrium.
The frequent complaint is that poor people either can’t cook or won’t cook. But, growing up, we didn’t rely on tinned food rather than batch-cooked stews and joints of meat because my family could only work a microwave, but because money was tight and came in small denominations. The weekly supermarket shop and store cupboard mainstays require a significant outlay. A few tins and frozen bags simply do not, and that’s before you calculate the fuel required to cook a roast chicken dinner. Without time and financial constraints we’d all eat far better – we don’t because both of these problems persist.
Entrenched income and health inequality has blighted the UK and divided the country. But poor diet is not the only cause. More than 500 parks have closed since 2014 due to cuts to council budgets, mostly in poorer neighbourhoods. This amounts to a massive failure on the part of government to provide safe, free, outdoor exercise for children. Rather than barking at working-class parents for feeding their kids chips, why not make a fuss about park closures?
Yes, we can and should do more to improve our own health. But the crisis in the NHS isn’t the fault of ill people and their individual choices, but deliberate and chronic underfunding designed to undermine the functioning and very existence of this country’s greatest invention.
By all means, try to eat your five-a-day, but recognise that all of our decisions are influenced by many factors. And regardless of the way we live our lives, everyone deserves healthcare as a mark of basic humanity in a civilised country.