Don’t get too excited by the war on obesity – every step forward taken by food manufacturers is countered by half a step backwards

Should we dignify the NHS angle whipped up by both sides in the Brexit referendum debate with valuable time and space here? No, I don’t think so either.

The argument that the health budget would either be jeopardised or liberated by a vote to leave the EU strikes me as childish, glib even. That puts it on a par with many exchanges over this spring’s other running drama, the junior doctors’ contract dispute.  

In or out, neither economic nor heathcare challenges will go away and the unforgiving tone of the arguments will linger long after they are resolved, damaging resumed cooperation, which will become necessary. There is a price for coarsening public life which is not always the tabloids’ fault.

Not least, it risks putting what Harold Wilson once called “the wrong people” in charge. So the premiership of flaky Boris Johnson, which might quickly follow a defeat for David Cameron on 23 June, would not turn Britain into a magical Big Rock Candy Mountain either.

Striking admission

Not that the NHS needs the old song’s “cigarette trees” or “soda water fountains” in a month when epidemic levels of child tooth decay have been reported and Mars, the makers of Dolmio pasta sauce, made the rare concession that their fat, sugar and salt contents are too high for more than a once weekly treat. Is such a striking admission progress?

We would all love to think so, that the major food, drink and tobacco firms are finally facing up to the externalised costs which their faulty products dump on more vulnerable consumers and wider society. But campaigners for others to follow Mars’ lead won’t be holding their breath. 

My grandchildren’s access to sugar frightens me and their parents

For every step forward processed food manufacturers seem to take half a step backwards, so that “Zero Percent Fat” translates as “Even More Sugar” or “Lashings of Salt.”  Even with George Osborne’s sugar tax, governments are timid.  

Thus the extraction of children’s rotten teeth has risen 60 per cent in five years. That could be dentists gaming the NHS budget in the same way Boots staff are now encouraged by their US private equity owners to exploit the NHS’s medical user review (MUR) scheme, according to a shocking report in The Guardian

Probably not in the Age of Sugar. Not since rationing ended after World War II has Britain had a proper public health regime for diet. I heard a professor lament last week: “If it was any other disease there would be riots in the street.”

Sweet rationing finally ended in Coronation Week 1953. I remember it well and still have fillings to prove it. Yet in those days “Sunday sweets” were just that, a weekly treat.

My grandchildren’s access to sugar frightens me and their parents. 

Free market argument

But the externalised health costs – classically the costs which a dirty industry shifts on to its neighbours via polluted air and asthma – are rarely discussed in what Brexit minister, Michael Gove, would call adult terms. Everyone knows that IVF is expensive (which is why the NHS must limit eligibility, heartbreaking but right), but a London coroner was unusual when he raised the cost of a caesarian delivery, allegedly the reason for North Middlesex hospital denying one to a mother whose baby died.

Yet feminists routinely debate their “right” to home birth and other natal variations without regard to their costs while a male barrister pops up on Radio 4, happy to discuss the drugs he supplied to his teenage boyfriend and his own drug binge when the boyfriend died. It put the lawyer into hospital. Who paid for that, I wonder?  

Feminists routinely debate their “right” to home birth and other natal variations without regard to their costs

The free market argument response to such points (Brexit leaders are mostly free market, their innocent followers are not) is “what do you expect from a healthcare system free at the point of use?” True, markets provide innovation and some answers, they serve to offset horrors like the collapsed Cambridgeshire older persons contract that HSJ has been monitoring.

The increasing involvement of US providers like Acadia Healthcare and Universal Health Services in Britain’s embattled mental health provision is not automatically cause for alarm. But, as with the Boots takeover by private equity, they will have to be closely watched by regulators with teeth and balls.

Did you miss the Theranos drama in the US? The $9bn health technology and laboratory testing firm founded in 2003 by Stanford college student, Elizabeth Holmes, when she was 19, was given virtual carte blanche by the desert state of Arizona to let patients book blood tests without the say so of a doctor. Wow!  

The “Theranos Revolution” was meant to be another example of Silicon Valley’s disruptive technology, shaking up old habits and professions. So it might be in time, but enough has gone wrong for US health regulators to want to ban it from blood testing.

On TV, Holmes is promising to do better.

Michael White writes about politics for the Guardian