'Silvio the NHS and Tasmania: what a combo!'

When he was in power, in addition to a funky mood all over the country, sexy Silvio used to promise Italian voters less taxation across the board. Meno tasse per tutti (“less taxes for all”) he used to say. _Ça va sans dire _that: i) it didn’t really happen; and ii) whatever else went on, wasn’t very fruitful for Italy, as the current situation testifies. [Digression 1: Truth be told, it’s not just Silvio’s fault, I think; those before and after him didn’t help either. But, boy did he do his best to screw things up!]

I thought of this while I was reading of a new study that has just come out, which discusses health- and lifestyle-related habits in the UK population. Not surprisingly (I would think), the main conclusion is that people in the UK are overall improving their lifestyle, drinking and smoking less than they were previously.

However, again not entirely surprisingly (just like the fact that Silvio’s tax promises didn’t come true), this applies effectively only to the middle and upper class, while people in more deprived conditions are still very much affected by very risky habits. This of course has clear repercussions on their health, making them at far higher risk (up to 5 times as much, according to the report) to develop cancer, cardiovascular diseases, etc $-$ all leading to much lower quality of life and higher cost for the NHS.

I suppose this begs the question (which, as far as I can tell, the report doesn’t answer) of whether the massive investments to promote healthier lifestyle, by both Labour and Tory governments in the last 10 years at least, have been actually good value for money. That’s of course a very tricky business; it’s complicated to develop interventions that everybody can take up equally (or even better, incrementally according to the underlying need), and the class divide in this country is really striking. [Digression 2: I know: that’s an extremely naïve point to make, but as someone who wasn’t born but lives here, the realisation is quite a slap in the face! I may be subject to some bias in saying this, but to my recollection, this was not the case, when I was growing up in Italy. Sure: Silvio & friends (on either side of the political spectrum) were most definitely better off. But I seem to recall that most people would have considered themselves “middle class”. Extreme poverty and deprivation did exist, especially in the South of the country, but I didn’t think the class system was so damning, back then. I’m afraid things are changing for the worse now?]

Anyway, the evidence points to the direction of clear effectiveness (and presumably cost-effectiveness) in some groups, but no effectiveness (and most certainly no cost-effectiveness) in others. So I ask myself: are we good enough in applying these interventions? Should we work even more towards stratified interventions that apply differently to different sectors of society?

Also: do we leave people too much freedom to actually take these interventions up? Should we do like the state of Tasmania (Australia) who is apparently thinking about issuing a complete ban on smoking for everybody born on or after the year 2000? No free will there: we know by now that smoking is bad and so nobody will.

I’ve no solution here: on the one hand, isn’t it wrong to know that something is really bad for the individuals (especially so for those who are worse off to start with) _and _society as a whole, and still allow it $-$ and even make some money out of it, at least in the (very) short run? [Digression 3: Just to be clear: I’m talking about smoking here, not voting sexy Silvio back in power. Surely that will never happen again? Or will it?] On the other hand, however, there’s plenty of evidence (this is kind of related) to show that just because something becomes illegal, that doesn’t mean people will stop doing it…

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