14 December 2008

Anti-obesity campaigns: Healthy Towns, another missed opportunity

I'm late to the discussion about the Change4Life Healthy Towns initiative, but I have a few comments.

Dudley, Halifax, Sheffield, Tower Hamlets, Thetford, Middlesborough, Manchester, Tewkesbury, Peterborough and Portsmouth have been given £30 million to promote cycling, walking, healthy eating and green spaces in a bid to curb obesity levels.

In theory I have no beef with the idea of more cycle facilities; cycling any distance in London for me means negotiating cruddy drivers and dual carriageways. I know two cyclists who have been killed on the roads in the past two years. Better signage for walking would be great too, I love London Underground's JourneyPlanner, which has opened up new routes and walking in the city for me. Access to good quality and affordable fresh food, who could argue with that? Likewise green spaces. Sounds great, right?

There are a couple of fundamental problems with Healthy Towns, however, which change things for me.

Firstly, the framing of these initiatives as part of a response to a global obesity epidemic perpetuates fat panic, positions "obesity" as a problem to be eliminated, promotes the idea that fat is costing the NHS a packet, and negates me and my kind.

Secondly, "health" is not really defined, apart from through obesity statistics. Health is multi-dimensional and extremely subjective, and the reductive tactic of allying it to bodyweight is, well, quite stupid. I suspect that Healthy Towns is a euphemism for "Towns Where We've Got Rid of The Fatties So they Can't Clog Up The NHS With Their Revolting Bodies And Cost Us a Fortune". Doesn't sound so friendly now.

Thirdly, 30 million does not buy a huge amount of infrastructure redesign amongst ten municipalities. I think it's likely that local authorities will try and do things on the cheap in a really muddled and ill-conceived way. I expect to see more instances where, for example, a local council does a deal with a dieting company, as has happened in East London, and where my council tax is funding Newham's association with Slimming World. Pardon my cynicism but is the commercial weight loss industry really the best advocate of my health? Nope.

Imagine a £3 million investment in Health At Every Size instead. Strategies to improve people's health that take a holistic view and which don't base health on an outmoded chart don't have to be expensive. If I was in charge of that money I'd spend it on:
  • Assertiveness skills classes so that fat people can learn to self-advocate for their health within a system that seems intent on denying us access to acceptable standards of care.
  • Systems for training health professionals to deal with fat people sensitively and helpfully.
  • Fat-friendly swims, fat-friendly social groups, fat-friendly yoga or trampolining lessons.
  • I'd set up collections of fat liberation materials within local libraries and make them accessible online, and in ways that reach people who are not library or internet users.
  • Oral history projects encouraging fat people to know about their community, their history, projects that enable people to feel empowered, less alone.
  • Accessible equipment, big kayaks, scuba gear, stuff that would make activities fun for people, with subsidies for shops selling large-sized gear.
  • Grants available for people exploring HAES through community projects, grants, research.
  • Good quality, non-judgmental counselling services and supportive resources for people dealing with fatphobia, self-hatred, dieting fallout, etc
  • A regular dance party.
Oh, the list goes on.

Finally, the whole shebang reminds me of Ruth Levitas' work on social exclusion. In 2004 she wrote about the ways that social exclusion is influenced by political ideology, she describes the ways that it was positioned under New Labour in the UK during the mid-1990s by charting a chronology and identifying themes within social exclusion. She argues that in the UK in the 1980s and early 1990s social exclusion was understood as multi-dimensional, connected to poverty and social inequality, and that its proponents sought to reduce inequalities through greater rights and a redistribution of resources, which she called RED. By the 90s this model was supplanted by two new approaches: Social Integrationist Discourse (SID) sought to integrate people into work as a means of addressing social exclusion, whilst Moral Underclass Discourse (MUD) characterised socially excluded people as morally distinct from the rest of society". Levitas is rightly critical of SID and MUD because they neglect how work is structured under capitalism (eg poor working conditions, McJobs), they stigmatise and shame people, and they support the idea that the state is essentially meritocratic. and that social inclusion can be achieved by hard work and opportunity.

I think this process is happening with Healthy Towns, and that Change4Life is on the same trajectory as welfare reforms of the recent past, a stick and carrot approach to social health, with the emphasis on the stick. Referring back to Levitas , these strategies are typically modelled on SID and MUD in that they propose a neoliberal agenda in which frighteningly deviant bodies are rehabilitated into the mainstream through the hard work of diet and exercise – never mind the evidence that diet and exercise are themselves problematic in relation to slimming down fat people.

Meanwhile, Tower Hamlets, one of the Healthy Towns, is a neighbouring borough to my own, and I'll be keeping an eye on developments there.

No comments: