There are – and I consider myself an expert in this area – many different ways of not knowing things.
There is the clear “I simply do not have any idea what you are talking about”, with which I would greet any enquiry regarding nuclear fission, Eastenders or Swedish. There is the “I don’t think I know that” uncertainty, which comes when asked something I might once have known or think I should know (How can I get to any London hospital? What is the capital of Venezuela?). Or there is the “Ohh, I should know that, don’t tell me…it’s coming…” stuff that I absolutely believe I do know but for some bizarre reason cannot quite access at the moment. Like, what is my middle name? What day is it? Or, is smoking good for me?
For decades the struggle to encourage people to live healthier lives has been blighted by an allegedly unknowing client group. When the first The Health of The Nation strategy launched 22 years ago it was underpinned by a belief that if we informed people that a fat-laced kebab with BBQ sauce is not a healthy meal they will internalise this new information and take a packed lunch down the pub – where they will have two units of alcohol and jog home, stopping only to nibble on some peeled apple and almonds.
But it turned out that getting the key messages about health across were more complex than anticipated. People didn’t seem to know – or perhaps didn’t want to know – that chips, lots and lots of beer, sitting down all the time and smoking were unhealthy. When, after 15 years of leafleting, shouting and showing really discomforting adverts, we began to get the message across, the pro chips and fags lobby shifted their defence away from “I didn’t know being 34 stone was bad for you” to “I am a free man and I have the right to make unhealthy choices” – which rather paralysed the health promotion lobby.
Indeed, not only has the shift from focusing on individuals’ health and wellbeing to fighting for their right to choose how they live their lives undermined the health promoters, it has also fuelled and serviced our relentless march toward neoliberalism too. Binge drinking bad for your health? It may be, but it is very good for the marketplace. And it is the marketplace we service first, health comes later.
Where once we warned the NHS would be unsustainable unless we reduced heart disease, we now have lobbies for the drink and tobacco industries arguing against tax rises that would drive consumers to buy illegally imported products and ultimately deny the exchequer tax income.
And of course, left in the middle of this unending battle for a healthier population are nurses. I wonder, do you ever just think “Ah, to hell with it”? What about when our individualistic worship of the marketplace and a willingness to only “know” what suits us runs away with the national consciousness? Or when words like “rights” are so bereft of meaning they become an excuse to do anything you want regardless of consequence. Do you ever think “Actually I think I’ll become an estate agent”?
Mostly of course you don’t. Mostly you keep trying to help. Not that that’s being noticed or valued at the moment – budgets, taxes and economics dominate and television programmes seem to celebrate people at their angriest, fattest and unhealthiest. Mostly you keep quiet and carry on. And I do admire the carrying on part. I just wonder, isn’t it a little like swimming against a very strong tide?
Mark Radcliffe is a senior lecturer and author of Gabriel’s Angel.