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‘The nature of our health inequalities has changed’

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A PCT in Essex is considering offering cash incentives to encourage unhealthy people to visit the GP. Presumably, one problem is deciding who – if they are not visiting the GP in the first place – these people are. Some people who stay away from the GP are healthy and no doubt the last thing the PCT wants to do is pay healthy people.

So I suspect there are two options.

One is having a nurse phone the people they haven’t seen in ages and ask them some questions: Do you smoke? Do you like Turkey Twizzlers and what’s your favourite vegetable? If the nurse finds themselves saying: ‘No sir, surprisingly, the kebab is not a vegetable. That caught a few of us in the office out as well,’ they may find themselves following it up with: ‘We were wondering if you might like to earn yourself £25 by having a health check?’

Or option two – and they are piloting something like this in Scotland – nurses could hang out in supermarkets targeting anyone who seems to be the size of Estonia, breathing like an asthmatic donkey and stocking up on Wagon Wheels. They can approach them, being careful not to come between them and the three-for-two arctic roll offer, and suggest a bribe to see the GP.

Either way, we know that getting the horse to water is one thing but making him put the jam doughnuts down is another.

Remarkably, the idea makes sense. If nurses and doctors can change lifestyles it can save lives and millions of pounds. Who could argue with the North East Essex PCT’s chief executive Dr Zollinger-Read, also a GP, when he said he was determined to tackle the 13-year gap in life expectancy between the rich and poor in his area?

Paying people to visit the GP brings a couple of problems into sharp focus. First, the tension between the responsibility of the individual and that of the health service. Second, the worrying implications of using financial cost as a fundamental NHS principle. Underpinning the despairing attempt to bribe people, is the hope that it will save money in 10 or 20 years’ time.

Health inequalities are not as they were 50 or even 25 years ago. Most people can afford to buy food. They may not choose to buy the ‘right’ food but obesity is not a disease of the financially impoverished and neither are smoking-related diseases.

We can think of people as relatively poor, marginalised or even culturally impoverished if it helps our ‘understanding’ but we have to recognise the nature of health inequality has changed. That means our responses to it need to be different, too. And by different I mean creative. I’m not convinced by bribery but desperate times it seems call for desperate measures.

Want to read more of Mark Radcliffe’s opinions? Just click the more by this author link at the top of the page.

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