Picture the scene: it is the evening of the 23rd of December 1874, and a distinguished-looking, bearded gentleman, with the improbable name of Dr. Diocletian Lewis, is delivering a sermon to the Christian ladies of the Baptist congregation of Hillsboro, Ohio. It’s a speech he’s made many times before, and it’s entitled “The Duty of Christian Women in the Cause of Temperance.” During his fiery address he exhorted the ladies to visit their local saloons and implore the owners to stop selling alcohol. Upon refusal they should commence a prayer vigil and hymn singing, until the recalcitrant saloon keeper repents and shuts his doors!
Thus began the “Women’s Crusade” that led to the formation of the Women’s Christian Temperance Union. The initial three-month Crusade closed all the saloons in 912 communities in 31 states across America. The movement it began was instrumental in delivering Prohibition just 45 years later.
So what’s the relevance of this story for today? Temperance was and is a middle-class moral reform movement. Whether its advocates wear dog-collars or stethoscopes, the basic idea is that the way to uplift the poor is to help them manage their poverty by removing the temptation to spend their money unwisely. So, what should we make of the decision of Haringey Council in North London to limit the number of fast-food outlets; or of the Government to introduce minimum unit pricing for alcohol?
Haringey Council has discovered that there are up to six times more outlets in poorer areas, with life expectancy nine years less than in the wealthier parts of the borough. They will also ban takeaways within 400 metres of schools. Meanwhile Alex Salmond and the Righteous Brothers have announced a 50 pence minimum price for alcohol – who can doubt that Mr Cameron will follow suit? And doctors calling for a 20% ‘fat tax’ claim it will reduce heart attack deaths by 2,700 per year. The common thread of all these measures is the same: that the way to improve social mobility and end health inequalities is to morally reform the consumption patterns of the poor – who stubbornly refuse to succumb to persuasion - by the use of coercive reform.
And “coercive” is the key word here. If middle-class foodies like Jamie Oliver - who pretends to be working class, with his dropped H’s and quaint glottal stops, and incessant use of the word “mate” – if his attempts to persuade the kids and their parents to give up the chips fail, then legislative repentance is the only alternative! We must all have our choices limited because some people can’t make the ‘right’ choices.
There is a hard core of activist medics and political meddlers who no longer believe that persuading or educating the public delivers the right ‘outcomes’, and who are bent on coercive reform. With escalating treatment costs in the NHS the way forward is seen as prevention. But you can’t trust the public to ‘do the right thing’. So expect a return to 1940’s paternalism, infantilising adult decision-making by introducing sin taxes to nudge us all in the right direction.
If we are to tackle health inequalities and “uplift the poor”, the way to do it is not by limiting their choices with price hikes and kebab-free zones, but by widening opportunities and creating jobs. This industry has a fantastic record in doing just that. Instead of meddling with outdated market interventions and moralistic measures government needs to end the duty-escalator, reduce VAT on pub food to 5%, cut red-tape and let us get on with creating jobs and adding value.
Instead the Government has created a ‘Behaviour Change Unit’. How scary is that? A Ministry for the Suppression of Vice and the Promotion of Virtue cannot be far behind!