The genesis of fatty lardbuckets

That child obesity isn’t what we’re told it is is true. Chris Snowdon has shown that quite conclusively.

I show some more credible evidence and argue that the true rate of obesity among children in this age group is closer to one in twenty, not one in five. Indeed, it could easily be one in fifty.

The point being that:

I argued last month that Britain’s childhood obesity statistics are worthless. They are based on an unjustifiable assumption about the scale of child obesity in 1990 and that error has plagued every subsequent measurement. A flawed methodology has led to the number of obese children being greatly exaggerated.

So, the problem is rather less than is being said. It’s also true that obesity isn’t about to bankrupt the NHS. For fatty lardbuckets die younger and it’s cheaper to have people dying younger – yea even if being treated for the disease of being a fatty lardbucket – than it is to have someone die at 90, healthy but Alzheimered for a decade. The same is true of those on tabs and booze. These things, even ignoring pensions, save governments money.

So, the reason why we should be fiscally concerned is wrong, the incidence of the problem is wrong too.

However, however, let’s assume that they’re right for a moment, there is some obesity epidemic and that’s something we should all be concerned about. What happens when that meets the other fashion of the age, self-esteem?

A primary school headteacher has been accused of “fat-shaming” pupils after he told parents that their children were too overweight and should walk to school to lose weight.

Dr Huw Humphreys, head of the Christ the Sower Ecumenical Primary School in Milton Keynes, Buckinghamshire, sent a newsletter to parents which said: “Our children, overall, are fatter and more obese than other children in Milton Keynes.”

He urged children to walk to school, adding: “They could really do with a lot more exercise.” Dr Humphreys later apologised, after his letter prompted a backlash from parents.

“It is simply not acceptable for the head to fat-shame our children – particularly when this is supposed to be a Christian school,” one parent said.

To be honest I can’t see the connection between self-esteem and which flavour of Sky Fairy – even one of the several about the bloke being nailed to a tree trunk – myself but then people, eh?

Let’s even go one further and say they’re both right. Obesity is a problem, self-esteem is a problem. What in buggery do we therefore do about fat shaming? Is it bringing a vital medical problem to attention or is it a societal imposition of why the fat kid always gets picked last for the football team?

Or, given both sets of whingeing, what is it that we’re actually supposed to do?

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  1. NHS:

    suggested that the NHS and education both suffered ‘hopelessly inappropriate’ management structures yesterday and was asked to justify that claim. I am happy to do so.

    The art of management is to ensure that tasks are appropriately identified as necessary, are then done effectively, once only wherever possible, and by those best able to do them. You might call that a somewhat brief theory of management, but for the current purpose it will do.

    Let me put this in the context of these two national, free at the point of delivery activities whose primary aim is to make available to all services that might otherwise be unaffordable for many. Implicit in their mandate then is not just the service, vital as it is, but the social and economic consequences of its delivery in this way.

    Given these facts (and I think they are facts) the management structure of the NHS and of education has to be chosen with three objectives in mind. The first is that the decision making unit has to be big enough to deliver the social and economic goals of these services. In other words, social and economic impact has to be possible as a consequence of the decisions made in addition to services that are excellent in their particular field. This, then requires that strategic decision making for both must cover significant swathes of the population that cover all the likely social spectra that it is intended be impacted by the redistribution implicit in the supply of services in this chosen way.

    How big must those units be then? Some cities will be big enough. So will a few counties (Yorkshire, perhaps). Scotland, Wales and Northern Ireland are. Almost no other counties will be. And nor, to be blunt, is the regional difference in demand for these services so different across the U.K. that localisation can ever be justified for that reason.

    In other words, both health and education have to be managed across very large regions of millions of people. Given the goals for the service no other management structure will do.

    Given the need for integration in service supply in both cases it is also true that fragmentation within those areas will be antithetical to effective supply. Health and social care need integration. So to do physical and mental health. Sub division can only create inefficiency. That’s also true of education where cooperation to ensure a balance of services to meet deeply varying needs is what is required. The over emphasis on academic results is the opposite of that at present.

    There is also cost to consider. That is the cost of duplication. And the cost of accounting between organisations. As well as the inefficiencies that lack of scale bring. Local spells expensive in every such process if too many boundaries are put in place. That is what is happening now. A bonfire of the boundaries is needed.

    That is because these boundaries are in any case not required: one pot pays for these services. It’s not local financial accountability that any such service requires: it is the setting of appropriate key performance indicators to suit local need that is necessary. This may be ensuring education to meet the particular needs of the local economy is available. It maybe healthcare to suit the particular age, gender and ethnic needs of a local population. These are the performance indicators that matter. And they aren’t measured financially. But they do target resources.

    Of course there are financial constraints: these have to be considered in service supply. And in the representations the major health and education authorities I suggest we need could make on government decision making based on their on-the-ground observations of the success or failure of service targeting to meet need. But do any of these things below the scale I suggest and neither the scope of the decisions that can be made or the scale of the impact that can be measured will be large enough to make any difference to service outcomes, and in health and education these are the criteria for management decision making structures that truly matter.

    So we need big, regional, service delivery, although empowered local managers matter, of course. But local management in these services can never be strategic. The result is that we don’t have effective strategy now because decision making units are far too small to deliver it. And that matters, enormously. It’s why I hate to say it, but top down reform is essential. But the outcome will be services focussed on what matters, which is not management and budgets, but patients, students and service supply in the broadest possible sense.

    I hope Labour is thinking this way. It needs to.

  2. This obesity “epidemic” and the American “opioid epidemic” strangely lack any theory of contagion. There is nothing about seeing a lard-ass at the ballpark that makes me run to the concession stand for another chili dog.

    Many a Republican candidate has dumped water on my attraction by turning to the “epidemic” buzzword. He is the candidate tough enough to use the “public health” tyranny to cure this disease! In fact, we have almost no public health problems (the public not being an organism in any case, except in the minds of Community Organizers). Most of our epidemics are the effects of outrageous personal behavior (including AIDS), and a few are the effects of government, such as recreational drugs, which you cannot buy except for cash in the late evening away from police protection and about which you cannot know the potency. The opioid “epidemic” blurs two separate problems, the effects of drug Prohibition and the tendency of patients to want more effective pain control than politicians think they should, just like we blurred several different “immigration” problems.