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Exercise Mandate? Work-Out Prescriptions With Penalties Proposed in U.K.


"cost of free health care for the receiver is his freedom"

U.K. council proposes exercise incentive program that has some concerned. (Image: Shutterstock.com)

Last week, there was a proposition made in the United Kingdom that would incentivise exercise for those deemed overweight, but many saw it as a proposed exercise mandate that would result in negative consequences for those who refused to take it up.

The proposition by the Westminster City Council in the report "A Dose of Localism: The Role of Council in Public Health" is part of the overall effort to have local governments take control of public health in an effort to save £5 billion on the U.K.'s National Health Service budget.

Among the suggestions in the report was a line that read:

Where an exercise package is prescribed to a resident, housing and council tax benefit payments could be varied to reward or incentivise residents.

Many focused on the flip side of this, that those who refused to take on the exercise would lose out on the additional money. BBC reported it as a provision where residents would have their "money docked if they refuse exercise regimes prescribed by doctors."

The report itself only mentions the word "exercise" once. In most other instances, it uses the word "leisure." It states (emphasis added):

Prescription of leisure activities to help raise activity levels. Several local authorities have introduced schemes that allow GPs [general practitioners] to prescribe physical activities at local facilities including council swimming pools, gyms, yoga and walking clubs. These schemes tend to have been delivered in partnership with PCTs. Following the transfer of commissioning responsibilities to Clinical Commissioning Groups (CCGs), local authorities will need to ensure that GPs are aware of the strength of the local authority in this area through their relationships with CCG Chairs on Health and Wellbeing Boards. Local authorities should consider making provision for prescription of leisure activities in their service level agreements with providers. Such schemes will deliver benefits to both GPs and local authorities.

Linking welfare measures to behaviours that promote public health. Relocalisation of council tax benefit and housing benefit combined with new technologies provide an opportunity for councils to embed financial incentives for behaviours that promote public health. The increasing use of smart cards for access to leisure facilities, for instance, provides councils with a significant amount of data on usage patterns. Where an exercise package is prescribed to a resident, housing and council tax benefit payments could be varied to reward or incentivise residents.

BBC reported some criticism of this idea, like from British Medical Association member Dr.Lawrence Buckman who said it was "draconian and silly" and "some of the silliest things I've heard in a long time".

Although, he went on to say a better way to make the population healthier would be to "stop restaurants and fast-food chains providing the kind of food that make people put on weight, and interfere with the way foods are sold in shops."

Charlotte Cooper in The Guardian criticized the council treating weight loss as a "panacea" for improvement of health and called the report the "result of mixing a loathing for poor people with the wider medically sanctioned disgust of fat in order to do things a bit more cheaply."

Jonathan Carr-West, acting chief executive of the Local Government Information Unit that drafted the report, wrote in a blog post titled "Fat is a Local Government Issue" to defend the proposition against some of the accusations being made in the media:

That’s not quite where we were coming from. The suggestion that councils could think about varying benefit levels stems, rather, from a recognition that going along to a leisure centre can be expensive and that, by taking steps to improve their physical health, residents ultimately save the public sector money. The point is to remove barriers to people who want to get healthier and fitter. That’s about supporting, not loathing, poorer people.

Some are concerned by the fact that such an incentive program was suggested by the government as a whole.

Daniel Greenfield for the conservative FrontPage Magazine wrote that this idea clearly shows the "cost of free health care for the receiver is his freedom. Referencing similar free healthcare that is being instituted in the United States, Greenfield noted that he believes "what is policy in Europe today, will be policy in America in 5-10 years."

Featured image via Shutterstock.com. 

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