In early 2023, Lars Fruergaard Jørgensen, chief executive of the Danish pharmaceutical company Novo Nordisk, and its UK corporate vice-president Pinder Sahota, met in Whitehall with the then health secretary Steve Barclay, England’s chief medical officer, Prof Chris Whitty, and various health and Treasury officials. They discussed the possibilities of a pilot scheme to improve obesity care in the UK.
According to internal documents obtained by the Observer, Novo Nordisk wanted “data from the Department for Work and Pensions” to “help profile those who are most likely to return to the labour market”. These individuals could then be targeted with Wegovy, the brand name for the company’s weight-loss drug semaglutide.
Simon Capewell, emeritus professor of public health at Liverpool University, observed that “targeting people in the interests of the state, for economic reasons, rather than prioritising the person’s own interests and health” was “unethical”. He also questioned the scientific “honesty” of a pilot scheme testing the efficacy of a drug in helping individuals back into the labour market, but using people who were already “considered by the DWP to be borderline for just returning to work”. It would “be a marvellous bit of marketing for the company”.
That Novo Nordisk study never materialised. Eighteen months later, though, a pilot study is being launched, to test not Wegovy but Mounjaro, the market name for tirzepatide, an anti-diabetic and weight-loss injection produced by the US pharmaceutical giant Lilly. The government trumpeted Lilly’s presence at last week’s “investment summit” and hailed the company’s £279m stake in helping “develop transformative medicines” and “trial innovative approaches to treating obesity”. The Mounjaro trial, based in Manchester, will involve 3,000 people in a five-year study of the “non-clinical outcomes” of treatment to see, in particular, whether the drug can enable more people to return to the workplace. “Our widening waistbands,” health secretary Wes Streeting wrote in an op-ed for the Daily Telegraph, are “holding back our economy”.
Politicians are particularly vexed by the rise in the numbers of people who are economically inactive, much of it because of long-term illness. The hope that it may be possible to address this, at least in part, through the use of jabs is beguiling, especially at a time when technical, as opposed to political or social, solutions are in vogue.
Drugs such as Wegovy or Mounjaro may well prove useful in helping individuals reduce weight, though their efficacy is far from certain, nor their side effects properly understood. That, though, is significantly different from a government strategy to use them as a means of bringing people back into the labour market.
The criticism directed at last year’s proposed Wegovy trial could equally apply to the new Mounjaro study – that it treats people according to “their potential economic value, rather than primarily based on their needs and their health needs”, as Dr Dolly van Tulleken, an obesity researcher at Cambridge University, remarked last week. While many studies show a relationship between unemployment and obesity, that relationship is not straightforward. There is some evidence that being obese reduces the chances of employment, but it is not so much that obesity causes unemployment as that becoming unemployed leads to weight gain.
George Orwell understood why. “A millionaire may enjoy breakfasting off orange juice and Ryvita biscuits; an unemployed man doesn’t,” he observed in The Road to Wigan Pier, castigating middle-class homilies on working-class diets. “When you are unemployed, which is to say when you are underfed, harassed, bored and miserable, you… want something a little bit ‘tasty’.” Unemployment “is an endless misery that has got to be constantly palliated”, which is why “the physical average in the industrial towns is terribly low”. It is an “endless misery” that today is exacerbated by a paucity of decent jobs, a lack of social infrastructure from youth clubs to libraries to pubs, poor transport facilities and shockingly low benefits.
Yet, the challenge of unemployment and of poverty continues to be seen as the problem of the individual, of laziness and lifestyle choices. Back in 1978, Margaret Thatcher told the Catholic Herald that poverty did not exist, and if it did, it was only “because people don’t know how to budget, don’t know how to spend their earnings”, and that at its heart lies a “personality defect”.
It would be easy to dismiss this simply as Thatcherite rancour. But the belief that the responsibility for unemployment and poverty lies with the unemployed and the poor themselves, and that such problems reveal moral rather than political or social failings, has deep historical roots and continues to shape policy to this day.
When William Beveridge wrote his 1942 report that helped lay the foundations of the postwar welfare state, he described the “Five Great Evils” that plagued society as Want, Disease, Ignorance, Squalor and Idleness. Not “unemployment” or “joblessness” but “idleness”.
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Even as society moved away from the ethos of Victorian “poor laws”, that saw the cause of poverty and joblessness in the “indolence” and “intemperance” of the poor, to create the modern welfare state and National Health Service, it retained an echo of the old moralist vision and of the notion of the “undeserving poor”. It’s an echo that could be heard in recent decades, in New Labour’s crusade against “problem families”, in George Osborne’s division of the nation into “strivers” and “skivers”, in Iain Duncan Smith’s imposition of a benefit cap on parents with more than two children to teach the poor that “children cost money”, which apparently they did not know until he came along.
Giving the unemployed weight-loss jabs fits into this history. As does Liz Kendall’s proposal last week to have “job coaches” visit mental health patients in hospital. And how long before people face sanctions for refusing to cooperate? A decade ago, David Cameron threatened to withdraw benefits from claimants who refused to be treated for obesity. It is not difficult to imagine such a plan reappearing. Once the finger is pointed at the individual, and unemployment and poverty become seen as moral rather than political issues, then coercion is rarely far away.
Unemployment is not a medical condition. Medical treatment should not be in the province of the DWP. Confusing the medical and the social makes it more difficult to improve lives in either sphere.
