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Harringay, Haringey - So Good they Spelt it Twice!

I was paying for some tent pegs in Poundland and the cashier asked me if I'd like to buy a bar of chocolate, a pile of which was prominently displayed on the counter. When I said - with some surprise - 'No thanks!', she then asked me if I would rather buy some sweets.

Given that at least an entire aisle of the store is given over to packets of sweets and chocolate - including what are labelled 'essential snacking' items such as chocolate-covered cranberries - there is absolutely no justification for pushing them like that at the checkout and if I had children with me I would have been very angry.

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I watched 5 mins out of 39 and I don't see the relevance Alan.

Life is too short.

This is not a field where I claim expertise, John. I'm simply a lay person trying to make sense of what I see and learn about what's going on around me. So bearing in mind that health professionals on HoL may jump in and correct me, here's my attempt at a summary.

The issue you and Christopher raised so starkly is: individual responsibility+willpower; or social  factors? Which seems to be an ongoing as well as a high priority discussion among health professionals. Particularly those concerned with health promotion and public policy choices affecting physical and mental health, and the economics of health provision.
This is linked to the interaction between individual choices and the environment, both physical and social.
Marmot is centrally interested in what we can learn from international comparisons. Especially about poverty and deprivation and its impacts on the health of both adults and children.

The answer Professor Marmot offers to your & Christopher's question is not either individual choices and responsibility; or action by and about the wider society.  He proposes both.

He doesn't reject or deny the usefulness of approaches which stress for example, improved access to medical care; nor behaviour changes with better diet, smoking cessation, and exercise which are linked to heart disease, and diabetes and some cancers.
But he also sees it as essential that society tries to reduce inequality in the conditions in which people are born, in which children grow-up , and how all of us live and - if we're lucky - get older.
His concept of the "health gradient" suggests that everyone has a stake in creating the conditions for good health across our society. Not simply because of the problems of the poorest families but because inequality affects us all across the gradient - the middle range of families and individuals as well. 
Plainly the increase in the numbers of children in families in poverty is a move in the wrong direction.

Everything you say is reasonable enough, in the context of health inequalities in the UK, which are a result of the huge divisions in society in income. And you are correct that everyone in society benefits when inequality is reduced; a number of studies have shown this. However, the original post related to supermarkets or other retailers placing sweets or chocolates at the point of sale. Everyone knows they do this, and that it is a source of temptation. However, I still believe that the individual has to take some responsibility if they give in to this temptation, when they know that, for example, excessive sugar consumption is bad for health.

Christopher, If you recall the book "Nudge" by Richard Thaler and Cass Sunstein, you'll recognise that what Poundland and other stores are doing is using a big Nudge to persuade people to eat stuff which is bad for them.  In other words to put them in harm's way. The opposite of what Thaler & Sunstein advocate, of course.

But I agree that people still have a choice. Nobody forces them to buy the chocolate.

So would Michael Marmot agree.

And I've just noticed that Amazon's "Look Inside" feature shows most of the introduction to Marmot's book which explains what led him to the ideas and research he now writes about. And why he thinks that simply telling people and reinforcing advice about sensible choices doesn't often work.
Far better than me trying to paraphrase it.

By the way this is not an ad for Amazon. If this taster tempts you into reading the book, it's in both Wood Green and Marcus Garvey libraries.

Or perhaps order it from the Big Green Bookshop.

P.S. This morning, rechecking the link above to email it to a friend, I noticed that Amazon had shuffled the preview pages slightly. Today at least, it begins on page 4.
"For those who assert that health is a matter or personal responsibility ... "

As you can see, I'm a Marmot fan. I find his book clear and readable. I enjoy his style. And I also like the way he sets his views and ideas within his own personal biography. But most of all, my hope is that if a few more people paid attention to him we could have more effective public health programmes.
We might even stop spending public money on posters with outright lies like this one from Haringey Council.

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