by Alan Frince
from issue number seven of Lumpen Journal
Harry’s bedside radio came on at 10am. It didn’t completely wake him, but brought him into a semi-conscious state in which the inane chatter of the presenters infused his blurry thoughts and brought on painful, frustrating dreams. After a few minutes he woke up enough to realise what the source of his annoyance was. The shrill sound of the presenters cackling at the same jokes they made every morning grated him. He glared resentfully at the radio, hit the snooze button and rolled over, trying to remember what he had been dreaming about before he had been interrupted.
Although he hated the breakfast show on the chart music station, he hated the highbrow stations even more. The other option would have been to not set an alarm at all and have a lie in—after all, he was always shattered on Saturday morning after a long week of 7am starts, late evenings at the office, and then staying up at night watching TV. But he didn’t want to waste the weekend sleeping so he tried to get up at a reasonable time on Saturdays and Sundays.
After five minutes the radio came back on, accompanied by a feeling of pressure around his wrist. His smartwatch was constricting to notify him of a calendar reminder. He begrudgingly opened his eyes and raised his arm in front of his face to read the notification. But by the time his eyes had focussed on the watch’s screen, he had already remembered what it was going to say: he needed to do his weekly health check.
He grunted, sat up, and swung his legs out from under the covers. He planted his feet on the ground, switched off the radio, and sat on the edge of the bed for a few minutes, trying to adjust to being awake. He was tempted to go back to sleep for another half an hour, but eventually managed to summon the effort to stand up and walk to the bathroom.
Standing in front of the toilet, he remembered just in time that he needed to collect a urine sample. He opened the cabinet above the cistern and took one of the little plastic tubes from the box. After collecting his sample and finishing his wee, he flushed the toilet and screwed the cap on the tube. He washed his hands and then brushed his teeth before heading to the living room, clutching the urine sample.
He walked over to the health-check machine in the corner of the room. It was about four foot high and resembled a supermarket self-checkout machine but without the part where you place your shopping and with a set of weighing scales in front of it. There was a large touchscreen at the top and below that were a few buttons and some holes which were needed to collect the samples.
It wasn’t compulsory to have your own health-check machine at home, but Harry and most of his friends did. It worked out cheaper in the long run than paying a subscription to use the local gym’s, and it was a lot nicer than queuing to use the free one in the basement of the shopping centre.
Harry stepped onto the scales and the screen came on, displaying the manufacturer’s logo on a bright white background that hurt his eyes. After a couple of seconds, the machine played a triumphant sound to congratulate itself on booting up and then displayed the home screen.
He pressed ‘Start Health Check’ and one of the holes lit up with green light. He slid the urine sample in and it was whisked into the machine, which whirred as it opened the tube and began its analysis. Another hole lit up, this time with blue light, and he inserted his right index finger. He grimaced slightly as a small needle pricked his fingertip and collected a few drops of blood. While the urine and blood were being analysed, the machine measured his weight and downloaded the week’s blood pressure and heart rate data from his watch.
He went and made himself a cup of coffee and some toast and then sat on the sofa to read some news articles on his phone while the machine did its thing. After a few minutes, it beeped and he went over to see the results.
The machine told him that his updated Health Score was 79—down two points from last week. He was a bit concerned as this was the third week in a row that it had fallen, but 79 was still firmly in the ‘Good’ range, which was the second highest of the four categories (‘Excellent’, ‘Good’, ‘Unsatisfactory’ and ‘Poor’). It was only once you reached ‘Unsatisfactory’ that you started having to pay contributions towards your treatment on the National Health Service, and only once your score was ‘Poor’ that you had to pay all of your own healthcare costs. He didn’t think it was likely that his score would drop that low. And besides, if it did, one of his workmates claimed to have a friend who knew how to order healthy blood and urine on the dark web to cheat the machine.
The screen said he had two health issues that he could address right now. He pressed ‘View’ and it showed him the first: his iron level was slightly low. A box on the screen asked if he wanted to order a bottle of iron tablets from People’s Health (a Procter and Gamble brand) for £4.99. He knew he could get some from the pharmacy on the corner for 99p, but if he bought the People’s Health ones through the machine it would be fed into the algorithm and could help his score. He pressed ‘Buy Now’ and his watch strap silently constricted to let him know that the order-confirmation had arrived in his inbox.
He pressed ‘Next’ and the screen told him the second issue: his mental wellness biomarkers indicated that he had an elevated stress level. This time he was presented with two offers. The first was a mindfulness workshop running in the office building he worked in for three days next week (the machine had found one that was taking place during his lunch break so he would be able to attend). The second was a short course of video therapy provided by TeleWell (a subsidiary of G4S). He chose mindfulness—it was cheaper and some of his colleagues would probably be going.
Once the course was booked and paid for, the machine informed him that his health check was complete. He switched it off and went back to the sofa to finish reading an article about the upcoming election. The Labour Party had announced that if they won they would reduce the NHS fees for those in the ‘Unsatisfactory’ category and look into reducing them for some people in the ‘Poor’ category. A spokesperson for the Conservatives had responded to the announcement by saying that Labour’s plans would mean big tax rises for healthy, hard-working families. The National Health Party had been even stronger in their criticism, saying that the fees were vital for protecting the NHS because they incentivised good health choices and ensured that healthy citizens did not have to pay for the irresponsible choices of the unhealthy minority.
Harry hadn’t decided who he was going to vote for. He didn’t particularly like any of the party leaders, although he did feel that the National Health Party were probably right about some things. On the other hand, they had been in power since the early 20s and it wasn’t like a lot had improved. Unemployment was still high and economic growth was slow—although they claimed that this was because of the other parties getting in the way in parliament. He didn’t really know who to believe.
Recently, at his sister’s house, his niece and nephew had been furious that he would even consider voting for the NHP. But they were young and idealistic. They had only been toddlers when the pandemic happened twenty years ago, so they didn’t remember what it was like. He still vividly remembered the day when he came home from secondary school and his mum, who had clearly been crying, told him that she had lost her job. He remembered queueing at the food bank, being too cold at night to sleep, and the day they got evicted.
When the National Health Party formed during the tail end of the pandemic, they argued that it had been wrong for so many people to lose their jobs and to be forced into lockdown over a virus which in most people caused no symptoms. They questioned why the healthy majority should have to suffer such economic and social devastation to protect the small minority who weren’t in good enough shape to face the virus.
The NHP had argued that this is what happens when we become obsessed with keeping everyone alive, no matter what the cost to society and no matter how many bad health choices they have made, rather than letting nature run its course. They said that it had made the country weak and vulnerable. And they said that the fact that the Prime Minister was so physically unfit that he had been hospitalised by the virus, leaving the country temporarily without leadership, was emblematic of the dangers of making unhealthiness socially acceptable.
As the NHP started to gain popularity, the other parties tried to pivot in the same direction in an attempt to hold onto their voters. The Labour Party said that immigrants coming into the country should have to demonstrate that they are fit and healthy or be required to pay some of their own healthcare costs. The Conservatives announced that they would introduce changes to the Equality Act to allow employers to carry out medical assessments on job applicants—a policy which they argued would help to ensure a robust and healthy workforce. The Liberal Democrats promised that they would subsidise memberships at several of the larger gym chains, paid for by making much-needed cuts to incapacity benefits, which were currently so large as to incentivise unhealthiness.
There was also a shift in the types of people that political parties put forward for elections. Although there continued to be increasing diversity in terms of gender, ethnicity and sexuality, there was also increasing uniformity as it became the norm for all political candidates to be young, non-disabled, slim, and muscular due to parties not wanting their politicians to be perceived as unhealthy.
Ultimately, though, the old parties were unable to beat the new one at its own game: the NHP won a decisive victory in their first election and had held onto power ever since.
Harry had always felt that the NHP had some good ideas, and he had voted for them in most elections, but—as he had explained to his niece and nephew—it wasn’t like he was a flag-waving supporter. He certainly had his concerns—especially around the National Reproductive Planning Programme. And when the NHP canvasser had knocked on his door, he had asked her, bluntly, ‘Isn’t this a bit like what the Nazis did?’.
The canvasser had replied that this was an excellent question and she was glad he had asked it. She explained that the programme was actually very different to what the Nazis did, for two important reasons.
‘Firstly, the Nazi programmes were really bigotry dressed up as science. They claimed that it was about improving the nation’s genetic fitness, but really they just used it as an excuse to attack groups they didn’t like. The NHP programme is based on objective measures of health and fitness. There is no hateful targeting of specific groups, just rational scientific planning for the benefit of everyone. Once you take away the prejudice and hate, reducing human suffering from disease and creating a more productive society by encouraging the healthiest people to reproduce more than the unhealthiest is just common sense.
‘Secondly, the Nazi programme was based on violent coercion. They committed mass murder and carried out forced sterilisations. In our programme, no one is forced to do anything.
If a person’s Health Score is in the “Poor” category then they can choose: either they pay a one-off fee of £5000 for the right to reproduce, or they can opt to be sterilised. Since they benefit from the fitness of the people around them, it’s only fair that they should also make a contribution to the nation’s health: either by choosing not to pass on their unhealthy genes or by helping to pay the costs of poor health and thereby safeguarding our NHS. So all of the sterilisations that take place are entirely voluntary—which is very important in a liberal society!’
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