Smoke, drink, pay

This was the headline on a story in today's Daily Mirror.

Like many of the policies that are enunciated from time to time, it seems designed to garner as much attention as possible for its creator. Rather less thought seems to have gone into the impact on the intended beneficiaries of the policy.

For a start, how is it to be implemented? How does a doctor know that someone is a user of alcohol or a tobacco?

Heavy smokers will carry some evidence of their habit, in the form of discoloured teeth, fingernails and blackened lips. Moderate users of alcohol are much harder to detect, unless they actually enter hospital drunk and only the real dipsomaniacs can be identified as such on sight.

The doctors could pose the question to the patient, in which case the patient is likely to lie. The doctor will then have to judge whether the patient is telling the truth, which may mean that moderate users will probably get away with the lie, which means the policy will be rendered less effective, although the doctors diagnosis may be impaired by the fact that information is withheld.

According to the Ministry official "non-communicable diseases (NCD) such as diabetes, strokes, heart attacks, kidney failure, cancer and high blood pressure are often due to the excessive consumption of alcohol and cigarettes.He said the ministry has decided to take these measures to encourage a drop in people’s consumption of alcohol and cigarettes."

Is it only for treatment of the diseases commonly associated with alcohol and tobacco use that are to be charged for, or will they be required to pay for all public health services? For example for injuries caused by a fall or an accident? What if hypertension or diabetes is due to hereditary factors, or possibly due to excessive consumption of sugar, something that Sri Lankan's are well know for?


It is true that valuable hospital resources are tied up by people suffering from lifestyle diseases but I believe the focus should be on prevention, which means education.

Paying something for health services may also not be a bad thing, especially if the funds are used to improve facilities, especially since the health budget is minuscule compared to the rest of Government spending but this needs to be based on sound principles.