In an ideal world each of us would consistently make informed decisions in the best long-term interests of ourselves and those we love. And in an ideal world, the wise choices would always be the easy ones.
Or, if we chose to put our long-term health, wealth and happiness at risk we would accept personal responsibility for the consequences. For example, if we insisted on chain smoking, binge-drinking, drug taking or over-indulging in junk food we would arrange private health insurance, so that any health problems arising would not end up being a burden on our families and the NHS.
In practice, we don’t live in an ideal world and sometimes a government has to step in to protect the most vulnerable, especially children. However, when government does take action it risks being accused of acting like a ‘Nanny State’ – in particular in certain sections of the press. There’s even now an annual Nanny State Index, which currently ranks the UK as the worst place in Europe for smokers. So whenever I see the term being used I ask myself these questions:
1. Will the action taken save lives? From the introduction of compulsory car seat belts to the ban on smoking in public places (each opposed at the time as Nanny State-ism) the answer has nearly always been yes. And the tragedy of Grenfell Tower illustrated clearly what can happen when Health and Safety isn’t taken seriously.
2. How much real choice do people have in practice? If you live in a deprived area, with betting shops and fast food outlets on every corner, do you really have the same choices as someone living in an area with a plentiful supply of gyms and farmers’ markets?
3. Who benefits financially from ‘choices’ like smoking, alcohol, junk food and gambling? If the beneficiaries are big businesses looking to boost executive pay and shareholder returns while government is prepared to accept a loss of tax revenue in the interests of public health, I think I know which I would trust to have the public’s true interests at heart.
4. How intellectually consistent are the opponents of public health initiatives? Usually the apparent proponents of individual freedom tend to employ arguments that favour commercial interests rather than personal freedom per se. For example, how many columnists who rail against government infringing personal liberty in the UK go on to argue for the legalisation of drugs, brothels or the right to bear arms? If defending personal freedoms was their real goal, surely their arguments wouldn’t be so selective.
This doesn’t mean we should accept government proposals unquestioningly and it doesn’t mean we should adopt a puritanical ‘killjoy’ mentality, becoming in effect health fundamentalists. That's why, here at Health Action Campaign, we've been researching what options are available to food companies who want to reduce levels of sugar and salt in their products, without using artifical alternatives and without compromising the taste for consumers. And Public Health England has published research indicating that e-cigarettes are 95% less harmful than smoking.
However, it is reasonable to expect government to level the playing field, particularly for the most vulnerable. We know for instance that childhood obesity levels are twice as high in deprived areas. And people in deprived areas typically die younger and after more years of poor health.
If the choice is between saving people’s lives and protecting their health on the one hand or being accused of being a supporter of the Nanny State on the other, I know which I’d choose.
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