Yesterday I read an article on the BBC News website entitled ‘Dawn of the Nanny State?’ It talked about supervised gym sessions for people at risk of type 2 diabetes, alcohol legislation and the new sugar tax all being introduced by the UK’s Conservative government.
The article suggests that these policies are being put in place because our unhealthy lifestyles are costing the UK’s National Health System a hefty £11 billion per year.
While the costs of disease are undoubtedly a problem, that is not how I view it.
Government intervention in factors affecting our diet, physical activity, smoking and alcohol for me doesn’t equal a nanny state because taxes and legislation are not the only things that are telling you what to do.
I believe that people can be trusted with their health – when they have the knowledge and support to do so. Yes, people do have individual responsibility to use their knowledge to live a healthy lifestyle, but they are being asked to lead that healthy life in spite of everything around them making it hard to do so. They don’t have the support.
We know that people’s behaviour is affected by the environment we live in. You know it too. The cost of food, drink, parking, tobacco, bus fares, train tickets all affect whether we decide to buy those products, and how often.
The decision of whether you decide to buy those products in the first place is heavily influenced by the advertising we see. We are so susceptible to advertising that commercial TV, radio and a HUGE number of websites are funded by it. When you get to the bottom of this article you will see advertisements, because that is how WordPress makes its money.
We can’t help but be influenced by adverts. The magician Derren Brown once did a trick where he predicted the brand and tagline two advertising professionals would design. He got it spot on, because he had bombarded them with subliminal messages on their journey to the room they designed the brand in.
Most interesting bit is from minute 3.45 of this video. How he did it is right at the end:
So the media and advertising are influencing our behaviour – including behaviour that affects our health. And we haven’t even talked about the ways in which neighbourhoods are designed.
Research has shown that there is a relationship between the facilities available in our local environments and our physical activity and diet (although a lot more research is needed before we really understand the relationship). Where is your nearest supermarket? Fast-food restaurant? How do you get to these places? Do you walk, drive, get the bus? Who put that pavement there, came up with that bus route? These elements are all affecting the choices we have available to us, and all have the potential to affect our diet and physical activity levels.
The basic availability of foodstuffs is also an example of how external influences affect our health. One of the reasons people don’t eat enough fruit and vegetables is because they are expensive. Chocolate and cake on the other hand are comically cheap. Why is this? In Europe, it’s because sugar and dairy fats were traditionally subsidised but fruit and vegetable production was not. We have the Common Agricultural Policy to thank for that.
So, while I can’t give you the real reasons why George Osborne or David Cameron choose to implement a national-level policy to change diet or smoking levels, I hope I can convince you that they are usually a good idea.
Evidence from public health and other fields has taught us that the environments we live in are an important determinant of our health. From food prices, to bus networks to advertising, we are responsible for our health in a place and time – in an environment – and as much as we may want to, we can’t ignore it.
Currently that environment is shaped by companies whose main aim is to make money, be that a food company, a drugs company or sports brand. While local government policies are not all aimed at making money, you can be sure that certain shops and services will bring in more income than others. Don’t get me wrong, I really don’t think making money is a bad thing, but that aim can come at the cost of other things we need and value.
The idea of the nanny state is about telling you what you should be doing. Public health is about giving you the realistic option to choose. When public health professionals call for the government to intervene, through legislation or taxes or other policy changes, it is not to intervene in your personal behaviour, but to intervene in your environment.
So I don’t think the nanny state is always something to be concerned about when it comes to health. Our environments, and consequently our behaviour, are shaped by businesses, advertising and a multitude of other factors that are not at all concerned with health. That government intervention is sometimes just helping to re-balance this environment.
For me it’s about making a healthy choice the easy option, rather than the difficult option that it is now – if being healthy is what you choose to do.