In recent years governments have all sought to improve public health; whether by advertising, campaigns or targeted programmes. In recent years, the governmental approach to public health policy has drawn strong influence from Richard Thaler and Cass Sunstein’s highly influential book Nudge: Improving Decisions About Health, Wealth and Happiness. However, some have started to question whether ‘soft’ approaches such as nudge are enough to change behaviour, and a recent House of Lords report [Ref: Parliament] has suggested that the public simply do not respond as positively to nudge as they do to more direct intervention. This has also been reflected in the public health policy being adopted or proposed by government; with increasingly interventionist policies being suggested or implemented. Central to this debate are several questions: are we capable of making our own healthy (or unhealthy) decisions, or could we do with a push in the right direction? Or, should the government go further than that to ensure that we don’t all drink, smoke and eat ourselves to death? With average life expectancy rising year-on-year, how should we weigh the government’s concern for our health against concerns about the erosion of individual autonomy?

The health of the nation: how healthy are we?
According to the latest national statistics, though life expectancy is steadily increasing, many in the UK will face major health problems during their lives due to a marked increase in ‘lifestyle diseases’ – illnesses and conditions related to the way we live our lives. ‘Lifestyle diseases’ include illnesses such as smoking-related cancers and lung and heart disease caused by obesity.  Aside from the impact on personal health, the cost to the public purse is significant; with the NHS paying out billions of pounds a year on treatments. Recently researchers have warned that obesity rates could rise in the UK to 40% by 2030 and one researcher lamented that the government is ‘enfeebled by their ideology’ and too worried about accusations of the nanny state [Ref: BBC News].

Living longer
On the other hand, given the startling statistical prediction, made by the ONS this August, that one in three girls and one in four boys born this year will live to 100 years of age, are we in danger of getting concerns about our health out of perspective [Ref: Guardian]? Did the novelist Kingsley Amis have a point when he famously quipped that ‘No pleasure is worth giving up for the sake of two more years in a geriatric home at Weston-super-Mare’? Others have variously criticised the exaggeration of problems like obesity [Ref: Straight Statistics]; the endless streams of conflicting dietary advice promoting confusion and anxiety [Ref: Social Issues Research Centre]; and the lack of meaningful context provided when newly discovered risks – such as eating too much bacon – are publicised [Ref: BBC News].

How free should we be to make unhealthy choices?
Governments throughout the ages have sought to improve public health, and no wonder; a healthier society is a more productive one and the less people get ill, the less they need looking after! Many argue that when it comes to public health the government have a duty to protect us. As public health affects us all, it is in our interests to allow the government to involve itself closely with it. Increasingly governments look to a range of policy measures to change our behaviour such as: outright bans, like the ban on smoking in confined public spaces; or hard-hitting and graphic public health campaigns [Ref: NHS Birmingham East & North]; or ‘nudge’ type policies that alter environmental cues (the positioning of lifts in buildings, for example) to prompt healthier behaviour [Ref: Guardian]. But others are worried about the implications of inviting the state into our lives in this way, and argue that it is none of the government’s business how much we all eat or smoke, or how badly we treat ourselves. As autonomous individuals we are quite within our rights to behave unhealthily if we so desire. Those raising such concerns emphasise that a truly healthy society requires individuals to ‘take charge of their own destinies’ and warn that the state is wrongly encouraging people to hand over personal responsibility for their lives to the government [Ref: Daily Mail].

Prevention is better than cure?
A key plank of the case for the government taking stronger actions to discourage unhealthy behaviours is the simple premise that prevention is better than cure. However, not all are equally convinced by this argument. Dr Iona Heath, President of the Royal College of General Practitioners, has argued, writing in a personal capacity, that an unaffordable obsession with preventing illness was diverting crucial resources away from front-line treatment [Ref: Daily Mail]. Meanwhile, restrictions on treatment for smokers and obese patients have stoked controversy amongst doctors [Ref: Pulse], whilst others have critiqued public health campaigns for patronising ordinary people and representing an attack on the ‘pleasures of working-class life’ [Ref: Guardian]. However, those lobbying for the government to do more counter that disadvantaged communities suffer the worst affects of ill health, experience lower average life expectancies and therefore need to be targeted [Ref: BMJ]. Others point out the powerful impact of advertising by the food and drink industry on people’s behaviour to underline the need for strong government action to both curb the excesses of industry and to promote healthy lifestyle choices [Ref: Marketing Week]. Is it time to call for tougher government action, even if intrusive, or to tell the government to butt out and respect individual autonomy?