TOPIC GUIDE: Public Health

"The government should take tougher action on unhealthy behaviour"

PUBLISHED: 31 Aug 2011

AUTHOR: Tony Gilland

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INTRODUCTION

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?

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Public Health DEBATE IN CONTEXT

This section provides a summary of the key issues in the debate, set in the context of recent discussions and the competing positions that have been adopted.

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?

 

ESSENTIAL READING

It is crucial for debaters to have read the articles in this section, which provide essential information and arguments for and against the debate motion. Students will be expected to have additional evidence and examples derived from independent research, but they can expect to be criticised if they lack a basic familiarity with the issues raised in the essential reading.

FOR

Tough action needed for better public health

Denis Campbell Guardian 19 July 2011

Why a nudge is not enough to change behaviour

Baroness Julia Neuberger BBC News 19 July 2011

Smoking ban is needed to protect children

Alex Cunningham Politics.co.uk 26 June 2011

Popularity should not dictate public health policy

Dianne Abbott Guardian 11 March 2011

AGAINST

Why eating right doesn’t matter

Julie Burchill MyDaily 15 July 2011

A White Paper won’t stop my mum smoking

Philip Collins The Times 3 December 2010

Public health and the obsession with behaviour

Dr Michael Fitzpatrick spiked 5 May 2010

‘Choose the yum and risk the yuk?’

David Spiegelhalter BBC News 6 May 2009

IN DEPTH

Should smoking in cars be banned?

Vivienne Nathanson and Simon Clark The Times 8 July 2011

Is smoking still defensible?

Nick Duerden Independent 4 July 2011

How the war on obesity went pear-shaped

Basham and Luik spiked 15 March 2011

Healthism is a vile habit: It is no longer enough simply to be well…

Brian Appleyard Independent 21 September 1994

KEY TERMS

Definitions of key concepts that are crucial for understanding the topic. Students should be familiar with these terms and the different ways in which they are used and interpreted and should be prepared to explain their significance.

BACKGROUNDERS

Useful websites and materials that provide a good starting point for research.

Behaviour Change

National Institute for Health and Clinical Excellence July 2011

A snapshot of thoughts on nudge theory

Karen Bollan Guardian 4 February 2011

Sugaring the pill

BBC Radio 4 27 October 2010

Michael Marmot speech

Fair Society Healthy Lives 12 February 2010

A liberal dose? Health and wellbeing: the role of the state

Richard Reeves Department of Health 1 February 2010

Fattened statistics

Peter Marsh Social Issues Research Centre 24 April 2006

The Effectiveness of Interventions to change Health-Related Behaviours

Ruth Jepson MRC Social & Public Health Sciences Unit May 2000

Smoking on the silver screen

Economic and Social Research Council

ORGANISATIONS

Links to organisations, campaign groups and official bodies who are referenced within the Topic Guide or which will be of use in providing additional research information.

AUDIO/VISUAL

Sugaring the pill

BBC Radio 4 27 October 2010

Michael Marmot speech

Fair Society Healthy Lives 12 February 2010

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