TThe British government’s plans to curb junk food advertising, ban the sale of energy drinks to children and phase out smoking have been met with a predictable refrain: that it’s all a plot by the “nanny state”. “Keir Starmer plans huge expansion of the nanny state”, the Telegraph warns. The daily mail reported a ‘furious reaction’ to the ‘nanny state’s’ smoking ban.
The sentence was first used on a large scale in 1965 when a former Conservative minister was unhappy about the introduction of 70 mph speed limits on motorways in England. He was expressing his view that the government should not treat its citizens like naughty children who need a nanny to tell them what they can and cannot do.
Since then, it has become a shorthand term – often directed at Labour by the Conservatives – to express dissatisfaction with a range of public health measures, including indoor smoking bans, minimum alcohol prices, calorie labelling on menus and speed limits on British roads. The impression is always the same: that mass public health measures are draconian, excessive and infringing on individual civil liberties. Meanwhile, the restrictions introduced in response to the pandemic, while vital at the time, did little to help the perception of public health as something that ‘takes away’ our freedoms.
As someone who works in this field, this framework is frustrating, because public health is, at its core, about providing freedom, including the freedom to live long and healthy lives. Public policy is often a delicate balancing act between intervention and individual freedom. We always work with the knowledge that while public policy can guide individual decisions, such as drink driving bans and speed limits on roads, people also like to make their own choices about their behavior.
But even the word “freedom” is loaded: using it to argue against certain policies assumes that one person’s desire for freedom doesn’t infringe on another’s. For example, should someone be free to drink and drive recklessly, even if it endangers someone else’s freedom to get home safely? Should someone be free to smoke in a car, even if it endangers children or other passengers who want to be free to breathe clean air and have healthy lungs?
With diet and tobacco, the argument is not about taking away someone’s freedom, but about regulation to limit corporate behavior that affects us all. For example, should companies be free to promote vaping to minors, even if it has negative health consequences for those who consume the product, or should regulation be put in place to protect their right to health? Should companies be free to market unhealthy foods to children, even if the consequences of childhood obesity are not only for them, but also for a health care system that is collapsing under the weight of chronic disease? This is where the pro-freedom and anti-nanny state arguments fail.
Here’s some realism. The NHS cannot treat an unhealthy and ageing population: the burden is too great for an overstretched health service. Prevention is the way to ensure that people stay healthy and don’t have to go to clinics and hospitals – and this prevention has to start in communities.
We have the advantage of living in a democracy where the government cares about our health and wants to give us the most freedom to live our lives free of disease and pain – and wants to continue to provide free (at the point of care) medical services to all of us through the NHS. Two ways this can happen is by creating incentives not to smoke and supporting us to keep our weight within a healthy limit. We cannot leave it up to individuals to sort it all out. They are fighting against a corporate attempt to sell cigarettes or unhealthy food, which is about maximising profit and not the welfare of the public.
Do we, and especially children, stand a chance against these forces? This is where government steps in to protect us, since its overarching concern is our well-being: we are the shareholders for whom it seeks to create value. So here’s a question: was the introduction of the 70 mph speed limit on motorways an overall positive move by government in 1965 to reduce road deaths? Did it achieve this goal (yes), and are we still debating whether to increase it to 90 or 100 mph (no)? Yes, it has limited the freedom of individual drivers to drive as fast as they like, but it has also made many more people feel free and safe to drive on the motorway.
These are the trade-offs that governments must make in the interests of all. And if that means we live in a ‘nanny state’, then maybe that’s not so bad.