The UK government’s plans to restrict junk food ads, ban energy drink sales to children and phase out smoking have been met with a predictable refrain: that this is all a “nanny state” plot. “Keir Starmer plots vast expansion of the nanny state”, the Telegraph warns. The Daily Mail reported a “furious backlash” to “nanny state” smoking bans.
The phrase was first widely used in 1965 when a former Conservative minister was unhappy about the introduction of the 70mph speed limit on England’s motorways. He was expressing the view that the government shouldn’t treat its people like naughty children who need a nanny to tell them what they are and aren’t allowed to do.
Since then, it’s become a shorthand – often directed at Labour by the Conservatives – for expressing dissatisfaction with a range of public health measures, including the indoor smoking ban, minimum alcohol pricing, caloric listings on menus and speed limits on UK roads. The sense is always the same: that mass public health measures are draconian, excessive and interfere with individual civil liberties. Meanwhile, the restrictions introduced in response to the pandemic, while vital at the time, didn’t help with the image of public health as something that “takes away” our freedoms.
As someone working in this field, this framing is frustrating, because public health is at its core about providing freedom, including the freedom to live a long and healthy life. Government policy is usually a delicate balancing act between intervention and individual freedom. We always work in the knowledge that while public policy can guide individual decisions such as bans on drinking and driving and speed limits on roads, people also like to make their own choices about their behaviour.
But even the word “freedom” is loaded: its use to argue against certain policies assumes one person’s pursuit of 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 isn’t about taking away someone’s freedom, but regulation to restrict corporations’ behaviour that affects all of us. Should corporations be free to promote vaping to minors, for example, even if it has negative health impacts on those consuming the product, or should regulation be put in place to protect their right to health? Should corporations be free to market unhealthy food to children, even if the consequences of childhood obesity are not only faced by these individuals, but also a healthcare system crumbling under the weight of chronic disease? This is where the freedom and anti-nanny state arguments break down.
Here’s some realism. The NHS cannot treat its way through an unhealthy and ageing population: the burden is too high on an overstretched health service. Prevention is the way to ensure that people stay healthy and out of clinics and hospitals – and this prevention has to start in communities.
We have the benefit of living in a democracy where the government is concerned about our health and wants to give us the most freedom to live our life disease-free and pain-free – and wants to continue to provide all of us with free (at point of care) medical services through the NHS. Two ways it can do this is through creating the incentives not to smoke and supporting us to keep our weight within a healthy limit. We can’t leave it up to individuals to figure it all out. They’re fighting against a corporate push to sell cigarettes or unhealthy foods, which is about maximising profits and not the welfare of the public.
Do any of us, especially children, stand a chance on our own against these forces? This is where the government steps in to protect us, given its overarching concern is our welfare: we are the shareholders it wants to create value for. So here’s a question: was the introduction of the 70mph limit on motorways an overall positive move by government in 1965 to reduce the number of fatalities on the roads? Did it achieve this aim (yes), and do we have debates any more about increasing it to 90 or 100mph (no)? Yes, it has restricted the freedom of individual drivers to go as fast as they like, but it has also enabled many more to feel free and safe to drive on the motorway.
These are the trade-offs that have to be assessed by governments for the good of everyone, and if that means we are living within a “nanny state”, then maybe that’s not so bad.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
