Libertarian but not Paternal: Reflections on the UK’s New Public Health Service

For some time now we have had a strong sense that soft paternalism is less a distinct set of political practices and more a collection of tools for behaviour change that can be taken in very different political directions. Thus, while David Cameron and George Osborne’s pre-election statements clearly indicated that if elected they would deploy nudge-style techniques in their administration, it was far from certain exactly what type of politics this would lead to. As more and more statements and policy directives start to emerge from the Coalition Government it is becoming easier to discern what soft paternalism may come to embody in British politics over the next five years.

Perhaps surprisingly, it is Andrew Lansley, the Coalition’s Secretary of State for Public Health, who has been most active is revealing the key characteristics of the new government’s version of soft paternalism. In a recent speech to the UK Faculty of Public Health Conference on the 7th July 2010, Mr Lansley set out his vision of behaviour change policy in the field of public health. This speech confirmed two things. First that government clearly intends to deploy soft paternalist tactics within its health sector reforms. Second, that it has a very specific neo-conservative take on what soft paternalism means.

It is clear that Andrew Lansley, and like minded coalitionists, feel that the particular brand of soft paternalism practised by the previous Labour government (whether it be in the form of school meal reforms or the Change4Life programme) was simply too paternalistic. Ironically reflecting on the inability of his government to pass the “Elimination of Obesity Act 2010,” Lansley outlined a paradigm shift in health policy that would invoke the power of local communities to generate and sustain the structures cultural change that health reform really needs.

While there are many sensible suggestions made within Lansley speech, one cannot help but feel that it represents another, thinly veiled, assault on the welfare state.  The role of the state within health care provision is problematised by Lansley on at least three front: 1) in the wake of public sector spending cuts we can no longer afford a heavy-handed state bureaucracy meddling in public health issues; 2) that the “nanny state” is actually not very adept at changing personal health conduct; and 3) that sometimes state intervention can make the public health situation worse (the example used here is the way in which social marketing campaigns against drinking, smoking and obesity can actually normalize these problems not stigmatize them).

Taking these points in isolation, I have to admit that there are some important issues raised here. However, when they are placed alongside Lansley’s alternative behaviour change solutions to public health reform, anyone with a belief in “progressive” brands of soft paternalist (as I have) may start to feel a little queasy. In the wake of a failing state, we are presented with less public funding for healthy living campaigns (like Change4Life), the threat of disbanding the Food Standard Agency (Ramesh, The Guardian, 12 July 2010), and an increasing role for the food and drinks industry in public health support. Perhaps the most worrying insights into what the New Public Health Service may look like, however, came in related statements made by Lansley (reported in the Telegraph, but not documented in the official manuscript of his speech). We thus hear that:

“it is perfectly possible to eat a Mars Bar, or a bag of crisps or have a carbonated drink if you do it in moderation understanding your diet and lifestyle […] Then you can begin to take responsibility for it and the companies who are selling you these things can be part of that responsibility too” (Smith, Daily Telegraph, 8th July 2010).

Such sentiments open-up a worrying space between the corporation and the citizen, which has historically been filled by the state (see here George Monbiot’s reflections on the current round of state deregulation in the UK).

While it is always likely to be popular to talk about healthy eating in relation to choice and personal moderation, one of the reasons that soft paternalism first emerging within British health policy was because the food and drink industry had generated structures of food provision (whether it be vending machines in schools, or cleaver marketing ploys) that actually made it very difficult to eat healthily and responsibly in the first place. If the fiscally restrained state is incrementally removed from the public health sector my fear is that healthy choice options will decrease and the long-term cost of ill health will increase. It appears that British soft paternalism may be soft, but not all that paternalistic!

Mark

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