Tag Archives: diet

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!



Thorntons and the corporate nudge

I had the expectation that the Easter vacation would probably enable me to escape well-intention nudges towards my eating habits – it is, after all, a time for the indulgent consumption of all things sweet! I was thus surprised (actually not all that surprised) to find some very interesting corporate nudging on my young daughter’s Thorntons “Girls Gift Parcel”.

On top of the box, which tantalizingly contained White Chocolate Buttons (40g), Milk Chocolate Buttons (40g), Milk Chocolate Raisins (40g) and Vanilla Fudge Cubes (40g), was a small picture of tooth bush brandishing mouse. The smiling mouse rather annoyingly states, “I know to brush my teeth twice a day!” As a parent, I have to admit that it is reassuring to think that every time my daughter reaches for a milk chocolate raisin or a fudge cube that she will be reminded of the importance to brushing her teeth.

But the cynic in me couldn’t help looking at thing differently. Isn’t it slightly strange that a chocolatier is promoting dental care? Isn’t this a little like McDonalds placing a statement on a Big Mac that reads “Ronald knows the importance of a healthy and balanced diet – and, by the way, you wouldn’t get anything remotely resembling that inside this box!”

My point is that when corporations nudge, it often serves to ethically cleanse their product of the potential damage it is doing to you. Perhaps an alternative strategy would be to supply information on the role of chocolate in accelerating dental decay. In addition, Thorntons’ teeth cleaning campaign feels somewhat patronizing when you are a parent – children know they should clean their teeth, getting then to actually do it is a different thing entirely. In a rather selfless act of hard paternalism I have thus been protecting my daughter’s teeth by assisting her consumption of her Easter chocolate mountain.


The burger woman and acts of citizenship

We’ve all become aware in recent years of Jamie Oliver’s crusade against unhealthy school meals and, indeed, his success in ensuring that Turkey Twizzlers – the staple diet of school canteens from Aberdeen to Aberystwyth and from Penzance to Penrith – have been consigned to the (recycling) bin. Another feature of Jamie Oliver’s campaign, of course, was the pictures of mothers of school-children selling items of (presumably) junk food to children through school fences or over the school gate. As a middle-class, educated and reasonably healthy academic, I was of course appalled by these guerilla tactics. Surely these mothers were guilty of the insidious crime of undermining their own children’s health or, even worse, the health of other children? burger by vanessa pike-russell @flikr

And yet, the work of Professor of Citizenship, Engin Isin (Open University) encourages us to think different about these parental practices. Isin argues that ideas of citizenship throughout history have been articulated through reference to those on the margins. It is these individuals and groups that can act as a kind of threat to us but it is these individuals and groups, too that are the source of our own security. We become assured of our own political identity by contrasting ourselves with these more marginalised people. I, as a well-behaved citizen of good character and reasonable diet, derive my own sense of worth and smugness from mothers such as these and their Turkey-Twizzler-eating offspring.

Isin goes further by suggesting that there are enduring ‘acts of citizenship’ that can emerge from these marginalised and disenfranchised groups, which can help to transform dominant ideas about citizenship. Is the act of passing or selling a burger over a fence to a child an act of citizenship? Will this act lead to different conceptions of what it is to be a British citizen? How do acts such as these lead us to question the extent to which the state can determine the diets of its citizens?


Hidden food and the nanny state in the kitchen

My mother tells a story of her childhood dislike of sprouts and my grandmother’s feeble attempts to disguise them as cabbage through a hastily conducted mashing-up process. Any parent can attest to the various culinary tricks, techniques and fables that routinely have to be deployed in order to encourage/force their children to eat more healthily: I, for example, am still waiting for my improved eye-sight and curly hair as just reward for my assiduous consumption of carrots and crusts!

pizza by wendalicious@flikrBut what was once an exercise in shrewd parental food repackaging is now becoming an arena of corporate action and state policy. On the 12th of May this year (2009) the British Food Standards Agency (FSA), in partnership with a range of popular high street restaurant chains, launched a new scheme for promoting healthy eating among Britain’s young consumers. The FSA’s ‘health through stealth’ approach to eating involves putting less salt in dishes, using lower-fat cheeses in pizza, and inserting ‘hidden vegetables’ in a range of menu options for children (FSA, 2009). Involving 400 companies and in excess of 2,000 restaurants (including Pizza Express, Pizza Hut, Frankie and Benny’s and Bella Italia outlets), the British government sees this new initiative as a significant act in public health improvement.

While the FSA’s ‘health through stealth’ approach to childhood nutrition reflects a broader series of attempts to restructure the ‘choice architectures’ that frame the consumption patterns of young people (including re-thinking school canteen provisions, the re-positioning of alco-pops in bars, and the movement of cigarette packs below the shop counter) there also appears to be something else going on here. Changing the hidden content of food appears to be less about making it easier for young people to choose to eat healthily, and more about making them do so without them realizing it. The choice here is all with the parents, in as much as they can decide to dine at Pizza Hut rather than McDonald’s, or Frankie and Benny’s as opposed to TGI Friday.

As a thoroughly paternalist policy then certain issues arise out of the hidden food agenda. While celebrated by government as a corporate commitment to public health, there is a danger that such policies could be self-defeating. So for example, despite improving the content of the food they offer is eating at Frankie and Benny’s really a healthy option? To what extent is a pizza really a healthy choice? My point is that this scheme could also be interpreted as a stealthy marketing ploy by partner companies to recast their image in the wake of the revolution in organic, slow and nutritious food? (Note for example that this scheme has coincided with the renaming of Pizza Hut as the much more nutritionally appealing Pasta Hut – whatever next, TGI’s becomes Thank God It’s Humus?)

Furthermore this policy initiative could also be counterproductive to the extent that rather than trying to educate children about the benefits of a healthy and balanced diet, it aspires to enable them to eat more healthy food in a completely unconscious way. This is hardly the “recipe” for developing a more culinary aware citizenry (and possibly contradicts the FSA’s own commitment to develop nutritional competencies among young people). While ‘health through stealth’ may not have people rushing for barricades in order to defend the gastronomic liberties of young people, it may thus prove to be an ineffective policy on its owns terms: my mother was never fooled by those sprouts you see, and she has never let us forget how she saw through the attempted dupe!