Nannying the giants: will increased preventative health care justify the nanny state ?
Edmund Stubbs, 11 November 2014
“Five Giants” threatening the wellbeing of society were identified by William Beveridge in 1942 as being “giants of too little”; want, disease, squalor, ignorance and idleness. These, he proposed, were to be vanquished by the improved education, housing and health services offered by a post-war welfare state.
However, according to Julian Le Grand, some new giants have now strolled into town. Our formidable new foes are the “giants of excess”.
Le Grand’s giants do not only threaten public health. A “giant of excess wealth” brings financial inequality to our nation, however, most of the new giants, born from “excessive” unhealthy behaviours, are dealing their heaviest blows against the nation’s health. Such behaviours range from heightened calorie and fat intake and tobacco consumption to sedentary pursuits such as watching too much television or high dependency on automobiles.
This week began with much media coverage concerning weight loss surgery; recommended for increasingly younger individuals. This expensive and resource draining procedure can be a lesser of two evils considering the lifetime health needs of individuals who remain obese.
The NHS was established to combat giants of too little. Its structure reflected the health concerns of its day: largely those of combatting infectious disease. We now face giants of excess: cancers, cardiovascular disease and diabetes. Thus, as proposed in the “Five Year Forward View” of NHS England, some thinkers are suggesting that the NHS becomes more of a “social movement”, assuming a greater responsibility for public health.
As with recent recommendations by doctors for calorie content labelling on alcohol, we are likely to see increasing “awareness campaigns” and “nudge policies” introduced to influence our decisions and behaviours. There has also been talk, especially within the Labour party, of introducing “sin taxes” to enhance NHS funding. Often nudge policies can cause annoyance, affecting all users regardless of their consumption levels. Importantly, sin taxes also lack progressivity, meaning lower income users are harder hit by increased prices.
Effective health care should no longer be symbolised by blue flashing lights and large, multi-bed hospitals (as seen in the Olympic opening ceremony), it is rather to be seen in public health programmes and preventative medicine accompanied by a fair degree of nagging.
We must recognise unhealthy behaviours in excess are not just a personal choice which “do not hurt anyone else”, they often harm those around us, and, on an aggregate level, cause significant damage to society. Nannying and nudging may be irritating, but it is something we must all get used to.
Edmund Stubbs, Healthcare Researcher at Civitas