Better Health For All

This week, at the Faculty of Public Health in Scotland’s Annual Conference, there will be welcome debates and discussion on the related topics of the right to health and on ethics in, of, and for the public’s health. A crucial component of this will be a session on the nanny state debate, a matter on which the Faculty of Public Health (FPH) is about to publish a report.

Public health activities are sometimes characterised as standing in conflict with individual rights. The reasons for this are straightforward: we often find tensions between what might serve an individual’s interests and what might promote the public or general good. In this sense, rights are of fundamental importance: it is rights that protect a person’s dignity; that allow our lives to be our own. In philosophical jargon, our rights place side-constraints on what the government might do.

Regardless of how much general good might follow from interferences with our rights, they protect us from torture and ill treatment, and from arbitrary and unjustified interferences with our liberty. Rights underpin a system of justice that accords with the rule of law. Rights protect our privacy and our personal and family lives. They safeguard our freedoms to associate with others, to practise a religion (or not), and to express our views freely. Rights protect minority interests against ‘the tyranny of the majority’. A society that doesn’t recognise and protect rights places us within, or at risk of falling into, political angst.

However, rights are not just about protections of ‘negative freedoms’; guards against wrongful government interference. To be realised, the empowering ethos of rights requires that government take measures that help promote a healthy society. This includes things like ensuring the right to a sound education, good housing, and of course conditions in which we can enjoy good health. Rights also require that government’s guard against and keep a check on other powerful actors—for example large corporations—whose influence may be enormous, and who present considerable threats if left with unchecked power.

As such, rights—including the right to health—are essential to good and ethical public health. Yet there are real difficulties, at times, in communicating this. One of the barriers to meaningful understanding within public debates on health policy is the nanny state, which is frequently presented as a ‘knock down’ argument. Where a proposed public health intervention is ridiculed for being ‘nanny statist’, the implication is that it necessarily and illegitimately interferes with our rights: that it is meddling rather than empowering. The impact of nanny state rhetoric is enormous. And, unsurprisingly, nanny state accusations are often simplistic. Indeed, they are often arbitrary or incoherent.

We must recognise that, at its best, the nanny state refers to valid concerns. None of us wants to live in a ‘health theocracy’. Just as too much emphasis can be given to simplistic accounts of individual autonomy, so too can the value of health be overstated. We want the right balance between autonomy and health, and require to think about other things that matter too. A good society recognises and promotes a range of important values, including health, happiness, liberty, autonomy, connectedness, and community. Our enjoyment of these is related directly to good government. Often a nanny state accusation is not even formally a claim about the rights of individuals. It may be a smokescreen to cover hidden interests, or just an easily used political slur that tarnishes a policy that in reality cannot—on any count—be said to be ‘nannying’.

I authored the report at FPH’s invitation, as a member of the special interest group on ethics, in consultation with experts in public health ethics, training, practice, and leadership. It provides examples and scrutinises how nanny state claims work in practice. It aims to explain the principled positions that support nanny state accusations, and expose the ways in which claims of nanny statism may be used without principled coherence. The report also provides practical guidance on means of responding to nanny state claims within public and political debates. It is hoped that we can advance health—and other important social agendas—without reducing ourselves to unhelpful slurs and slogans that perpetuate harms and injustices. Our focus should rather be on achieving a more fair and equitable society.

Written by John Coggon Honorary Member of the Faculty of Public Health, and Professor of Law, Centre for Health, Law, and Society, University of Bristol Law School. John launched a report entitled ‘The Nanny State Debate: A Place Where Words Don’t Do Justice’, which was launched at FPH in Scotland’s Annual Conference in Peebles on 2 November 2018.