Balancing Between Conservative Personal Responsibility and Liberal Nanny State

Balancing Between Conservative Personal Responsibility and Liberal Nanny State

The NHS is 67 years old, on its knees and struggling, and its patients are not doing much better. Launching the Labour Party’s new plans for public health today – it’s an election year after all – the shadow health secretary, Andy Burnham, argued that the solution was a combination of patient responsibility and government intervention: a perfect positioning of Labour between personal choice (the Tory favourite) and a nanny state (the domain of Labour’s political roots).

But is this enough? And can this approach not only solve the modern problems of obesity, diabetes and other behaviour-related conditions but also revitalise the NHS and get it off its knees?

Personal Responsibility

Food does not get eaten unless you put it in your mouth, exercise doesn’t happen if you stay on the sofa and cigarettes have to be bought, unwrapped and lit in order to be smoked. At the end of the day, people behave in unhealthy ways because at some level they choose to.

But people in my profession would be out of a job if that was it. Childhood, learning, beliefs, emotions, parenting, friends, the media, expectations and habit all lead to a sense that there’s not much choice at all and at that moment of thinking “cake now or health in the future”, cake pretty much always wins out. So it is right to call for more personal responsibility, but it would help if someone would take the cake away.


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Burnham (along with Luciana Berger, who holds the shadow public health brief) wants to see more intervention and more responsibility – or empowerment as Burnham calls it. Among other things, he wants to see half the population taking up recommended activity levels, and for children in particular two hours of PE a week plus up to a further three hours a day of further activities through breakfast and after-school clubs in extended school hours. It’s a fortuitous focus given the finding of a new study from Cambridge researchers that suggests that a lack of exercise is responsible for twice as many deaths as obesity. They argue that just 20 minutes of walking a day could cut the risk of early death by 30%.

Commercial Responsibility

But if we’re all taking on more responsibility, it is therefore also right for the government to intervene in the activities of the commercial world. Plain packaging should stop smokers being walking adverts for their favourite brands and may make the habit less attractive to those who haven’t yet started.

Labour is proposing to cap the levels of sugar, fat and salt sold in children’s food – something that has been notoriously difficult to achieve against a strong food lobby, who have still yet to find voluntary consensus for the traffic light system on food packaging, another focus for Burnham. Any taxes on sugar and fat have been ruled out in favour of “making food healthier in the first place,” Berger said.

Health Dependencies

Limiting fat, salt and sugar in foods for children would of course help parents make better choices (without even knowing it), and lowering alcohol levels may help with the teenager determined to binge drink. But is that really all that is needed to make a new generation of children the healthiest so far and to save the NHS and save us from these modern problems?

I think that both the demise of the NHS and the rise of both obesity and diabetes reflect a much more fundamental problem beyond either patient responsibility or the nanny state; a culture of health dependency.

Some 200 years ago doctors used leeches, bled their patients and blistered their feet. Today, we have drugs; we’re encouraged to take more medication and that medicine can cure our every ailment. But much as we are told that things are better now, we are not told that far from working for everyone, these drugs only work for some of the people, for some of the time and that even if they do work benefits are often minimal. What about all those for whom the treatment didn’t work, who experienced side effects, or even got better on their own? We never hear about that in the media. Instead there’s a pill for every ill and doctors can and should manage our every ailment.

And nor are we told that all drugs have side effects and that there are no drugs for the coughs, colds, fatigue, tummy aches and wind that so often end up at the doctor. As doctor Angus Wallace recently wrote: people turn to nurses to clean grazes or wounds rather than do it themselves these days.

The emphasis on early detection through screening, symptom detection and health checks is a good thing but symptoms such as bowel changes (colon cancer?), bloatedness (ovarian cancer?) and indigestion (heart disease?) are so commonplace that the doctor’s waiting room fills up, outpatient departments are swamped and our beloved NHS starts to creak. Better health information for patients, and crucially, how to critique it may be one way forward for the NHS.

The shadow health secretary wants to save the NHS and make people healthier. But this is more than just about patient responsibility and the nanny state. Until all parts of society start to take responsibility; until we can see the limits to medicine and where we can start to look after ourselves, know when to seek help and when to wait, the NHS is destined to stay on its knees.

The Conversation

This article was originally published on The Conversation
Read the original article.

About The Author

ogden janeJane Ogden is Professor of Psychology at the University of Surrey. Her research interests include eating behaviour and obesity, communication in the consultation, and women’s health. She has authored many books, including 'The psychology of eating: From healthy to disordered behaviour', 'Fat Chance, the Myth of Dieting explained', and 'Health Psychology: a textbook'.

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