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Nannyish or neglectful

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Mark Easton | 18:23 UK time, Tuesday, 9 December 2008

Where does Britain figure in a league table of nanny states? Well, according to boffins in the prime minister's Strategy Unit in 2004, about two thirds of the way down (see below). Some will argue we have moved rapidly up the league since them.

The government's recent interventions on smoking, access to benefits, junk food, gambling and prostitution reflect a philosophical shift in Whitehall that can be traced back to the turn of the millennium. Before I expand on that - a bit of context.

In 1848 the first British Public Health Act which brought water and sewage systems under state control was opposed as "paternalistic" and "despotic".

In the early 70s there was public resistance to the compulsory wearing of seatbelts. More recently, bans on smoking in public places were regarded as the epitome of the nanny state.

It has been a long process, but the government's role in encouraging behavioural change is accelerating. The signs of a rethink on the balance between state and individual responsibility emerged in the Treasury's Wanless review of the NHS in 2002.

It talked of the huge cost savings associated with having a "fully engaged" public. What it meant was that getting people to change their behaviour is far more cost-effective than doling out drugs.

"In absolute cost terms, the NHS currently spends around ten times as much on statins as it does on smoking cessation programmes. In cost effectiveness terms, smoking cessation has been estimated to cost between £212 and £873 per quality-adjusted life year (QALY) compared to a range of £4,000 to £8,000 per QALY for statins."

The message was clear. "The achievement of major policy outcomes, requires greater engagement and participation from citizens - 'governments can't do it alone'." That was the conclusion of another Whitehall think-tank, the Strategy Unit working to the prime minister in the Cabinet Office.

Graph showing government's responsibiltyIn 2004 the unit published Personal Responsibility and Changing Behaviour [pdf link] - effectively a blueprint for greater state intervention to influence public behaviour in areas like health and welfare. (The chart to the right can be found on page 13 of the report.)

The document surmised that "people in Britain appear fairly comfortable with the balance that UK policy has generally struck between state and individual responsibility." That balance, it suggested, put Britain mid-way through the nanny state league.

In the USA and Scandinavia, voters have tended to favour a shift towards more individual responsibility while people in Latin America, Japan and the former Soviet Union want government to exert greater control.

The British public doesn't seem too exercised either way and so, the strategists argued, the UK could afford to tilt more towards a state intervention model.

"It was once unthinkable to ban smoking on aircraft; now it is almost unthinkable to allow it," they pointed out. "Similarly, today's narrowly-balanced attitudes towards the state ban on prostitution reflect a steady softening in attitudes among the public over the past 20 years."

Within a few months of the document's publication, a strategy document on public health policy in England was published. It is obvious how emboldened ministers had become.

The White Paper railed at the "sterile national debate... between those proposing a heavy handed nanny state on one hand, and those supporting inactivity bordering on neglect in the name of individual freedom on the other."

Suddenly Whitehall was awash with initiatives to change behaviour - on health, welfare, the environment and crime.

"Higher levels of spending and better-run public services can achieve improved outcomes. But in the long-run improvements depend as much on changes in personal behaviour" is the government's argument.

But do we want to be more like Austria or more like Moldova?


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