Let’s not be unreasonable: governments can’t control everything. Systems fail. Events creep up. But it’s a matter of legitimate concern when risks are known, quantified and still inadequately addressed.
As a society we have a complex relationship with risk, straddling the law, politics and commerce. Many will say the risks taken by individuals with their own health and safety is their own affair; indeed, that the right to take risks is our liberal, democratic birthright. But one might argue just as reasonably that when an individual gambles unsuccessfully, it is society that suffers the repercussions – the health costs, the opportunity costs, the resources expended – and that communities, represented by government, have the right to limit their exposure.
That explains today’s expressed desire to “fix” obese people – why wouldn’t we send them on healthy eating and exercise courses if we can help end a condition that costs the NHS £8.8bn a year?
The easiest answer is that it won’t work. What we know, not least from research undertaken by the behaviour and health research unit at Cambridge University, is that the least effective way to deter people from taking risks is to warn them off, and encourage forbearance. Those issuing the warning may be disbelieved. Those being warned may be unwilling to sacrifice immediate and known pleasure for the distant, theoretical prospect of better health, or delayed death.
Knowing that over-eating or under-exercising is risky will not in itself induce those engaged in such activities to stop. But awareness of that limitation – the knowledge that people cannot and will not address the risks themselves – can move them towards participation and advocacy for solutions that actually work. Changing the environment, research suggests, can limit the scale of risk-taking. Knowing what doesn’t work may lead us to focus on what does.
Theresa Marteau, director of the Cambridge unit, says this is the point to impress on policymakers. Not least because they already know it to be true. In 1974, over 50% of men and 40% of women in Britain were smokers. Now, less than 17% of the UK population smokes. Smoking was in long-term decline already, but after years spent prioritising individual risk, the ban on smoking in public places greatly accelerated the process. Environmental change continues with the removal of cigarette packets from view in shops and the ongoing effort to make the packaging undesirable, a new measure it is hoped may deter another 300,000 smokers.
But our problems don’t stop at smoking. Policymakers know that though numbers are falling, we drink too much. Alcohol misuse is the biggest risk factor for death, ill-health and disability for those aged between 15 and 49 in the UK. Some 58% of women and 65% of men have been recorded as overweight or obese. More than 20 million Britons are physically inactive. Add the three together and the grand total is the obesity crisis.
We know that over the years, portion sizes and calorie content for fast food and basic supermarket items have rapidly increased. Plate sizes are larger, glass sizes are larger, and that encourages more purchases and greater consumption. Consumers lose track of portion size: a diner given unlimited quantities of soup in a “bottomless” bowl will keep drinking it; a drinker given a small measure of wine in a large glass will order more of it.
We know too how these psychological opportunities are exploited by companies happy to heighten public health risks for profit. They do it because they can, and because the officials and politicians who should have our interests at heart are vulnerable to their lobbyists. Despite the understanding that individuals struggle to manage risk themselves, the environment has been allowed to get worse, not better.
What can governments do, you ask, without an unacceptable level of intervention? Isn’t this a debilitating prospectus that would see the so-called nanny state interfering where it shouldn’t? But put it another way. When the state knows inaction has direct costs in terms of wasted resources and ultimately lives cut short, isn’t it obliged to act?
There is a balance, but we struggle to get that balance right. By next year we’ll have a sugar tax on soft drinks. Five countries already have one, with some reporting consumption of fizzy drinks down by up to 25%. In the first year of a Mexican initiative, fizzy drink sales dropped by 12%.
But Theresa May, having pledged in her last term to tackle inequality, took speedy steps to water down the government’s environment-shaping, anti-obesity strategy, to make it more acceptable to the wishes of manufacturers, supermarkets and fast-food companies.
In its efforts to reduce the huge numbers of people getting cancer as a result of smoking, the NHS offered classes and drugs to help people quit. This was helpful – of course. But on its own it would never have been enough – limits were placed on tobacco advertising, taxes were raised on products, smoking was banned in public places, and now those goods aren’t even allowed to be on display in the shops. With the cookery lessons and fitness classes now promised by the government, the health service is offering the chance for people to help themselves to stop being obese. But it will always take more than that to tackle such an epidemic.
We can argue about personal responsibility for risk, and the limits of intervention, but given what we know about what works and what does not, isn’t there a case to be made for interventionist government in the interests of the people? Nanny doesn’t always know best, but really – a nanny who knows something is wrong, knows why and knows the solution but sits on their hands isn’t much of a nanny at all.
• Hugh Muir is associate editor of Guardian Opinion
