Myths of the individual and the nanny state

By Phil Mellows

- Last updated on GMT

Related tags Public health

Mellows: against the welfare state
Mellows: against the welfare state
Phil Mellows says the Government is going about the UK's drinking problem the wrong way and we need to tackle the conditions in which people live.

I never had a nanny. When mum and dad needed respite from the toils of childcare they just plonked me outside the pub with a half of lemonade and a packet of crisps.

Clearly I was one of the lucky ones. The way some people rage against the 'nanny state', being looked after by Mary Poppins or similar must have been awful. Health secretary Andrew Lansley invoked the nanny state in his speech​ the other day urging us to take more responsibility for our own health. The equivalent, perhaps, of packing the nanny off down the pub for the day and leaving her charge with a dot-to-dot book. What I suspect he's really against, though, is the welfare state. The nanny state just sounds a more reasonable target. Even so, he stirred up a lot of debate, including this one on Newsnight​.

The discussion was a bit of muddle, to be honest, and it kept descending into sensational soundbites. But at least it had Kate Pickett, co-author of The Spirit Level​, a book that argues, among other things, that inequality in a society determines poor health. She looked a bit detached up there on the screen, chipping in like Holly in Red Dwarf.

But she did manage to get her point across: that trying to get people to individually change their behaviour — drinking less, for instance — is starting at the wrong end of the problem. What we have to tackle is the conditions in which they live.

A 2003 academic text​ fluttered around Twitter in the wake of Lansley's speech. It asked why the poorest sections of the population were so resistent to public health messages to deter them, from smoking and concluded that these apparently stupid people were making a wholly rational judgement on the matter, based on 'lay epidemiology': "Poor housing conditions, occupational hazards, and environmental dangers are more immediate threats to the health of those in lower socioeconomic positions than is smoking. Smoking cessation may become a priority only when these other hazards have been reduced."

Add to that the pleasure people get from a smoke and you might as well keep on puffing. And it's the same with drinking and stuffing your face with cream cakes. Only when people's material circumstances change for the better, argued the report, will they feel like chucking their bad habits.

Yet well before the ConDems came to office, since the early 1970s in fact, we have seen a steady shift away from welfarism towards a do-it-yourself approach to health. At the back this lies the notion of a rational individual making free choices on the basis of the evidence laid before them.

This is how they would like us to be, perhaps, but it's a myth. We are not individuals, you see. Never have been. Human existence is rooted in an economy, and economies are social. This socio-economic reality makes our relationship with alcohol and other drugs much more complex than the simple action of a chemical on an organism, and it can't be reduced to a matter of choice*.

Giving people the responsibility for their own health sounds a brilliant idea for any government that wants to cut back on public expenditure. It's what the drinks industry's been arguing for, too, in a bid to shake off over-regulation. Which is why there is bewilderment at plans for a more restrictive licensing regime.

The apparent contradiction comes from the fact that any government that preaches free choice has to stake out tight boundaries to that freedom, to define rational behaviour on its own terms, and then exclude the undeserving problem child, like the nanny that asks us to behave nicely then locks us in the playpen.

*See, for instance, Julian Buchanan's 2006 paper​ on problematic drug use.

• Read more Phil Mellows on The Politics of Drinking... and more​ website at​ or follow Phil's tweets at​.

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