Nanny or steward? The role of government in public health

SummaryThe past year has witnessed contentious debates about public health in England around smoking bans, alcohol licencing, food labelling and junk food advertising. Some people argue that any government intervention in these areas is ‘nanny statist’—an unnecessary intrusion into people's lives and what they do, eat and drink. Others argue that only the state can alter the environment that shapes people's decisions and behaviour. This paper suggests that there is a strong argument to be made for government intervention to safeguard public health. Legislation brings about changes that individuals on their own cannot, and sets new standards for the public good. Rather than condemning such activity as ‘nanny statist’, it might be more appropriate to view it as a form of ‘stewardship’. The paper draws on international evidence about alcohol use, smoking and road safety to show how taxation, advertising bans, regulations proscribing behaviour and education create a public health framework and shape individual choices towards healthier and safer behaviour.