Choosing Health White Paper
Government 2004


Foreword by Tony Blair:

"changes need to be based on choices, not direction. We are clear that Government cannot – and should not – pretend it can ‘make’ the population healthy. But it can – and should – support people in making better choices for their health and the health of their families. It is for people to make the healthy choice if they wish to".


Preface by John Reid, Health Secretary:

"In recent decades, the debate about the respective roles of Government, individuals, communities, industry and others in improving health has too often become bogged down in a ritual battle between two ends of a political spectrum. On the one hand, a paternalistic state is encouraged more and more to limit individual choice, constrain personal decisions and ban action which promotes unhealthy behaviour. On the other, the Government is asked to stand back, leaving people’s health to whatever the hidden hand of the market and freedom of choice produces.

First, people told us that they want to take responsibility for their own health. They were clear that many choices they made – such as what to eat or drink, whether to smoke, whether to have sex and what contraception to use – were very personal issues. People do not want Government, or anyone else, to make these decisions for them. Second, what they did expect was that the Government would support them in making these choices. They wanted clear and credible information, and where they wanted to make a change and found it hard to make a healthy choice they expected to be provided with support in doing so – whether directly or through changes in the environment around them – so that it is easier to ‘do the right thing’.

Choosing health sets out key principles for that support. Our starting point is informed choice. People cannot be instructed to follow a healthy lifestyle in a democratic society. Health improvement depends upon people’s motivation and their willingness to act on it.

While we respect individuals’ rights to make their own choices, we need to respond to public concern that some people’s choices can cause a nuisance and have a damaging impact on other people’ s health. We need to strike the right balance between allowing people to decide their own actions, while not allowing those actions to unduly inconvenience or damage the health of others. Moreover, in the case of children there is a greater case and requirement for protection. Children need a protected environment as they learn about making lifestyle decisions that impact on their health. This is a responsibility that Government shares with parents.

These considerations, therefore, run through this White Paper: helping people to make healthier choices for themselves; protecting people’s health from the actions of others; and recognising the particular needs and the importance of emotional and physical development of the young. These form the basis of achieving a balance between the healthy outcomes we all want to see and the equally valued freedom to determine our own way of life that is so important in a democratic society".


Executive summary:


7. [Society] needs policies and approaches which reflect the realities of people’s lives today. That means an approach which respects the freedom of individual choice in a diverse, open and more questioning society; which recognises the realities of the impact of the consumer society on those choices; which addresses the fact that too many people and groups have been left behind or ignored in the past;

8. The first and critical stage in that process was to listen to the views of the people in England, to get in touch with their real concerns and to ask what they wanted and how they could be helped to realise their aims. For this White Paper, it is the public who have, for the first time, set the agenda and identified what ‘for their own good’ means, not Whitehall. They have made clear where they want support, where they want to be left alone by Government and where they want Government to intervene.

Underpinning principles

9. (1) Informed choice. People want to be able to make their own decisions about choices that impact on their health and to have credible and trustworthy information to help them do so. They expect the Government to provide support by helping to create the right environment. However, this principle is subject to two qualifications. First, people believe that we need to exercise a special responsibility for children who are too young to make informed choices themselves. Second, people agree that we need special arrangements for those cases where one person’s choice may cause harm or nuisance to another, such as exposure to second hand smoke. We need to balance rights and responsibilities, in ways that protect health.

10. Overarching priorities

Reducing the numbers of people who smoke;

Reducing obesity and improving diet and nutrition;

Encouraging and supporting sensible drinking;


  • smoking – a boosted campaign to reduce smoking rates and motivate smokers in different groups to quit supported by clear information about health risks, reasons not to smoke and access to NHS support to quit, including Stop Smoking Services and nicotine replacement Therapy;
  • obesity – a new crossgovernment campaign to raise awareness of the health risks of obesity, and the steps people can take through diet and physical activity to prevent obesity;
  • alcohol – working with the Portman Group to cut down binge drinking.

15. Social responsibility scheme for alcohol – we will also work with industry to develop a voluntary social responsibility scheme for alcohol producers and retailers, to protect young people by:

  • placing information for the public on alcohol containers and in alcohol retail outlets;
  • including reminders about responsible drinking on alcohol advertisements; and
  • checking identification and refusing to sell alcohol to people who are under 18.

21. We will strengthen measures to protect children and young people and help them understand and manage risk – including risks in sexual activity and smoking.

Underage tobacco sales – we will develop a communications programme to support local authority enforcement of underage tobacco sales and we propose to bring forward legislation to strengthen powers in this area.

27. Smoking is a major cause of ill health. Balancing the rights of people who choose to smoke against the interests of the majority who object to being exposed to secondhand smoke at work and in public places was one of the most controversial issues in the consultation. This is an area where campaigns and public demand for change have not done enough to achieve national targets to reduce prevalence in smoking. We therefore intend to shift the balance significantly in favour of smokefree environments. By 2006, all government departments and the NHS will (subject to limited exceptions) be smokefree.

We will consult on detailed proposals for regulation with legislation where necessary, so that by the end of 2008, all enclosed public places and workplaces will be smokefree except those specifically exempted.