of Health's Communicating
about risks to public health :
generally more worrying (and less acceptable) if
perceived to be involuntary (e.g. exposure to
pollution) rather than voluntary (e.g. dangerous
sports or smoking)".
Office/HM Treasury guidance Principles
of managing risks to the public
Government will seek to allocate responsibility
for managing risks to those best placed to
control them. It will consider the need to
regulate where risks are imposed on others. It
will aim to give individuals a choice in how to
manage risks that affect them, where this does
not expose others to unacceptable risk or cost.
Units Risk: Improving
governments capability to handle risk and
1.20 The risks
that the public faces may be voluntarily
undertaken (for example, smoking or dangerous
sports), with greater or lesser degrees of
awareness of the risk, or imposed by other
individuals or organisations.
will not normally intervene where individuals
take risks voluntarily and where they alone are
affected. In these circumstances, governments
have a role in ensuring that individuals are
aware of their responsibility and of the
consequences of the risk that they are taking.
However, they may also indirectly impose costs on
others, for example to the taxpayer through the
cost of medical treatment.
governments have a regulatory role in providing
the legal framework where the activities of
businesses and individuals give rise to risks to
governments will seek to ensure that those who
impose risks on others bear the cost of the
consequences of the risk.
2.10 In many
cases, it will be up to individuals or businesses
to manage their own exposure to such risks where
they have the knowledge or capacity to do so
for example, through the lifestyle they
choose or the investment decisions they take.
5.42 In many
cases, individuals will be best placed to manage
the risks that affect them and will expect to be
able to do so. It has long been accepted that
individuals are more likely to tolerate a risk
when they perceive that they are able to control
their own exposure to it.
Departments have policy responsibility for
handling risks that directly affect the public,
they should consider the scope for increasing the
availability of choice to individuals, supported
by relevant information and advice.
Annex 4: key
factors when looking at judgements of risk
Degree of control and is the risk voluntary or
In general, people are more likely to accept the
consequences of risks that they take willingly,
and are therefore within their control, than
risks over which they have no choice.
Wanless Report: Securing
Good Health for the Whole Population
are, and must remain, primarily responsible for
decisions about their and their childrens
personal health and lifestyle. Individuals must
be free to make their own choices about their own
government or other bodies do intervene, it is
essential that social welfare is improved and
that personal freedoms are respected.
are primarily responsible for their own health
and lifestyles. As discussed in the analysis
above, they are generally best able to make these
decisions as they know more about their personal
preferences and situation and generally are the
best judge of their own health and happiness; and
any intervention into an individuals
lifestyle can raise legitimate questions of
and, over time, changing social attitudes to
health and lifestyles is likely to be much more
effective in the long run than a punitive
approach that does not also aim for a change in
attitude. Laws and regulations not accompanied by
public support incur high enforcement costs, and
could jeopardise the development of a consensus
for future public health measures.
7.59 It is
important that any government intervention is
well managed, to protect against an inappropriate
infringement of liberty or unintended
consequences. To assist in the development of
targeted interventions that increase both health
and welfare, the following principles are
suggested for adoption by government.
- 5. The
right of the individual to choose their
own lifestyle must be balanced against
any adverse impacts those choices have on
the quality of life of others.
regulation is enacted, it is important that it is
both efficient and respects civil liberties.
& tax for healthier alternatives:
8.13 In addition to public health campaigns,
health professionals have a role in ensuring that
citizens are more fully informed about ...
alternative, less harmful, products and lifestyle
choices they could make.
should therefore provide incentives for consumers
either to lower consumption or to switch to less
damaging products, thereby reducing demand for
harmful goods to the socially optimal level.
Furthermore, the suppliers of harmful products
will have an incentive to produce less damaging
goods, either through switching product mixes or
investing in new technology.
8.42 Interventions to improve public health have
the potential to reduce significantly personal
freedoms. This is most clear when government acts
explicitly to prevent or restrict individuals
from behaving in certain ways, or from consuming
8.43 In general,
if the freedom to be curtailed or limited is a
significant one and valued highly by the
individual, the state would need strong reasons
to impose its will over the individual on public
health grounds. Usually, there should at least be
a strong consensus, preferably public but
certainly professional, that the public health
measure is necessary to prevent harm to others.
Government can of course legitimately intervene
when ones freedom to act would infringe
human rights for example, a person with a highly
infectious disease may need to be quarantined
without consent. In other cases, however, the
mere fact of social or professional consensus may
not provide sufficient justification for action.
individual consent provides the strongest
foundation for government action. However, in
cases where it is only the individual's health
that is at issue, the question of intervention
without consent poses challenges. Nevertheless,
there are examples where such measures have been
enacted and have become accepted (see box 8.6 on
safety belts). First, individuals may already
prefer not to be free to choose, and may accept
restrictions. Second, they may come to accept the
reasons behind the restrictions and no longer see
them as an imposition. Nevertheless, it is
important to recognise that measures should be
justifiable in the public interest and to
individuals as a reasonable restriction of their
Responsibility and Changing Behaviour
Consideration is given to how government acting
as a more effective persuader can be
squared with an agenda of enhanced personal
responsibility helping people to help
the limits of top-down
policies to change behaviour are highlighted. In
some cases, the application of alternative
approaches might allow government to relax more
punitive and rigid approaches to behaviour
the eventual aim is to entrench a habit of
personal responsibility and restraint, and a
self-sustaining social norm.
cant do it alone:
outcomes rest heavily on the lifestyle
and behaviour of citizens (diet,
exercise, smoking, drinking) and only
modestly on the quality of secondary
- Crime and
antisocial behaviour is at least as
strongly affected by the values and
behaviour of individuals and communities
as by the activities of the police and
criminal justice system;
Research has suggested that more
variability in educational outcomes is
explained by what happens in the home
than in the school.
1.2 For many
traditions of social and political thought
greater personal responsibility is a good in
- it enables
society to function with a less coercive
state and judicial system;
- it enables
public goods to be provided with a lower
exercise of responsibility strengthens
individual character and moral capacity;
personal responsibility in terms
of restraint and support for others
enhances the quality of life of
the whole community.
1.3 A further
key argument is cost-effectiveness.
Detailed cost-benefit analyses in health, crime
and education have shown that behaviour-based
interventions can be very much more
cost-effective than traditional service delivery.
For example, smoking cessation programmes deliver
around ten-fold more quality-adjusted life years
per pound than expenditure on drugs to reduce
the division of responsibility between
individual, community and state.
Assessments of causal responsibility:
Generally speaking, people tend to assign
moral or fair
responsibility on the basis of who, or what, was
the cause. Hence we seek compensation from the
reckless individual or organisation that causes a
major accident, but think it wrong for an
individual to have to pay for treatment for an
illness resulting from factors beyond their
control, such as their genes or pollution.
Similarly, more moral responsibility is assigned
for educational choices to eighteen year olds
than five year olds, on the basis that an
eighteen year old has far more knowledge, control
and ability to predict the consequences of their
This has been characterised as a presumption that
individuals should take responsibility for their
knowingly taken life-choices (for
good or bad) while the state or community should
seek to attenuate bruteluck effects,
such as result from family social background.
2.1 All modern
societies suffer the consequences of prohibitions
that are only partially effective for
example, against hard drug use. Clearly laws on
their own have only limited efficacy where other
powerful drivers of behaviour are involved. There
is a mature and growing body of knowledge in
psychology offering a more sophisticated approach
to behaviour and behaviour change, but that
remains largely untapped by many policymakers.
interventions to curb drug use have been
popularly supported despite relatively modest
evidence of significant impact.
the most simple and important point is that
consistency matters behaviour is most
powerfully shaped when all the influences on a
young person, from infancy to adulthood, point in
the same direction.
logic: helping people help themselves
3.5 ... a key role of the state is to encourage
in us behaviour that is in our own best
interests. ... sometimes everyone engages in
behaviours that they may regret or that do them
harm, or harm to those around them.
There is a potential tension between, on the one
hand, an agenda of encouraging personal
responsibility and, on the other hand, of the
shaping of the determinants of personal behaviour
by the state. How can this be resolved? One
solution is to recognise that policy can have
twin goals which operate together - policy must
at once empower and give choices, but at the same
time policy should set the default to be in the
best interests of individuals and the wider
public interest. To be effective, this twin
approach needs to be built around a sense of
partnership between state and individual. Hence
in employment, while individuals are not
ultimately forced to work, the strong default
pressures are that they will. In education, young
people are not forced to stay on in school and
acquire qualifications, but the default pressures
are that this is what they do. And in health,
governments do not ban unhealthy foods or
smoking, but seek to refashion the behavioural
pressures towards healthier choices.
See also the
Government's Saving Lives: Our
Healthier Nation .