Securing Good Health for the Whole Population

Derek Wanless for Department of Health

 

 

Government intervention:

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.

1. Interventions should tackle public health objectives and the causes of any decision-making failures as directly as possible;

2. Interventions should be evidence-based, though the lack of conclusive evidence should not, where there is serious risk to the nation’s health, block action proportionate to that risk;

3. The total costs of an intervention to the government and society must be kept to a minimum and be less than the expected benefits over the life of the policy; interventions should be prioritised to select those which represent best value;

4. The distributional effects of any programme of interventions should be acceptable (aligned with societal equity objectives); and

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.

Individual responsibility & rights:

7.3 Individuals are, and must remain, primarily responsible for decisions about their and their children’s personal health and lifestyle. Individuals must be free to make their own choices about their own lifestyles.

7.4 If government or other bodies do intervene, it is essential that social welfare is improved and that personal freedoms are respected.

7.43 Individuals 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 individual’s lifestyle can raise legitimate questions of personal freedom.

Self-harm v harm to others:

Incomplete appraisal of costs and benefits

7.16 The full costs and benefits should include all those that affect the individual, and those that the individual creates for others by his or her action.

7.45 The forthcoming consultation ahead of the White Paper is a good opportunity to engage the population on the issue of their own health and the balance between an individual’s ‘right to choose’ and the impact that individual behaviour has on the wellbeing of others. In particular, the consultation should consider the acceptability of different ways of tackling smoking.

7.58 Beyond this, government also has a responsibility to assess the social and economic failures described above, to judge whether and to what extent it should intervene further, in order to improve social welfare and population health, while balancing individual freedom and individual responsibility for behaviours that affect the health of others.

7.59 - 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.

Social attitudes – discrimination, risk perception:

7.25 Social context can have a powerful influence on individuals’ decisions. A person’s tastes and attitudes – which form the basis of how individuals value the benefits and costs of an action – are shaped, in part, by environment. The effect of the family and social environment on children is particularly strong. Peer approval (or disapproval) can also have a profound effect.

7.26 Where decisions are made in an environment where unhealthy lifestyles are prevalent, it can be difficult for individuals to choose healthy options. Their tastes and attitudes will be shaped so that unhealthy choices will be seen as preferable. Shifts away from the social norm carry the additional costs of potential disapproval.

Education not legislation:

7.29 Influencing 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.

Reduce discrimination & social exclusion:

7.33 … interventions to encourage greater equity in society also need to be considered.

Policy conflict & transparency:

8.5 The policy objectives must be considered, as these will affect the selection of the type of lever used and the degree to which government is prepared to intervene. Political judgment must be used to resolve conflicting objectives. These conflicts need to be recognised and investigated, and any judgments should be explicitly and transparently made.

8.7 Where regulation is enacted, it is important that it is both efficient and respects civil liberties.

Information & 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.

8.17 Taxes 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.

Recommendations:

9. The following principles are suggested for adoption by government:

  • Interventions should tackle public health objectives and the causes of any decision-making failures as directly as possible;
  • Interventions should be evidence-based, though the lack of conclusive evidence should not, where there is serious risk to the nation’s health, block action proportionate to that risk;
  • The total costs of an intervention to the Government and society must be kept to a minimum and be less than the expected benefits over the life of the policy: interventions should be prioritised to select those which represent best value;
  • The distributional effects of any programme of interventions should be acceptable; and
  • 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.

9.2 The Government should set a clear national framework of objectives for all the key risk factors such as smoking and obesity.

9.5 The Government should seek advice about what quantified objectives it should set for progress in tackling all major determinants of health and health inequalities. The process should involve consultation, and quantified objectives should be subdivided where appropriate to cover important subgroups, particularly those key to achieving objectives to reduce health inequalities.

9.7 A consistent framework (such as the methodology developed by NICE) should be used to evaluate the cost-effectiveness of interventions and initiatives across both health care and public health. (Paragraphs 3.96 and 6.42)

Full Engagement

9.18 The forthcoming consultation ahead of the White Paper is a good opportunity to engage the population on the issue of their own health and the balance between an individual’s ‘right to choose’ and the impact that individual behaviour has on the wellbeing of others. In particular, the consultation should consider the acceptability of different ways of tackling smoking. (Paragraph 7.45)

9.21 Feedback should be sought regularly from the population and important subgroups to provide an indication of their degree of awareness of issues and of the current best advice, as well as the acceptability to them of possibly controversial state interventions. (Paragraph 7.60)

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