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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