A New Year prescription

Here’s a New Year suggestion for the government: stop trying to improve people’s health by telling them how to live their lives.

‘We call on Tony Blair’s government to ban tobacco’, declared a recent editorial in The Lancet, one of Britain’s leading medical journals (1). This was only the most extreme in a series of proposals to deter behaviour considered prejudicial to health. These include calls to ban smoking in public places (resisted by the government in favour of voluntary restrictions) and measures to restrict the advertising to children of snacks, soft drinks and other foods considered dietetically incorrect.

Anti-alcohol campaigners have complained that TV soaps feature too many scenes in which characters drink alcohol, demanding that EastEnders, Coronation Street and the rest are brought into line with the requirements of public health propaganda. (Given the austere lifestyle now demanded by health promotion zealots, the consequences for TV drama could be catastrophic.)

Following the great obesity panic of 2003, the New Year threatens to bring a series of government initiatives to tell people what they should and shouldn’t be eating, and how much exercise they should be taking.

The most obvious objection to the coercive drift of government health policy is that it is likely to be ineffective, if not counterproductive. In the era of ‘evidence-based’ policy, where is the evidence that restricting fast-food adverts will have any effect on the so-called epidemic of obesity? All experience suggests that exhortations to young people to behave virtuously in matters such as diet and exercise (not to mention in relation to alcohol, drugs and sex) are more likely to result in contrary behaviour. This is particularly the case when children observe that adults do not appear to follow the standards that are being preached to them.

It is well known that the prohibition of alcohol in the USA in the 1920s fostered crime and corruption on a grand scale, and culminated in the increased consumption of spirits (though it may have temporarily curtailed beer-drinking). Cigarette smugglers, already running a flourishing illicit trade, would be the major beneficiaries of any further restrictions (or price increases). Official censures against fast food may have the perverse effect of making McDonalds fashionable among truculent adolescents. (Have anti-corporate campaigners considered that the recent demonisation of fast food might be a corporate plot to win over the youth market?)

The more important objection to current health promotion policies is that they are authoritarian and anti-democratic. They implicitly replace the relationship between state and citizen with that between parent and child, or therapist and client.

The autonomous individual who is the foundation of a democratic society gives way to a feeble and fragile individual who needs protection against the wiles of the advertisers – and indeed against the inherent weaknesses that result in chemical dependency on nicotine or other substances. If more than 20 per cent of the population still smokes, and hence require intensive measures of nicotine replacement or medication with sibutramine, all supplemented by prolonged psychotherapeutic ‘support’, then can they be considered responsible and capable citizens?

Though it is highly questionable whether any of the proposed measures of health promotion will improve anybody’s health, they involve substantial incursions into individual autonomy and hence constitute a serious threat to our increasingly restricted democracy.

Dr Michael Fitzpatrick is the author of MMR and Autism, Routledge, 2004 (buy this book from Amazon (UK) or Amazon (USA)); and The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA). He is also a contributor to Alternative Medicine: Should We Swallow It? Hodder Murray, 2002 (buy this book from Amazon (UK) or Amazon (USA)).

(1)Lancet, 6 December