‘Informed choice’ is no choice at all
The UK government’s White Paper Choosing Health makes a mockery of the c-word.
One of the most striking things about the UK government’s White Paper on Public Health, published earlier this week, is its emphasis on choice. It is mentioned twice in the title alone – Choosing Health: Making Healthier Choices Easier – and 35 times in the paper itself. UK health secretary John Reid says the paper’s ‘starting point’ (no less) is that people should be ‘free’ to make ‘informed choices’ about their lifestyles. Brushing aside howls of nanny statism from some quarters (and accusations of Not Doing Enough from others), Reid declared: ‘We believe that, in a free society, men and women ultimately have the right within the law to choose their own lifestyle, even when it may damage their own health.’ (1)
That even this latest piece of petty interventionism into our personal lives can be launched in the lingo of choice shows how degraded the c-word has become in British politics. In its quest to ‘improve the nation’s health’, the White Paper proposes banning smoking in public places where food is prepared, restricting TV ads for junk food aimed at kids, and publishing endless advice about what kinds of food and exercise we should eat and take – yet it does all of this in the name of ‘supporting’ people in ‘making healthy choices’ (2). When a government can talk about bans in one breath and enabling choice in the next, you know that choice today means something other than individual self-determination.
Take the idea of informed choice, a buzzphrase of our age and the choice of choice in the White Paper. Some mistakenly believe that the ‘informed’ in informed choice refers simply to information, as in providing people with enough info to empower them to make real decisions. So the White Paper argues that ‘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’ (3). The proposal for a traffic light system on food products – where foods with a high fat, sugar or salt content would get a red label for ‘stop’ and fruit and veg would get a green label for ‘go’ – has been hailed as a way of allowing us to make informed choices (4).
In fact, the informed in informed choice comes from the other OED definition of informed – not as in to ‘impart information’, but as in ‘enlightened, educated, knowledgeable’. The informed choice is the right choice, the good choice, the healthy choice, the kind of choice made by Islington-dwellers who walk and cycle, buy fruit and veg, rarely patronise the likes of McDonald’s, and spend time cooking meals at home (with fresh ingredients, of course). The distinction isn’t between choices made with the help of info and choices made without, but between enlightened people who make The Informed Choice and unenlightened people who do not; between those who are knowledgeable and those who are seen as being beyond the reach of reason, easily swayed by garish TV ads for tempting ‘junk food’.
Informed choices are not about choice at all; they are about pointing us dullards in the direction of salvation. As Dr Michael Fitzpatrick noted in The Tyranny of Health, today’s debates about health are often thinly disguised moral judgements on lifestyle and behaviour (and especially the lifestyle and behaviour of a certain class of people). ‘Once we had the seven deadly sins; now we have the four targets of health’, wrote Fitzpatrick, in response to the last White Paper on Public Health. In this context, the informed choice is the path to enlightenment, and those who stray from it can expect to be reprimanded. As the White Paper says, it’s all about choice, but with ‘two qualifications’….the government will ‘exercise special responsibility for children who are too young to make informed choices themselves’, and will enforce ‘special arrangements for those cases where one person’s choice may cause harm or nuisance to another’ (5).
One newspaper report on the White Paper was happily headlined ‘The choice is yours’ – perhaps, so long as you make the right (informed) choice, don’t make any choices that cause nuisance to anybody else (such as lighting up), and hand the choices over your kids’ eating and other health habits to the government. So, actually, the choice isn’t yours.
The White Paper makes a mockery of choice – yet the response from the government’s critics has been, if anything, even worse. Aside from a few cranky cries of Britain turning into a nanny state, made by right-wingers who, in the words of one commentator, hate the government for ‘telling them how many bottles of claret they can drink’ (6), most commentators have criticised the government for allowing us too much choice. They argue that by making choice the cornerstone of the White Paper, the government has overlooked those millions of people who are apparently – because they’re addicts or poor or just a bit stupid – incapable of making choices.
A leader in the Guardian raised the problem of smokers, who, it believes, are so in thrall to nasty nicotine that they cannot be left alone to make decisions, informed or otherwise. ‘[Reid’s] emphasis on giving people the information, but letting them make an informed choice, ignores the fact that smokers are gripped by an addiction’, the paper said (7). Jacqui McClusky of the children’s charity NCH argued that poor families are unable to make informed choices because they apparently cannot afford the kind of foods that might soon have a green-for-go label stuck on them. ‘The government has emphasised the importance of individual choice, but ignored the fact that those families living in poverty have little choice’, she claimed (8).
Iain Macwhirter, columnist with the Glasgow Herald, went so far as to argue that, ‘Right now, the tyranny of choice poses a far greater danger to liberty and well-being than the nanny state’. Macwhirter is gutted that the government did not demand ‘legal restrictions’ on advertising during children’s programmes, instead proposing a voluntary code, because ‘as every parent knows, it is extraordinarily difficult to combat the images transmitted daily through television and other media which implant in children’s minds a profound antipathy to anything remotely healthy’ (9). So again, choice needs to be restricted – because children are under the sway of the evil marketing of big food companies, and parents are apparently powerless to resist the resulting pester-power demands for ‘happy meals’ over ‘healthy meals’. In short, if you’re a smoker, poor, or a parent, choice is the last thing you need; far better just to be told what to do and be done with it.
If these are the ‘choice wars’, then they’re a sad spectacle. On one side we have a government that offers us hollow choices over healthy living, where really we are given guidance on the reportedly right and enlightened way to live. And on the other side the government’s critics, who want to rein choice in even further, all in the name of helping the helpless, of course, those who, unlike the Informed sections of society, are not in a position to make the right choices. We need to reclaim choice from this sorry lot, and put a bit of self-determination back on the agenda.
spiked-conference: Whose Choice Is It Anyway? Challenging the New Conformism. On 11 March 2005, spiked is hosting a conference interrogating the meaning of choice in the age of the new conformism, at a venue in central London. For more information, email Helene Guldberg.
Who would choose ‘Ronseal politics’?, by Mick Hume
The politics of pick’n’mix, by Brendan O’Neill
(1) Smoking ban proposed for England, BBC News, 16 November 2004
(2) Choosing Health: Making Healthier Choices Easier, HM Government, November 2004
(3) Choosing Health: Making Healthier Choices Easier, HM Government, November 2004
(4) Choosing Health: Making Healthier Choices Easier, HM Government, November 2004
(5) Choosing Health: Making Healthier Choices Easier, HM Government, November 2004
(6) Why isn’t New Labour proud to be the nation’s nanny?, Polly Toynbee, Guardian, 17 November 2004
(7) Dr Reid’s curate egg, Guardian, 15 November 2004
(8) The choice is yours, Guardian, 17 November 2004
(9) What’s all this about a nanny state? You can smoke outside, Iain Macwhirter, Herald, 17 November 2004
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