Irish obesity policy: Is it ‘nanny state’ or neglect?
More than a quarter of the adult population in the Republic classified as obese, according to figures published by the European Commission earlier this year. File Picture: PA
In Ireland at least, Covid-19 is receding from the front pages to take its place alongside the other chronic, seemingly ineradicable public health problems of our time.
But the pandemic still has lessons for our overall approach to public health. Above all, the Government response to Covid-19 shows us that, with enough political will, previously unthinkable measures can be put in place to protect individuals.
Of course, there are often good reasons why some measures were not considered pre-pandemic. Public health policy is never simply a matter of weighing risks and benefits; we must also preserve liberty. Fundamentally, individuals have the right to make their own decisions, and this cannot be infringed upon without very good reason.
One possible reason we might be willing to accept limits on liberty is to prevent harm to third parties. Given the high stakes of an infectious and potentially fatal disease, we may be willing to tolerate limits on liberty that, ordinarily, we would consider at best unpalatable, at worst, deeply unethical.
Choosing what to have for dinner from among the available options is about as basic as liberties get. Why should the Government be allowed to use measures like taxation to influence my food choices?
Phrased in this way, the question assumes that, as long as the Government doesn’t intervene, I am perfectly free to choose what to eat.
But my choices are limited by factors beyond my control. I may live near a supermarket, or in a remote rural location without a car. I may have a fridge and a cooker in my home, or not.
I may be able to have gourmet takeaways delivered right to my door in minutes, or not. Even with all these advantages, my choices are still influenced by outside factors.
Have you ever left work intent on making a nourishing, home-cooked meal, only to find yourself bombarded by less healthy food marketing on the bus, interrupting your podcast, at the checkout?
Some 150 years ago, philosopher John Stuart Mill was already worried about how businesses shape our choices.
Mill argued that governments must protect individuals against industries such as gambling and alcohol. He argued that, since governments must raise taxes somehow, they should use taxation to act as a counterweight to industries that profit from, as he put it, “encouraging excess”.
Just like the gin palaces and gambling houses of Mill’s era, the food industry profits from unhealthy eating, and thus has a vested interest in encouraging such behaviour.
In this context, it seems naïve to think we are free to make our own choices, as long as the Government doesn’t intervene.
Rather, by failing to intervene, governments just leave the way clear for industry to manipulate us, leaving us with limited options, all too many of which are neither healthy nor truly free.
It’s not that the authorities are unaware of the problem.
In Ireland alone, since 1992, there have been no less than five programmes for government with obesity as a key challenge, four obesity taskforces, four national frameworks, two 10-year national action plans, 13 reports on recommendations and progress, four national nutrition surveys, five sets of guidelines, three policies, and four healthy eating strategies.
If the goal was to convince the public that healthy eating and weight maintenance are important, these measures have been successful — just think of how many Irish people diet along with every year.
But if the goal was to actually reduce obesity or improve health, they have been an abject failure.
It seems that the missing ingredient in our public health formula is not individual awareness or willingness, but environmental measures that empower individuals to actually make healthy choices.
In explaining how intervention and even coercion can be compatible with liberty, Mill used the example of a man walking towards a dangerous bridge.
He noted that persuasion and education would always be preferable to coercion, even in this scenario. If a bystander had the option simply to tell the man the bridge was dangerous and then allow him to make his own decision on how to proceed, that would, of course, be the right thing to do, but direct intervention is justified if it is the only way to prevent the man from unwittingly putting himself in grave danger.
For Mill’s man-on-the-bridge analogy to be relevant in the context of obesity policy and the individual facing the risks of developing obesity, we need to imagine that, as he goes about his day, making choices about the best course of action, the man is constantly bombarded with claims that the view from the bridge is breathtaking, that all of the cool people hang out on the bridge, that the people who own the bridge are working hard to make it safer, and that most people get across the bridge just fine, if they are adequately careful and sensible.
If you fall into the water, the problem is with you; the bridge is fine, and, anyway, forcing them to fix the bridge would be “nanny state-ism”.
By framing the issue this way, they mask their own control over the environment and the ways in which they manipulate us.
By failing to act as a counterweight to this control and manipulation, government is failing in its responsibility to enable and defend the liberty of citizens. In this context, it’s not just that government may step in, but that ethically speaking, it must.
This article is based on a recently published scientific paper exploring obesity, ethics and the ‘nanny state’, a collaboration between researchers in medicine and philosophy at NUI Galway and marketing at Trinity College Dublin.
