‘Nanny State’ comments get on my goat

By Prof Geoff Dobb

‘Nanny state’ is now the predictable response to public health initiatives from those with little understanding of the issues. This catchcry is then taken up by the radio shock jocks and other commentators as an excuse not to inform the Australian community or oppose measures that will improve their health.

Now, I don’t know about you, but I loved my Nan. She cared for me, kept me from harm, and we had a lot of fun. How come ‘Nanny’ has become associated with suggestions of burdensome restrictions and abandonment of fun? Australians are free to make their choices about lifestyle as long as the choices are legal. But these choices need to be informed, the healthy options should be easy to access and obvious, and price signals should be used to support the healthy and discourage the unhealthy. And I know you were going to ask – yes, there is evidence that such price signals change behaviour.

Unfortunately the adverse depiction of the lobbying for public and preventative health comes mostly from those who will profit from product sales and those with an uninformed view of the consequences of not taking the healthy options.

As a doctor at the sharp end of hospital medicine the impact of tobacco smoking, excessive alcohol, obesity and lack of regular exercise on hospital admissions and recovery from acute illness are all too obvious to me. I have considerable respect for my colleagues who are public health physicians, but have concern that their advice and expertise are undervalued by those in the health bureaucracy – until the health of the nation is threatened by an acute epidemic or pandemic. The effects of chronic disease on the nation’s health are less attention grabbing but the effects on health are every bit as important and profound, as recently recognised by the World Health Organisation.

There are some promising signs. The Preventative Health Taskforce and the Australian National Health Agency can provide leadership in this area and guide policy development, but it’s still too early to judge their impact. The National Partnership on Closing the Gap in Indigenous Health Outcomes and the National Binge Drinking Strategy will be watched closely to follow any effect on health outcomes. There’s been plenty of talk. Now it’s time to see the walk, and here the initiative on plain packaging of tobacco is world-leading.

Yet, in other areas, Australia is leading in the wrong direction. The conflicting price signals on alcohol are an example (see the report on the NAAA Summit). The lukewarm response to initiatives that would give consumers more information on the nutritional quality and quantity of ‘fast foods’ is another, and the lack of adequately informative health warnings on alcoholic beverages yet another.

With the vested interests behind opposition to such initiatives, it is likely that real change will only come when legislation makes the change mandatory. Public health has a track record that supports this assertion: from John Snow and the Soho pump, to the British Clean Air Act, to Victorian legislation on car seat belts that was followed by other States, to the State and Territory legislative changes that have influenced the reduction in tobacco smoking.

Legislation sends the strongest message on the behaviour our community believes is right. This is not the ‘Nanny state’. It is the responsibility of legislators if they care and want to help keep us from harm, and can be done so it doesn’t get in the way of fun and choice.