Opinion: when it comes to public health issues like the regulation of alcohol, nanny state debates don't provide the answers.
Government paternalism is a controversial topic. Many believe making law and policy to influence choices in an effort to promote wellbeing is an unreasonable and unethical style of policy making, while others believe that saving lives is the priority even if that means certain restrictions. The use of forceful and absolutist language to claim that governments are intruding on individuals’ choices in an unreasonable and patronising manner (or "nanny state" rhetoric) has become a popular and highly effective strategy for those who oppose government paternalism in public health policy.
Governments have the legal power to pass laws to control where and how we buy alcohol, fatty foods or sugary drinks. They have the power to control where and how companies can advertise these products. They have the power to increase tax on these products, or even prohibit their sale entirely. But should governments use these powers, and if so, to what extent?
Let's take a look at recent new laws that regulate alcohol, to illustrate how nanny state rhetoric has been used to present the ethics of some of these laws in black and white terms, when in reality they are anything but. The Public Health (Alcohol) Act became law in Ireland in 2018. Amongst other things, it will mean that alcoholic beverages must cost a minimum amount calculated from their strength and volume.
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From RTÉ Radio 1's Drivetime, Barry Lenihan reports on what will and won't happen as a result of the Public Health (Alcohol) Act
Alcohol producers will not be able to advertise at bus stops or within a certain distance of a school, and that alcohol must be segregated from other goods with physical barriers in certain shops. The public health evidence strongly indicates that these rules would lower harmful alcohol consumption amongst the population. Nonetheless, should the Government's legal powers be used in this way?
The debate on this question is highly polarised. Advertising organisations have called the rules "unenforceable and unworkable", while public health organisations claimed that dropping plans for cancer warning labels on alcohol bottles would be an "insult" to cancer sufferers. Sweeping and largely unsupported remarks were made about the new legislation, ranging from a claim that the new alcohol rules would destroy the rural economy to a claim that Ireland will never escape from an underage binge-drinking crisis without these new regulations.
A large part of the debate has been taken over by the use of nanny state rhetoric. The purpose of this is to move discussion of the ethical acceptability of the laws away from the usually complex reality and into a space where you must choose to believe one position or the other. This makes it easier for those with vested interest in the outcome to gather support for the position that best suits them. The alternative – reasoned analysis using all available facts – often does not produce clear-cut ethical answers, and this does not serve vested interests well, even though the less clear-cut answers usually provide more accurate and helpful ethical evidence for policy-makers to consider.
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From RTÉ Radio 1's Drivetime, Alcohol Action Ireland's Eunan McKinney and Drinks Ireland's Patricia Callan, discuss the new rules about the advertising of alcohol.
Here's one example. The debate on whether the Public Health (Alcohol) Act 2018 should make it compulsory for alcoholic beverages to carry a cancer warning label, similar to those seen on cigarette packets, is dominated by nanny state rhetoric. An organisation representing Irish alcohol producers accused the government of being "anti-small business" and said that a "sweeping and heavy-handed 'alcohol causes cancer' statement makes little sense".
Deputy Michael Collins TD told the Dáil that "before we finish, there will be a requirement to have a little booklet hanging onto every bottle. The way we are going, a person will have to read such a booklet before he or she can buy alcohol. There is no common sense. There is not one bit of common sense going on in here". This kind of rhetoric invites, even forces us, to decide if we are on the side of common sense, or are we on the side of going too far.
But a public health law is not unethical just because it attempts to influence people's choices. The issue that the Public Health (Alcohol) Act 2018 tries to address – namely the fact that alcohol causes 900 cancers and 500 deaths every year in Ireland means that the more controversial rules within it deserve more detailed and reasoned ethical analysis.
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From RTÉ Radio 1's Today With Sean O'Rourke Show, a discussion on the Public Health (Alcohol) Act with Michael Collins TD and Professor Frank Murray from the Royal College of Physicians of Ireland
Cancer warning labels would indeed place some constraints on how alcohol producers choose to market their products. They would also indeed hopefully have some influence on individual consumption decision, for that is their purpose. But consider also that alcohol advertising has a proven influence on the drinking patterns of young people, and that much alcohol advertising is subliminally targeted at this group.
Behavioural science tells us that people are very bad at judging the cumulative effect of decisions and will tend to prioritise current wants over future plans, all of which is exacerbated when the person is young. Thus, cancer warning labels are intended to address very real behavioural phenomena to prevent people from developing a dangerous relationship with alcohol early in life, and this must be balanced against the constraint of choice.
READ: How alcohol advertising influences drinking behaviour
While nanny state rhetoric is a powerful tool for those with vested interests in the outcome of public health policy, it does not help us to reach the best decisions on ethical public health policy. The next time you see it being used, consider challenging the person doing so to a more detailed discussion of the facts and issues at stake.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
