Promoting the public health requires a Nanny State

Food, work, stress- Image of fruit as part of a good sugar reduced diet

Two features in the latest edition (12th September 2015) of the British Medical Journal highlight the need for a Nanny State to promote and secure the public health

Firstly, a news item about a preliminary opinion of the European Court of Justice and secondly a Blog by Tim Ballard, vice chair of the Royal College of General Practitioners

The news item relates to the legislation passed by the Scottish government in 2012 to introduce a minimum price of 50p per unit of alcohol with the aim of reducing the prevalence of alcohol abuse. Implementation of the legislation was delayed because of a legal challenge from the drinks industry. The advocate general of the European Court of Justice has now concluded that national rules on pricing can be imposed that restrict trade and distort competition but only if they are appropriate for the attainment of the objective pursued and superior to alternative measures such as increased taxation.

Supporters of minimum pricing have welcomed this opinion as showing that minimum unit pricing is not precluded by EU law and can be implemented if it is shown to be the most effective public health measure available.

The Blog item is about Jamie Oliver’s new campaign for levying a voluntary sugary drink tax in restaurants as a means of tackling the obesity epidemic. It contains this statement by Tim Ballard, “Throughout my career I’ve been concerned by the desire of successive governments to place doctors in the front line to deal with the consequences of lifestyle choices, long believing that the pen in the hand of the legislator is mightier than the pen and the prescription pad.”

When I was a member of the now defunct Public Health Alliance/UK Public Health Association I was intrigued that one of its stated aims was to combat so called anti-health forces. Anti-health forces was a new term to me and at first it seemed rather fanciful, but now I understand that promoting the public health is a constant battle against the likes of the drinks industry in respect of alcohol abuse; and against the agri-food complex in respect of the obesity epidemic.

We need much more of the “pen in the hand of the legislator” and less of the pointless transfer of responsibility for tackling key public health challenges to doctors and others whose powers to make any impact are, as Tim Ballard acknowledges, very limited indeed. So, roll on the Nanny State – after all Nannies are good things!

Paul Walker

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