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Last Updated: Tuesday, 25 July 2006, 23:11 GMT 00:11 UK
From nanny state to a helping hand
By Nick Triggle
Health reporter, BBC News

Tony Blair has made public health the subject of his end-of-term speech on Wednesday.

He raised the issue of how far the state can intervene and at what point individual responsibility kicks in. Does this mark a new tack for Labour?

Scene from the 1940s
People in the post-war period were more deferential

After WWII, and following the birth of the NHS, successive governments began to take an interest in the health of the nation.

Public health adverts on TV took a tough stance, telling parents what foods they should be giving their children.

The government also funded programmes to ensure cod liver oil was given free to young children, pregnant women and nursing mothers.

Such a dictatorial attitude from ministers was permitted for a generation which had grown up with rationing and deference to authority.

But, as Tony Blair has pointed out in his first major speech on public health in Nottingham on Wednesday, such a tack would fall on deaf ears today, as the government attempts to tackle the growing obesity and binge drinking problems.

Choices

Instead, he has set out a vision whereby the government merely creates the right environment for individuals to make healthy choices.

The "soft touch" approach does not quite mark a shift in emphasis - similar messages were voiced when the last public health white paper was published in 2004.

But it does show the government is serious about its attempt to rid itself of its nanny state image.

Dr Fiona Adshead, the government's deputy Chief Medical Officer for England, said the drive was born out of a need to be realistic about how people live their lives.

The real challenge is that people don't want to hear messages from government on television campaigns but people will listen to messages in sources like lifestyle magazines or watching on soaps and so on
Professor Ian Philp, from Sheffield University

"We have to understand how people live their lives. We can't approach it from the fantasy of how we would want them to.

"Some people will not always make the healthy choices.

"But I think if we can get the message across that a small change can make a big difference, and it is up to the individual to take responsibility for that, anything is achievable.

"What we can do is create the conditions for individuals to do that. Clear food labelling is one way this can be done, but we have to look to tailor approaches to individuals."

To do this, the government is embracing a technique called social marketing which attempts to use well-researched, subtle measures to get people to make healthy choices.

One example often cited by government officials is a scheme run by health chiefs in the south London borough of Lambeth.

Since the start of the year the local primary care trust has been targeting shops selling cigarettes to young professionals and people on low incomes.

Retailers

With the agreement of retailers, sleeves have been placed on cigarette packets giving details about local smoking cessation services.

The government has also been promoting the rolling out of health trainers, personal instructors who give advice about how people can adopt healthy lifestyles.

The government has promised 1,200 will be employed by 2007, and while it is on target many of these are being funded by businesses, the voluntary sector and even the army.

And for some this goes to the heart of the problem with the government's approach.

Overweight woman eating chips
Obesity rates have been rising

Just last week, England's Chief Medical Officer, Sir Liam Donaldson, was warning in his annual report public health budgets were being raided to solve the NHS problems with deficits.

Meanwhile, others believe the government should not be afraid of being accused of being a nanny state and taking a tough stance as they have done with the smoking ban.

Kevin Barron, chairman of the House of Commons Health Select Committee, said ministers were "too nervous".

"I think that what all governments have to do is to think about what's good for the public, getting the right messages out, and then just getting on with it basically.

"Put right, argued properly, we shouldn't be scared of somebody shouting to us 'nanny state'."

But Professor Ian Philp, a health expert at Sheffield University and national director for older people, said the government should be careful about being too heavy-handed.

"The real challenge is that people don't want to hear messages from government on television campaigns but people will listen to messages in sources like lifestyle magazines or watching on soaps and so on."


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