some (academic) rebuttal arguments to the nanny state line

‘Nanny-state’ accusations can function as powerful rhetorical weapons against interventions intended to promote public health. 

Public health advocates often lack effective rebuttals to these criticisms

For those with a bit of   time and energy, here are some things to read –  some decent academic literature on this topic. This is basically a reading list.

These, maybe apart from the first, are academic and rooted in political philosophy and different notions / interpretations of the  the term freedom or Liberty.

Next blog will be more street talking.

Hopefully the references all work. If they don’t email me and I’ll sort.

1) One hundred and fifty ways the nanny state is good for us 

This is the classic popular read

The institute of public affairs (which I can only assume is akin to the IEA in this country) published a list of 75 policies or institutions it would like to see abolished:

http://ipa.org.au/publications/2080/be-like-gough-75-radical-ideas-to-transform-australia

Or 150 examples of heinous intrusions on personal freedom:

http://tobacco.health.usyd.edu.au/assets/pdfs/publications/150-examples-of-nanny-state.pdf
In response Simon Chapman published a list of 150 ways the nanny state is good for us. 

It’s somewhat of a classic:

http://theconversation.com/one-hundred-and-fifty-ways-the-nanny-state-is-good-for-us-15587



2) Hastings Centre series post Bloomberg

For those with a more academic bent – an excellent series of articles in the wake of the end of Bloomberg time as mayor 

well worth reading

A Broader Liberty: JS Mill, Paternalism, and the Public’s Health

Lawrence O. Gostin

http://scholarship.law.georgetown.edu/ois_papers/19

Defending Public Health Regulations: The Message Is the Medium

DOI: 10.1002/hast.243. HASTINGS CENTER REPORT January-February 2014

Making the Case for Health-Enhancing Laws after Bloomberg

  HASTINGS CENTER REPORT January-February 2014

Bloomberg’s Health Legacy: Urban Innovator or Meddling Nanny?

Lawrence O. Gostin

http://scholarship.law.georgetown.edu/facpub/1285

http://ssrn.com/abstract=2334823
A Broader Liberty: JS Mill, Paternalism, and the Public’s Health

Lawrence O. Gostin

http://scholarship.law.georgetown.edu/ois_papers/19
Bloomberg, Hitchens, and the Libertarian Critique

HASTINGS CENTER REPORT January-February 2014. DOI: 10.1002/hast.242
Innovative Policies under Bloomberg’s New’ Public Health

HASTINGS CENTER REPORT January-February 2014. DOI: 10.1002/hast.244
Bloombergs Nanny State Refuting opposition to the newpublic health . Gostin 

http://blog.constitutioncenter.org/2013/12/bloombergs-nanny-state-refuting-opposition-to-the-new-public-health/ 




3) Public Health mini symposium  

Lastly a mini symposium in Public Health from 2015 are also excellent, I have made as much available here as the paywall will let me

Public Health August 2015 Nanny State. http://www.publichealthjrnl.com/issue/S0033-3506(15)X0008-4

The rise or fall of the nanny state?

F. Sim, P. Mackie. p1015–1016

The State can be an institution that has much or little control over the lives of its citizens. Over the millennia of successive civilisations, we have seen many models of nationhood emerge, differing widely in the freedoms offered to their people. In the UK and many other developed Western nations of today, the extent to which the State is perceived to have control is an important aspect of the nation’s culture. A commonly used, largely derogatory term for such influence or control is the Nanny State.

Who’s afraid of the nanny state? Introduction to a symposium

Roger S. Magnusson, Paul E. Griffiths.  p1017–1020
The ‘nanny state’ has become a powerful symbol in debates about the merits of public health policies. In rhetorical terms, associating a policy proposal with the nanny state is to spoil and disparage it, at least in western, liberal democracies where individuals have become highly sensitised to the risks of state intrusion into the private domain. Debates about the nanny state are not new. However, they have a particular salience when it comes to policies for reducing behavioural or lifestyle-related risks factors including tobacco use, harmful use of alcohol, poor diet and obesity.

Relational conceptions of paternalism: a way to rebut nanny-state accusations and evaluate public health interventions

S.M. Carter, V.A. Entwistle, M. Little. p1021–1029

Nanny-state’ accusations can function as powerful rhetorical weapons against interventions intended to promote public health. Public health advocates often lack effective rebuttals to these criticisms. Nanny-state accusations are largely accusations of paternalism. They conjure up emotive concern about undue governmental interference undermining peoples’ autonomy. But autonomy can be understood in various ways. We outline three main conceptions of autonomy, argue that these that can underpin three different conceptions of paternalism, and consider implications for responses to nanny-state accusations and the assessment of public health interventions.

Highlights

•Public health interventions are sometimes criticized as ‘nanny-state’ actions.

•A ‘nanny-state’ action is a type of (allegedly) paternalistic action.

•An allegedly paternalistic act is considered wrong because it undermines autonomy.

•‘Nanny-state’ accusations rely on a flawed libertarian conception of autonomy.

•A relational conception of autonomy and paternalism is more useful to public health.

Nanny-state accusations are largely accusations of paternalism. They conjure up emotive concern about undue governmental interference undermining peoples’ autonomy. 

But autonomy can be understood in various ways. 

We outline three main conceptions of autonomy, argue that these that can underpin three different conceptions of paternalism, and consider implications for responses to nanny-state accusations and the assessment of public health interventions.

Results

The conceptions of paternalism implicit in nanny-state accusations generally depend on libertarian conceptions of autonomy. These reflect unrealistic views of personal independence and do not discriminate sufficiently between trivial and important freedoms. Decisional conceptions of paternalism, like their underlying decisional conceptions of autonomy, have limited applicability in public health contexts. Relational conceptions of paternalism incorporate relational conceptions of autonomy, so recognize that personal autonomy depends on socially shaped skills, self-identities and self-evaluations as well as externally structured opportunities. They encourage attention to the various ways that social interactions and relationships, including disrespect, stigmatization and oppression, can undermine potential for autonomy. While nanny-state accusations target any interference with negative freedom, however trivial, relational conceptions direct concerns to those infringements of negative freedom, or absences of positive freedom, serious enough to undermine self-determination, self-governance and/or self-authorization.

Conclusion

Relational conceptions of autonomy and paternalism offer public health policymakers and practitioners a means for rebutting nanny-state accusations, and can support more nuanced and more appropriately demanding appraisals of public health interventions.




Which nanny – the state or industry? Wowsers, teetotallers and the fun police in public health advocacy

M. Moore, H. Yeatman, R. Davey. p1030–1037

There is no option for avoiding the ‘Nanny’. The only option for communities is to make sensible choices about which ‘Nanny’ will dominate their lives and at what time, which ‘Nanny’ will make us healthy and which ‘Nanny’ will undermine our health and our freedoms. Those political ideologues who use ‘nanny statism’ largely do so to further their own agenda and are invariably inconsistent in how they apply their concept of non-interference. Who’s afraid of the ‘Nanny State’ is not the question should be asking.

Highlights

•The paper wrestles with the challenge presented by conservatives who increasingly rely on the nanny state as a method of preventing arguments for governments to intervene to protect public health.

•The attitude is based on seeing government in terms of ‘interfering’ when they seek to regulate. The nanny state is a call for ‘non-interference’.

•The highlight of the argument in this paper is that government regulation should be based on issues of dominance rather than interference. If government does not prevent dominance, then industry fills the gap.

•They will have a nanny. The choice is do they accept nanny alcohol, nanny gambling, nanny tobacco and so on. Or are they better to accept the role of government in as far as it acts as a nanny.

Abstract

There is no option for avoiding the ‘Nanny’. The only option for communities is to make sensible choices about which ‘Nanny’ will dominate their lives and at what time, which ‘Nanny’ will make us healthy and which ‘Nanny’ will undermine our health and our freedoms. Those political ideologues who use ‘nanny statism’ largely do so to further their own agenda and are invariably inconsistent in how they apply their concept of non-interference.

Who’s afraid of the ‘Nanny State’ is not the question should be asking. Rather the question ought to be – which Nanny should cause the greatest concern? 

The prime reason that the ‘Nanny State’ conjures fear is that it is a threat to the freedoms that are a key element of democratic societies. The tenet understood by the concept of the ‘Nanny State’ is that the more regulation that is made by the State, the more freedoms are whittled away and it is the intention of the wowsers, the teetotallers and the fun police to do so.

It is time to rethink the ‘nanny’ concept, from the narrow sense of loss of individual freedoms (and one which favours ‘free enterprise’ and money making interests of big industry) to that which enables individuals and populations freedom from domination. Such a change particularly pertains to our understandings of the role of government.
Pettit’s work in framing the notion of freedom in terms of ‘dominance’ rather than ‘interference’ is pertinent. It provides a more realistic way in which to understand why industry uses the ‘Nanny State’ argument. It is to maintain its own dominance (i.e. in matters of public health) rather than allowing governments to interfere with that dominance.

Public health advocacy work is regularly undermined by the ‘Nanny State’ phrase. This paper explores a series of examples which illustrate how public health is being undermined by the ‘Nanny Industry’ and how industry uses fear of government regulation to maintain its own dominance, to maintain its profits and to do so at a significant financial and social cost to the community and to public health.

Informed choice and the nanny state: learning from the tobacco industry

Janet Hoek. p1038–1045

To examine the ‘nanny state’ arguments used by tobacco companies, explore the cognitive biases that impede smokers’ ability to make fully informed choices, and analyse the implications for those working to limit the harmful effects of other risk products.

Highlights

•I examine informed choice and nanny state rhetoric used by the tobacco industry.

•I analyse how this rhetoric has impeded policy adoption and implementation.

•Marketers of other risk products are drawing on tobacco industry rhetoric.

•Public health researchers have an opportunity to reframe the nanny state.

•State intervention does not remove free choice, but may be a prerequisite to it.

Objectives
To examine the ‘nanny state’ arguments used by tobacco companies, explore the cognitive biases that impede smokers’ ability to make fully informed choices, and analyse the implications for those working to limit the harmful effects of other risk products.

Study design
A critical analysis of the practices engaged in by the tobacco industry, the logic on which they relied, and the extent to which their work has informed approaches used by other industries.

Results
The tobacco industry’s deliberate strategy of challenging scientific evidence undermines smokers’ ability to understand the harms smoking poses and questions arguments that smoking is an informed choice. Cognitive biases predispose smokers to discount risk information, particularly when this evidence is disputed and framed as uncertain. Only state intervention has held the tobacco industry to account and begun ameliorating the effects of their sustained duplicity. Evidence other industries are now adopting similar tactics, particularly use of ‘nanny state’ claims to oppose proportionate interventions, is concerning.

Conclusions
Some marketing strategies have deliberately mis-informed consumers thus directly contributing to many public health problems. Far from removing free choice, government policies that restrain commercial communications and stimuli are prerequisites necessary to promote free choice.




Public health and the value of disobedience

Gerard Hastings. p1046–1054

The writings of a sixteenth century French teenager may seem a stretch for a public health readership, but Etienne de la Boétie’s treatise on Voluntary Servitude explains why unjust systems prevail and how they can be changed. They prevail, he shows, because we let them (the losers always vastly outnumber the winners); and they change when we retract our permission (as Ghandi demonstrated). These vital insights have inspired progress down the centuries – the enlightenment philosophers, the French Revolution, Tolstoy, the American civil rights movement as well as the Indian struggle against the British Empire.



Freedom and the state: nanny or nightwatchman?

P. Pettit. p1055–1060

There are two rival images often offered of the state. In one the state serves like a nanny to provide for the welfare of its members; in the other it requires people to look after themselves, providing only the service of a night-watchman. But this dichotomy, which is routinely invoked in debates about public health and welfare provision in general, is misleading. What the rival images turn on is not competing pictures of how the state should function in people’s lives but competing pictures of what it is to guard the freedom of its people.

Highlights

•A major issue in public health is whether the state should cater for individuals or let them cater for themselves.

•On the one side are those who argue for a nanny state.

•On the other are those who argue for a nightwatchman state that lets people generally look after their own welfare.

•The conflict is often represented as a conflict between those who care primarily about welfare and those who care mainly about freedom.

•A philosophically more challenging account would trace the divide to two different images of what freedom involves.

There are two rival images often offered of the state. In one the state serves like a nanny to provide for the welfare of its members; in the other it requires people to look after themselves, providing only the service of a night-watchman. But this dichotomy, which is routinely invoked in debates about public health and welfare provision in general, is misleading. What the rival images turn on is not competing pictures of how the state should function in people’s lives but competing pictures of what it is to guard the freedom of its people. On the neo-liberal theory, which has been dominant over the last century or so, providing for people’s freedom means leaving them to their own devices and fortunes. On the neo-republican theory, which answers to a much longer tradition, it means democratically identifying a common set of basic liberties in the exercise of which everyone should be protected by law and, if necessary, resourced. This older way of thinking about freedom has important merits missing in the newer and argues strongly against the nightwatchman state.



Reprint of: Food reformulation and the (neo)-liberal state: new strategies for strengthening voluntary salt reduction programs in the UK and USA

B. Reeve, R. Magnusson. p1061–1073

Globally, excess salt intake is a significant cause of preventable heart disease and stroke, given the established links between high salt intake, high blood pressure, and cardiovascular disease. This paper describes and evaluates the voluntary approaches to salt reduction that operate in the United Kingdom and the United States, and proposes a new strategy for improving their performance. Drawing on developments in the theory and practice of public health governance, as well as theoretical ideas from the field of regulatory studies, this paper proposes a responsive regulatory model for managing food reformulation initiatives, including salt reduction programs.

Highlights

•Excess salt intake is a significant cause of preventable heart disease and stroke.

•This paper analyses voluntary salt reduction strategies operating in the UK and US.

•It presents a strategy for improving these initiatives using legislative scaffolds.

•This model escalates from self-regulation to co-regulation if industry fails to achieve targets voluntarily.
Globally, excess salt intake is a significant cause of preventable heart disease and stroke, given the established links between high salt intake, high blood pressure, and cardiovascular disease. This paper describes and evaluates the voluntary approaches to salt reduction that operate in the United Kingdom and the United States, and proposes a new strategy for improving their performance. Drawing on developments in the theory and practice of public health governance, as well as theoretical ideas from the field of regulatory studies, this paper proposes a responsive regulatory model for managing food reformulation initiatives, including salt reduction programs. This model provides a transparent framework for guiding industry behavior, making full use of industry’s willingness to participate in efforts to create healthier products, but using ‘legislative scaffolding’ to escalate from self-regulation towards co-regulation if industry fails to play its part in achieving national goals and targets.




Case studies in nanny state name-calling: what can we learn?

R.S. Magnusson. p1074–1082. Open Access

The ‘nanny state’ has become a popular metaphor in debates about public health regulation. It fulfils a particular role in that debate: to caution government against taking action. This paper presents case studies of nanny state criticisms, using them to identify a series of contextual features that may assist in better understanding, evaluating and where appropriate, resisting the rhetorical force of nanny state criticisms. The case studies presented include Rush Limbaugh’s reactions to Michelle Obama’s efforts to encourage American food companies to market healthier food to children; Christopher Hitchens’ critique of New York City Mayor Michael Bloomberg’s public health policies; and the reaction of neoliberal think tanks to Australia’s plain tobacco packaging legislation.



Of nannies and nudges: the current state of U.S. obesity policymaking

R. Kersh. p1083–1091

In the sprawling American political debates over obesity, which date back a decade and a half, ‘nanny state’ has been a rhetorical cudgel used to oppose those seeking even modest state action to address rising obesity rates. This essay explores obesity policy through the prism of state involvement, focusing on four possible types of response to what virtually all those involved—physicians and nutritional scientists, public-health advocacy groups, even food industry executives—agree is a serious threat to individual and collective health.

Lastly

For those that have persevered (well done) here is a prize

This paper is excellent

RELATIONAL CONCEPTIONS OF PATERNALISM: A WAY TO REBUT NANNY- STATE ACCUSATIONS AND EVALUATE PUBLIC HEALTH INTERVENTIONS 

http://aura.abdn.ac.uk/bitstream/handle/2164/6292/SUBMITTED_PUHE_D_14_00498_R1_Main_Text.pdf;jsessionid=27FFC561F40D4D9D1423C6AA1311FF6E?sequence=2

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