Health Secretary Andrew Lansley wants to nudge, not nanny

Health Secretary Andrew Lansley wants to nudge, not nanny

In the UK General Election in May there were few who doubted that the food industry got the result it wanted. A Conservative-controlled government would be more 'business-friendly', would seek to disband or reform the Food Standards Agency with which industry was enduring an increasingly difficult relationship, and regarding the economy the business community in general had little confidence left in the Labour administration and was seeking change.

The publication of the Department of Health's White Paper, Healthy Lives, Healthy People, yesterday (1 December) will have given the food industry further reason for satisfaction with the result.

True to what he had said in opposition, Health Secretary Andrew Lansley has given companies a significant say in determining how key food/health issues such as obesity and alcohol abuse are tackled. It will establish five networks with membership from government, business and the voluntary sector focusing on food, alcohol, physical activity, health at work and behaviour change. A 'public health responsibility deal' will be launched next year.  Industry satisfaction is matched by the chagrin of many campaigners, academics and politicians.

It is easy to paint this as a laissez-faire, right-of-centre administration bowing to the lobbying of big business and giving industry and the market free rein. Sceptics would suggest that conclusion is the easiest to draw because it is totally accurate.

However, defenders of the Responsibility Deal would argue that it fits with a number of other strands of the new administration's health policy and wider thinking. 

It is certainly fair to say that engagement with industry chimes with the White Paper's emphasis on preventive measures. Once again, campaigners will point to industry dragging its feet on reformulation and the big divide between public health and industry on front-of-pack nutritional food labelling. But there is a strong case for saying that cooperation between public health and industry can yield progress on diet and health issues. Some would go as far as to say that getting industry 'onside' is vital and can be fruitful. The FSA's campaign on salt reduction is held up, by both sides, as a successful case to point.

Health professionals may have been critical of some elements in the White Paper but they have been supportive of the emphasis on preventive measures.

It also puts the emphasis on personal responsibility, a move away from the 'nanny state' to one which 'nudges' people to improve their diet, rather than prescribing how we should live. Health campaigners are sceptical about this. Such an approach may work relatively well with higher income and better educated consumers but, many academics contend, will be less successful in changing behaviour among lower income groups, where many diet-related health problems are at their worst. Industry, on the other hand, loves the personal responsibility mantra: 'there are no bad foods, only bad diets'.

The British Medical Association (BMA) said it was encouraging that the Government is seeking to create an environment where individuals can make healthy choices, but said doctors were also looking for concrete action from Government. 

"We agree that 'nudging' people to be healthy may be more effective than only telling them how to live their lives," said Dr Vivienne Nathanson, BMA director of professional activities. "However, if people live in an environment where they are surrounded by fast food advertising and glamorous alcohol marketing, nudging will have a limited effect. We need an environment that helps us make healthy choices and sometimes tougher action is needed to achieve this."

Anna Dixon, director of policy at The King's Fund, also supported the idea of nudging people towards adopting healthier lifestyles but said that the ban on smoking in public had shown that tough positive action by government was also necessary.

Moreover, given the criticisms that Lansley's nudging philosophy has received from his own party – essentially that it is nannying by another name and still seeks to 'micro-manage' people's lives – one can imagine that the nudges such that they are will be fairly gentle ones. 

The reform package is also a decentralising one. The previous administration was criticised for adding hugely to the bureaucracy of the NHS and the Conservative administration was always likely to seek to address this, both on cost and ideological grounds. The primary manifestation of this is giving local authorities responsibility for localised public health policy, but it could be said that giving some responsibility for health improvement strategies to the five multi-stakeholder networks – after all it is not only industry which is represented on these panels – is part of the same shift. There is something of the Prime Minister's overarching 'big society' philosophy in this too, though Professor Sir Ian Gilmore, outgoing president of the Royal College of Physicians said the White Paper looked "looks less like the 'big society' and more like big business".

At the risk of being bland, the proof of the low-fat pudding will be in the eating. Critics complain that the Government has placed too much onus on the industry's own moral compass. 

Industry should be concerned that this view is far from confined to radical campaigners. Professor Tim Lang, who is not only a highly respected academic on food policy but also a government advisor, said: "The White Paper is over-reliant on corporate responsibility. History tells us that public health advancement occurs when frameworks change. Obesity and lifestyle change won't come from corporate responsibility, not least since too many of the companies driving and profiting from unhealthy living pour money into marketing that lifestyle."

Much is made by those within the business world who believe strongly that priorities are changing and that corporate social responsibility can no longer be fairly characterised as window-dressing and greenwash. It appears that in the food sector, the coming few years will provide plenty of opportunities for those individuals to step up to the plate. Food companies are likely to have a freer rein and it will be beholden on industry to use that freedom responsibly.