Source: The Independent (uk)
Date: 2010-07-13
Author: Jeremy Laurance / Medical Life

Andrew Lansley, the trim 58-year-old health secretary, is
impatient with Government efforts to make us fitter or slimmer or
healthier.  . . .

Julian le Grand, professor of health policy
at the London School of Health Economics and a former No 10
adviser to Tony Blair, has an interesting take on this – he
calls it libertarian paternalism. Instead of requiring people to
make healthy choices – by giving up smoking, taking more
exercise, eating healthily – he has suggested turning things
around so the automatic default option is the healthy option, and
people have to choose deliberately to depart from it.

Among his suggestions are a proposal for a smoking permit, which
smokers would have to produce when buying cigarettes . . .

The beauty of this idea is that instead of opting in to healthy
schemes, people would have to opt out to make the unhealthy
choice – by buying a smoking permit, choosing not to
participate in the exercise hour or adding salt at the table. The
ingenious thing about this approach is that it preserves
individual choice, and can therefore be defended against charges
of a "nanny state". You are not being made to do anything or
being banned from anything. There is no prohibition. It is a
softer form of paternalism.

Lansley, on present form, is unlikely to be interested. Yet the
evidence on the benefits of paternal regulation is staring him in
the face. The proposal to ban smoking in all enclosed public
spaces (including, most controversially, pubs) split the
government and provoked a prolonged political battle over "nanny
state" Britain. Instead it triggered the biggest fall ever seen
in smoking in England, with over two billion fewer cigarettes
smoked in the first year. A study last month showed, more than
1,000 heart attacks were prevented.

We may not like nanny but we are going to miss her.