Pioneering NHS Adviser Proposes A Radical Prescription For Health Care

Main Category: Smoking / Quit Smoking
Article Date: 25 Oct 2007 - 1:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

A leading government adviser has proposed a radical plan to persuade people to stop smoking, take more exercise and change their diets.

New figures published show that England tops the European league as the fattest nation in the EU. Professor Julian Le Grand, chair of Health England and a former senior Downing Street aide to Tony Blair, said a completely fresh approach was required by Government to reverse the epidemic of obesity and to tackle similar ills caused by "excess consumption".

In a speech to the Royal Statistical Society last night, Professor Le Grand said instead of requiring people to make healthy choices by giving up smoking, taking more exercise and eating less salt, policies should be framed so the healthy option is automatic 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, an "exercise hour" to be provided by all large companies for their employees and a ban on salt in processed food.

The idea, dubbed "libertarian paternalism", reverses the traditional government approach that requires individuals to opt in to healthy schemes. Instead, they 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.

By preserving individual choice, the approach could be defended against charges of a "nanny state," he said. "Some people say this is paternalism squared. But at a fundamental level, you are not being made to do anything. It is not like banning something, it is not prohibition. It is a softer form of paternalism."

"Saying it is all the fault of society invites a nihilistic response, that nothing can work short of a revolution. We need new thinking and new ideas. We face new health challenges from obesity and old ones from smoking which add up to something of a crisis. There is a real risk that our children will die at a younger age than us," he said.

On smoking, he said permits could be issued annually and the signature of a doctor might even be needed. This would require individuals to "opt-in" each year to being a smoker, rather than "opting out" by choosing to give up.

"Sellers of tobacco from supermarkets to tobacconists would have to see the permit before any sale. To get a permit would involve filling out a form and supplying a photograph as well as paying the required fee. Permits would only be issued to those over 18 and evidence of age would have to be provided. The money raised for the permits would go to the NHS."

Professor Le Grand said the public health challenge was very different from half a century ago when William Beveridge founded the welfare state to tackle the "five giants" of want, disease, squalor, ignorance and idleness.

"His giants could be described as the giants of too little: too little income, too little work, too little education, too little housing, too little health care. Today's giants are the giants of too much."

http://www.ash.org.uk