Nanny or canny? Community perceptions of government intervention for preventive health

Abstract

Critics of government intervention for the prevention of lifestyle-related chronic disease often conceptualise such efforts as ‘nanny state’, reflecting a neoliberal perspective and derailing wider debate. However, it is unknown how the community perceives such interventions. Given the importance of public opinion to government willingness to implement population-level system change, we aimed to better understand Australian community attitudes towards government-led prevention, in particular whether nanny state conceptualisations reflect community attitudes. We used an iterative mixed methods approach to data collection and analysis based on focus groups (n = 49) and a national survey (n = 2052). Despite strong endorsement (91%) of personal responsibility for health, 46% of survey respondents thought government plays a large role in prevention. The nanny state conceptualisation was not dominant in either the survey or focus group data. Qualitative data analysis highlighted alternative conceptualisations, namely government as a: canny investor; leader on positive health behaviour; partner or facilitator for health. Respondents’ level of support for specific interventions overlaid these general conceptualisations with considerations of the target population and risk factor, intervention mechanism and government motives. Community perceptions regarding prevention therefore reflect more thoughtful and complex interpretations of preventive actions and policies than suggested by nanny state conceptualisations. We argue that advocates and legislators should not allow debate around preventive measures to be restricted to the nanny state–libertarian continuum, but engage the community in more collectivist considerations of future health costs, beneficiaries, equity and likely outcomes of both action and inaction in order to garner community support and identify information gaps.