Obesity, public health ethics and the nanny state

Abstract

Unhealthy dietary patterns are an important contributor to obesity and related non-communicable diseases (NCDs). As with any public health challenge, as well as providing care to affected individuals, whole-population interventions are required to mitigate the environmental determinants of population dietary patterns. The World Health Organisation (WHO) has established recommendations, including a set of low-cost, high-impact ‘best buys’ for governments seeking to implement these strategies. The Irish government has stated that it wishes to make ‘the healthy choice the easy choice.’ Yet, in marked contrast to its approach to tobacco- or alcohol-related harms, the Irish government has shown reluctance in implementing those WHO-endorsed strategies or other population-level measures to address unhealthy dietary patterns. Meanwhile, commercial interests work to discredit these measures as “paternalism” or more commonly as “nanny state” violations of individual liberty. We conducted a narrative review of the philosophical literature on paternalism, particularly the work of the 19th century philosopher John Stuart Mill, who originally formulated what became known as the ‘harm principle.’ Though an ardent defender of free trade and individual liberty, Mill argued that governments have a responsibility to limit the activities of commercial interests (such as taverns or gambling houses) where they encourage ‘excess’ that might harm the individual or society. The philosophical literature on paternalism gives strong arguments that government measures to limit potential public health harms arising from the consumption of unhealthy diets are not violations of individual liberty. On the contrary, governments are ethically obliged to make such interventions as are necessary to protect the liberty of individuals who are being misinformed and manipulated by industry. Rather than public health measures representing nannying by the state, we argue that they serve to counteract the ‘nefarious nannying’ by commercial actors, thus enhancing individual liberty rather than diminishing it.