Tuesday, 16 June 2015

Nanny state name-calling

An Australian academic called Roger Magnusson has written an article for the journal Public Health about 'nanny state name-calling'. Insofar as he has a point to make, it is that the things libertarians complain about do not actually impede liberty. He uses several 'cases studies' in his article to illustrate this, including a rant by Rush Limbaugh and articles by Jacob Sullum and Christopher Hitchens.

He lets himself down badly by understanding neither what the market is nor what the people he is criticising actually believe. With regards to Limbaugh, he characterises his position (and, therefore, the 'neoliberal' position) as follows:

The state should be agnostic about what citizens choose to eat and drink, and whether or not they smoke, deferring instead to the wisdom of the market.

But the market represents nothing more that the aggregated decisions of citizens. It would make more sense to say: "The state should be agnostic about what citizens choose to eat and drink, and whether or not they smoke, deferring instead to the wisdom of citizens." This, of course, is an eminently respectable and liberal position to take. You would have to be a snob or a control freak to disagree with it, hence the need to obfuscate with talk of 'the market' as if it were something that is imposed on people.

...in an article entitled ‘The war on fat: is the size of your butt the government's business?’, Joseph [sic] Sullum frames government actions to reduce population weight gain as anti-capitalist manipulation. ‘[T]he war on fat … reflects an anti-capitalist perspective that views people as helpless automatons manipulated into consuming whatever big corporations choose to produce. The anti-fat crusaders want to manipulate us, too, but for our own good’.

His name is Jacob Sullum, not Joseph Sullum, but hey, this is a public health paper, we can't expect the peer review to pick up these things...

There are some important lessons here for public health campaigners. Nanny state theorists have become experts in framing health interventions as insults to the dignity and intelligence of ordinary people. This helps to explain why the nanny state critique applies not only to interventions that truly restrict the freedom of individuals (e.g. smoke-free laws), but to non-coercive, information-based interventions – like health warnings, and clearer nutrition labelling – that are aligned with the values of consumerism: informed choices and personal responsibility.

That really depends on what you call 'non-coercive'. Sullum's article was about Kelly Brownell, a leading campaigner for the 'Twinkie tax' and other illiberal anti-obesity interventions. As Sullum explains, Brownell intends to reduce obesity "through a combination of taxes, subsidies, censorship, and regulation." You don't need to be a radical libertarian to view sin taxes as a restriction on liberty—they are, after all, essentially fines for living your life as you see fit. Nor is it ridiculous to see advertising bans as a form of censorship which negatively impacts consumers by limiting the information available to them. Banning adults from hearing or viewing commercial speech can very easily be considered as both a limit on freedom and an insult to the "dignity and intelligence of ordinary people." And that's before we even get to the freedom of people in business, whom Magnusson is not interested in at all.

It is true that nutritional labelling is not a restriction on liberty as such, but that is not what Sullum was writing about. It is also true that plain packaging is less of a threat to smokers' liberty than smoking bans, but this is only a question of degree. Plain packaging has all the hallmarks of the nanny state—it is patronising and excessive, for a start. It infringes property rights and one of its explicit aims is to make smokers enjoy their cigarettes less. Smoking bans are arguably worse. They seriously hinder people's freedom of association as well as infringing property rights. But the fact that one is worse than the other does not make the other okay. Both justify the nanny state tag which is, after all, a pretty mild pejorative.

As for the public health crusade being "anti-capitalist", if you doubt this then spend a little time familiarising yourself with the likes of Gerard Hastings, Martin McKee, Richard Horton, Michael Jacobson, Michael Marmot, Richard Wilkinson et al. (see here, here and here for a taster).

With the exception of smoke-free laws, and notwithstanding the unsuccessful efforts of New York City's Health Department to impose a maximum serving size of 16 fluid ounces (473 ml) for sugar-sweetened drinks, the popularity of the nanny state metaphor does not demonstrate that personal liberty and freedom are being seriously threatened by government.

Woah, there. That sweeping statement requires some examination. The only public health policies that threaten personal liberty are bans on smoking and Big Gulps? I think not. Extortion through taxation and censorship through advertising surely merit inclusion, as do minimum pricing, licensing restrictions, and bans on happy hours, alcopops, drinking in the street, menthol cigarettes, snus, e-cigarettes... The list is pretty much endless. Bans are the stock in trade of public health and bans restrict freedom by definition.

Magnusson then launches into a crass, ill-advised and incoherent 'case study' of the much-missed Christopher Hitchens. He picks Hitchens because he was an eloquent critic of the nanny state who died of a smoking/drinking-related disease. Magnusson writes...

Hitchens' resistance to smoke-free laws in public places is less consistent with libertarianism, and more consistent with the view that non-smokers should be obliged to put their health at risk to accommodate smokers.

Not if you know anything about libertarianism, it isn't. It is highly consistent with libertarianism to say that a bar-owner should be allowed to decide whether or not people smoke on the premises. Non-smokers are free to go elsewhere. The owner has no obligation to 'accommodate' them, nor does a non-smoking owner have an obligation to accommodate smokers. Their gaff, their rules. Since even Magnusson concedes that smoking bans "truly restrict the freedom of individuals" it should be obvious that any principled libertarian would oppose them.

Magnusson clearly thinks that Hitchens got his comeuppance when he died of cancer and wants to believe that he renounced his principles on his death bed.

Yet it is precisely at the time when illness strikes – when it will usually be grotesquely inappropriate to highlight an individual's misfortunes for the purposes of public policy debate – that one truly catches a glimpse of the public interest that public health policies are intended to protect.

Despite it being "grotesquely inappropriate to highlight an individual's misfortunes for the purposes of public policy debate", this is exactly what Magnusson is doing. The problem is that Hitchens is a poor example of a sinner repenting. He didn't, really. Magnusson claims that "experience changes perspectives – even those of nanny state critics". That may often be true—regrets are easy to have—but despite his appalling illness, Hitchens explicitly said...

‘It sounds irresponsible if I say yes, I'd do all that again … [b]ut the truth is it would be hypocritical of me to say no, I'd never touch the stuff if I'd known, because I did know, everyone knows … I decided all of life is a wager … It's strange, I almost don't even regret it, though I should.'

Despite quoting these lines, Magnusson nevertheless concludes that Hitchens' "[cancer] diagnosis created a rare opportunity for a seasoned nanny state theorist to re-consider that critique". Even if this weren't incredibly tasteless, Magnusson could hardly have found a less fitting person to use as an example.

Having danced on Hitchens' grave, Magnusson displays some semblance of understanding why people care about lifestyle freedoms...

There are two sides to this libertarian impulse. The first is personal autonomy, which reveals itself in an instinctive opposition to any government intervention that affects the freedom of the individual. The second is personal responsibility, reflected in the belief that individuals must be self-reliant, rather than dependent upon government, and in the belief that individuals are, in fact, wholly autonomous, free from influence, and adapted to the challenges of their environment. If the first side of the libertarian coin (personal autonomy) is a shield against the totalitarian state, the second side (personal responsibility), protects against the nanny state.

That's about right. However...

Conspicuously absent from most nanny state rhetoric is any genuine attempt to engage in the messy business of defining the appropriate balance between the interests that society has in an efficient private sector, a high standard of health across the community, and a free society that gives individuals genuine space to choose and to grow as individuals. 

Really?! Have the last 300 years of philosophy and political economy not existed? 

Although it is possible for governments to trample on the dignity and civil liberties of individuals in pursuit of better health outcomes, most nanny state criticisms offer no hint of a workable test for identifying when public health measures ought to give way to self-governance.

Oh yeah? Then how about this, from John Stuart Mill?

"The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others." 

This one line has been the subject of millions of written words since 1859. There are so many books and essays on the subject of the public good versus individual liberty that it is doubtful that any one person will ever read them all. It has arguably been the central question in political writing since the French Revolution. Every serious critic of the 'nanny state' has addressed it. You don't have to agree with the libertarian position, but you can't just pretend that it amounts to no more than saying the words 'nanny state'.

Mill's harm principle is an easily understood and workable test. It might not be perfect, but it works pretty well as a rebuttal to 'public health' paternalism. By contrast, Magnusson acknowledges that governments can "trample on the dignity and civil liberties of individuals in pursuit of better health outcomes" but provides no test to show when this line is crossed. Is it too cynical to suggest that Magnusson's line is crossed when it involves something he likes doing?

The real concern of nanny state theorists is not freedom as such, but the role of the state.

Yes, freedom from the state! It is impossible to discuss the freedom of the individual without discussing the role of the state. Only in the wacky world of 'public health' do the fundamental threats to freedom come from Coca-Cola and Burger King.

Nanny state name-calling reflects the irreconcilable contest between what Robert Beaglehole and Ruth Bonita have called a ‘social policy approach to healthy lifestyles’, and a neoliberal philosophy that seeks to shift social responsibilities ‘from the public sphere (where they formed part of the business of government) to the private sphere (where they become matters of only individual, familial or household concern).’

Er, that's begging the question, isn't it? How about we ask why "social responsibilities"—like whether adults can buy tobacco, alcohol and food at the market price from whomever they choose—should be shifted from the private sphere, where they have traditionally belonged, to a bunch of control freak politicians, half-witted academics and fanatical single-issue pressure groups?

Neoliberals want to liberate the state from being held accountable for the health of the population.

Again, this is an assertion dressed up as fact. The state is not accountable for the health of the population unless it is actively harming the health of the population.

During the 20th century, law has been an indispensable part of many advances in public health, contributing to reductions in road traffic injuries, the control of infectious diseases, safer and healthier foods, safer workplaces, and fewer deaths from tobacco.

Let's take these one at a time. Road traffic laws are rules of conduct for motorists designed to protect the individual from other drivers—the only exception is seat belt laws which are contentious amongst libertarians. Road accidents are not a public health issue. They are an issue of safety and the car industry has done at least as much as the state in improving safety.

Infectious diseases are a public health issue because they can usually only be dealt with by collective action.

Food standards are also a suitable area for government action because nobody would wish to eat an unsafe food. People do, however, wish to smoke tobacco, drink alcohol and eat 'unhealthy' food. Tackling unsafe food and infectious diseases are uncontroversial precisely because they represent risk without benefit, whereas the current targets of 'public health' involve products about which the individual is capable of making a trade-off between risk and benefit.

In extreme cases, government action on supposedly unsafe food, as with unsafe workplaces, becomes controversial, excessive and illiberal (there are any number of ridiculous Health and Safety rules to illustrate this).

Finally, the credit that can be given to government for reducing the smoking rate, beyond educating people about the dangers, is questionable. There is considerable evidence showing that 'smokefree' laws, graphic warnings and plain packaging, to name but three, have been hopelessly ineffective on this score.

Oh, and as for 'healthier foods', I thought the rationale for 'public health' intervention in diets was that foods have become less healthy?

Self-evidently, these advances would not have happened unless the state acknowledged its responsibility for the health of the population.

It's not self-evident at all. There are some things that individuals cannot do alone which require collective action. It is no use being a careful driver if someone is going to drive at you at 100mph whilst inebriated. Vaccinations do not work properly unless the vast majority of people take them. It is not a question of the state taking ownership of the people's health. It is that people sometimes use the state to achieve for themselves what they cannot achieve individually.

By contrast, someone who doesn't want to eat at McDonald's can do so without any help from the state. See the difference? That, in a nutshell, is the difference between a public health issue and a 'public health' issue.

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