Sunday, 28 October 2018

Nanny state or prudent prevention?

Nanny state” is a term used by people who are generally politically to the right or are of libertarian tendencies. It is often used to pour scorn on policies where the government could be seen to be over-riding or interfering in individual choice or discretion. In the United States, they use the term “big government”.
Of course, there are lots of different perspectives about whether the “nanny state” in general or in respect of particular issues is a good or a bad thing. As my former parliamentary colleague, Margaret Hodge, once said "some may call it the nanny state, but I call it a force for good".
Lee Kuan Yew, the architect and former prime minister of the modern Singapore said that he was proud to have fostered a nanny state, arguing that if the state hadn’t intervened in “how you live, the noise you make, how you spit, or what language you use” then Singapore would never have made the economic and social progress it has achieved.
The first use of “nanny state” is generally attributed to the late Iain Macleod, a Conservative MP, in a magazine article in which he opposed the UK government’s proposals to introduce a 70mph speed limit. Although there will be considerable debate about whether particular speed limits are correct – in general or in particular situations – very few people would no w suggest that there should be no speed limits at all.
In all spheres of life, there are ongoing debates about the interface between individual and collective rights:
  • Your right to build an extension on your home conflicts with my right to light in my home
  • Your freedom to throw your rubbish on the floor conflicts with my right to avoid paying the cost of picking it up
  • Your right to produce food in unhygienic ways and premises conflicts with my right to expect to eat food that won’t leave me in hospital
  • Your rights to smoke in restaurants conflicts with my right to eat without a significant increased risk of cancer
And it is absolutely right that there should be wide-ranging debate and discussion and the production of evidence before any decision is taken which might infringe on individual rights.
I am astonished when I hear the rantings of Brexiteers who assert, to populist acclaim, that Brexit means the UK tearing up the European Convention of Human Rights (ECHR). Of course, the ECHR is nothing to do with the EU. With Winston Churchill being one of its principal supporters, the ECHR was drawn up after WW2 to promote freedom and protect rights across Europe.
Government ministers – of all parties – have occasionally become impassioned when they have lost a case in the European Court of Human Rights. But, that is only to be expected when judges are being asked to rule on issues where individual and collective rights come in to conflict. What we do know is that the views of both judges and the public on the same issue may change over time. Would many people nowadays support the re-introduction of smoking in pubs and restaurants? I rather doubt it.
It is only right that there should be the fullest debate when there are proposals which, obviously in the community interest but also in the interest of many individuals, significantly impact on individual rights and discretion.
I remember, during the 1970s and since, the robust public debate about fluoridation of water. Notwithstanding the fact that the level of fluoridation proposed in our local water supplies was lower than naturally occurred in many parts of the UK, it did not stop emotive and populist arguments against the proposals alleging that this was ‘mass medication’ of Hitleresque tendencies.
There has also been a long-running debate about organ donation. Should we switch from a position where, post-mortem, organs can only be donated for transplant with the explicit consent of the individual or their relatives to one where there is a presumption of donation, unless the individual has specifically vetoed it.
Then, two weeks ago, a government Health Minister announced that “we are going to issue a public consultation, as of now, on adding folic acid to flour”. It was clearly timed to feature in Spina Bifida and Hydrocephalus Awareness Week. But, why should this ‘mass medication’ happen; after all, if folic acid is added to flour automatically, it’s going to be very hard to prevent it being part of your diet.
In 1991, the Medical Research Council published a report recommending that white flour in the UK was fortified with folic acid as this had been shown in other countries to prevent neural tube defects (NTDs) in foetuses. This advice was backed up again by expert committees in 2006 and 2017. Although such fortification already happens in over 80 countries worldwide - including the United States, Canada and Australia – surprisingly, no countries in the EU do it.
It’s also worth remembering that in the UK, we already have rules for the fortification of flour with calcium, iron and vitamin B1.
Until now, successive UK governments have had a policy of voluntary folic acid supplementation, for women of child bearing age. So, what has made this government change its mind?
  • First, voluntary supplementation appears to be missing out those who need it most, such as young mothers in the poorest communities.
  • Secondly, the proportion of women who reported taking folic acid supplements prior to pregnancy has declined from 35% in 1991-2001 to 31% in 2011-12.
  • Thirdly, the latest National Diet and Nutrition Survey states that 91% of women of childbearing age have a red blood cell folate level below the level estimated to lower the risk of neural tube defects (NTDs).
I’m not aware of any evidence to suggest that any harm will come from folic acid supplements at the levels proposed. And, on that basis, I’m minded to support the proposal.
There is to be a formal public consultation about this. No doubt, you will tell me what you think.