Developments in libertarian paternalism

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Abstract

The Government has announced a range of initiatives that, in conjunction with the private and charitable sectors, it hopes will encourage people to lead healthier lives. These initiatives, similar to personal financial incentives to effect behaviour change, can be classified under the libertarian paternalism rubric; i.e. they are not aimed at forcing people to do things, but are aimed at 'structuring' people's decisions so that they choose healthier options. This report outlines the initiatives.

Neue Entwicklungen

On November 10th 2008, the Government announced that it had selected nine towns to receive funding to advance what is known as its 'Change4Life' initiative. The towns chosen, the so-called "Healthy Towns" (which are, on the whole, not really very healthy at all), represent many areas of England, and are Dudley, Halifax, Sheffield, Tower Hamlets, Thetford, Middlesborough, Manchester, Tewkesbury and Portsmouth. Many of these towns are relatively disadvantaged, so one may presume that this initiative is also tied into the Government's policy to reduce health inequalities (see report "Recent developments in health inequalities policy").

Between them, the Healthy Towns will receive £30 million of Government funds to promote physical activity and healthier diets through a range of initiatives. The towns have agreed to provide matching grants to the Government investment, which, in terms of its financing, therefore resonates to some extent with the US Medicaid programme (incidentally, the Change4Life policy also resonates with proposals put forth by President Obama, which may in turn reflect the Anglo-Saxon tendency to place quite a lot of emphasis on individual responsibility). The Healthy Towns are required to state how they will use the money, and a selection of the initiatives is as follows:

1. A 'Points4Life' loyalty scheme in Manchester that rewards people with free activities or healthy food if they take excercise.
2. In Thetford, a scheme to encourage people to cycle more and to maintain their bikes.
3. A new urban garden in Tewkesbury to encourage people to keep fit and rebuild green spaces.
4. In Halifax, a grow your own fruit and vegetable scheme for housing tenants.
5. A scheme to make Sheffield a breastfeeding friendly city.

The Health4Life programme is not restricted to the so-called Healthy Towns, however. It is a national programme that the Government hopes will go some way towards tackling the obesity epidemic. The Government is seeking to gain a range of commitments from the private and charitable sectors that would, in theory, help people to buy healthier products, work in healthier environments, and generally life healthier lives. Examples of such commitments include:

1. Tesco and Asda, which collectively serve 36 million customers each week, have agreed to communicate to customers and workers the benefits of healthy eating, and to run promotions that support healthier lifestyles.
2. ITV, the main commercial TV channel, has pledged to support the Change4Life initiative on-screen and on-line, by, for example, running campaigns to encourage people to lose weight.
3. PepsiCo will fund advertising to promote the benefits of an active lifestyle. 

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral
current    previous

Overall, I am in support of this policy initiative. I think it's a good idea to try to involve the private and the charitable sectors with Government policy in this manner, and such attempts (if sustained) at trying to get people to live healthier lifestyles is to be applauded. Of course, it would be better if there were some mechanisms in place to assessed the effectiveness of the initiatives in an adequate manner, and it may well be the case that many of the initiatives will ultimately fail to show any effect (it is notoriously difficult to effect behaviour change after all, and many people are likely to remain ignorant of or resistent to these initiatives). But, in my mind, these concerns do not give adequate reasons for why we should not try to encourage people to live healthier lives, and, moreover, some of the initiatives (e.g. creating greener spaces in urban areas) will in any case confer benefits that extend beyond 'health'.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Initiators of idea/main actors

• Regierung

• Bürgergesellschaft

• Wissenschaft: Scientists and opinion leaders have a mixed opinion of these initiatives, mainly in terms of whether they are likely to be effective

• Privatwirtschaft, privater Sektor: Many of the big food product manufacturers seem supportive, although some of those who produce unhealthy products are obviously going to be less than keen on these initiatives

• Medien

Stakeholder positions

The Government is motivated in this policy by its perceived urgent need to tackle the high and rising rates of obesity, particularly among children (who are, believe it or not, the adults of the future). It needs to bring the private sector (i.e. supermarkets, TV companies etc) on board so as to get the message across to the general public, and, as indicated above, has successfully managed to recruit several large companies and is in negotiation with many more. My feeling is that the general public, by and large, support initiatives to lead healthier lives (even if they don't necessarily act upon those initiatives), and therefore the private sector is probably sensible in supporting the initiatives, as it may help them to secure larger market shares.

The Government has to be careful in going too far too quickly with these initiatives though, because large sectors of the public and the media are highly critical of moves in the direction of the 'nanny state'. With respect to the Healthy Town initiatives, their implementation is dependent upon the local authorities, who appear to strongly support this policy direction (otherwise I suspect they wouldn't have been chosen as Healthy Towns). If the Government can maintain that it is genuinely trying to 'help the people' (which isn't easy) rather than 'punish the people' or 'blame the people' etc., I don't anticipate that there will be strong resistance to this policy direction.

Actors and positions

Regierung
Central Government	sehr unterstützend		stark dagegen
Bürgergesellschaft
Cancer, diabetes and heart foundations and pressure groups	sehr unterstützend		stark dagegen
Wissenschaft
Scientists/Opinion leaders	sehr unterstützend		stark dagegen
Privatwirtschaft, privater Sektor
Supermarkets, convenience stores and food product manufacturers	sehr unterstützend		stark dagegen
Some of the TV channels	sehr unterstützend		stark dagegen
Medien
TV, Newspapers	sehr unterstützend		stark dagegen
current    previous

Influences in policy making and legislation

This is not applicable. The initiatives can and have been implemented without a legislative process.

Legislative outcome

n/a

Actors and influence

Regierung
Central Government	sehr groß		kein
Bürgergesellschaft
Cancer, diabetes and heart foundations and pressure groups	sehr groß		kein
Wissenschaft
Scientists/Opinion leaders	sehr groß		kein
Privatwirtschaft, privater Sektor
Supermarkets, convenience stores and food product manufacturers	sehr groß		kein
Some of the TV channels	sehr groß		kein
Medien
TV, Newspapers	sehr groß		kein
current    previous

Positions and Influences at a glance

Adoption and implementation

I think I have already covered all this above. The Government is currently actively trying to sign other organisations up to the programme, and appears to welcome any organisation that wishes to take part.

Monitoring and evaluation

The monitoring and evaluation of the initiatives is a point of controversy. A number of experts believe that the initiatives are being insufficiently and inadequately monitored for their level of effectiveness. The Government seems to have adopted something of a 'shotgun' approach, perhaps believing that if they do enough, some of it is bound to work. They have supported their argument by presenting data that shows, for example, that only 11.5% of parents with overweight or obese children recognise it, that parents underestimate how much unhealthy food they give their children and overestimate how much exercise their children do, and that only 38% of adults know that obesity can lead to heart disease and only 6% know it is linked to cancer. The Government possibly believes that by giving parents more information, this level of ignorance will decline and people will make better choices. Hence, the libertarian paternalistic nature of the programme (even if the Government doesn't acknowledge it in such terms).

Expected outcome

It's too early to observe any actual effect, and as noted above, it is unlikely that many of the initiatives will be adequately scientifically assessed.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch
current    previous

It is too early to comment on the effect of the initiatives (even if it proves ultimately possible to do so, which, as noted above, is open to some doubt).

References

Sources of Information

Department of Health. Change4Life launches. 2 January 2009. www.dh.gov.uk/en/News/DH_092813.

Department of Health. Change4Life launches largest ever children's health survey. 30 January 2009. www.dh.gov.uk/en/News/Recentstories/DH_093993.

Department of Health. Nine towns share £30 million to kick start Change4life movement. 10 November 2008. www.dh.gov.uk/en/News/Recentstories/DH_090107.

Department of Health/National Health Service. Change4Life web page. www.nhs.uk/change4life.

Reform formerly reported in

Personal financial incentives to improve health Process Stages: Umsetzung, Idee, Pilotprojekt

Author/s and/or contributors to this survey

Oliver, Adam

 

Empfohlene Zitierweise für diesen Online-Artikel:

Oliver, Adam. "Developments in libertarian paternalism". Health Policy Monitor, April 2009. Available at http://www.hpm.org/survey/gb/a13/1