Our new Nanny State? The Senate inquiry into tobacco, alcohol, and bicycle helmet laws

New Yorkers’ had a Nanny. Do Australians have one too?

Earlier this month, Senator David Leyonhjelm announced aSsenate inquiry into legislative and policy measures introduced to restrict personal choice “for the individual’s own good,” including laws related to tobacco, e-cigarettes, alcohol, marijuana, bicycle helmets, and film classification.

Leaving to one side the irony of a government inquiry into government’s unreasonable interference in our lives, many of the products to be considered by the inquiry are of central concern to public health. Smoking remains Australia’s largest preventable cause of death and disease, responsible for some 15,000 deaths, and costing Australia $31.5 billion in social and economic costs annually. Alcohol is linked to over 60 different health conditions, and accounts for around 3430 deaths per year.

Public health advocates call for a strong government response to these health problems, because preventive measures are more cost-effective than treatment, and because legislative and policy measures work.

Laws and regulations concerned with restricting the sale or promotion of cigarettes and alcohol are often seen as examples of the “Nanny State” in action, i.e., unwanted government interference in what should be our own, freely-made choices. But it’s wrong to frame these measures simply as the state acting “for the individual’s own good.” Governments have a legitimate interest in ensuring population health, and in preventing the healthcare costs associated with alcohol and tobacco consumption. So too do we, as taxpayers.

Governments also act a check on the powerful corporate interests that have a profound influence on our drinking, smoking, and eating habits. We might as well ask, why isn’t there an inquiry into Big Tobacco and Big Alcohol, and their impact on our freedom to live healthy, productive lives?

It’s possible for governments to overstep their boundaries, and to introduce measures that are overly paternalistic and completely out of step with community needs. But by adopting the prejudicial language of “personal choice” the Senate inquiry seems to have closed itself off already to the kind of useful debate that we might have about the role of the modern state in protecting population health.

Perhaps the inquiry should consider a new collection papers published in the journal Public Health under the heading “Who’s afraid of the Nanny State? Freedom, regulation, and public health.” This special issue explores and unpacks the meaning of the Nanny State rhetoric so beloved by Senator Leyonhjelm, drawing upon work by academics from a variety of disciplines. It offers new ways to conceptualise the role of the state, and highlights the vast array of tools available to governments when acting to protect public health.

Don’t be fooled by the rhetoric. Laws and policies on bicycle helmets, cigarettes, and alcohol save lives. And they do so in a much less intrusive way than chemotherapy for lung cancer, a liver transplant, or surgery for traumatic brain injury.

4 thoughts on “Our new Nanny State? The Senate inquiry into tobacco, alcohol, and bicycle helmet laws

  1. Very superficial. I’ll just point out one aspect. Concentrating only on reducing risk without examining consequential reductions in benefits is an elementary mistake. That’s why class 1 evidence looks at e.g. “all causes mortality” and not just the direct effect of the treatment being studied. Bicycle helmet laws cost the health budget money by reducing cycling levels in a population that doesn’t get enough exercise.

    Look at the whole picture or look stupid.

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  2. Chris Rissel and Li Ming Wen published ‘The possible effect on frequency of cycling if mandatory bicycle helmet legislation was repealed in Sydney, Australia: a cross-sectional survey’ in Health Promotion Journal of Australia 2011; 22(3):178-83. They surveyed 600 residents, one in 5 of whom said they would cycle more if they were not compelled to wear a helmet. The authors caused some debate with their argument that repealing mandatory helmet laws would help meet City of Sydney targets for increased participation in cycling. Studies evaluating the impact of motorcycle helmet repeal laws would seem to suggest that repealing bicycle helmet laws would increase brain trauma in cyclists who were involved in an accident. After all, a helmet protects the brain when it strikes a hard surface with force. Which poses an interesting question for public health ethics: how to value the benefits of increased physical activity arising from cycling participation against the predictable increase in severity of cycling-related injuries. How to value an increment in fitness in the population against the brain-injured cyclist, now in a nursing home, whose brain turned to slosh after a collision. More at: http://blogs.crikey.com.au/croakey/2011/12/19/the-cycle-helmet-debate-continues/

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  3. Thanks Roger for bringing attention to research supporting the claim that mandatory helmet laws discourage cycling. As you say, it raises important issues about whether it’s ethical to trade off an increase in head injuries against a decrease in physical activity (which is important to maintaining a healthy weight). Also, I think that focusing on helmets obscures a more significant issue, which is the creation of transport environments that are safe for cyclists. Perhaps if Sydney had dedicated cycling lanes that were completely separate from roads and car traffic then we wouldn’t have to worry so much about helmets. The cycle lane in Washington DC is known as the ‘suicide lane’ because in most cases it’s just part of the road, and I certainly wouldn’t be brave enough to cycle there without a helmet!

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