What if the 'nanny state' is exactly what our health needs?

When you hear the phrase ‘nanny state,’ what comes to mind? For many, it evokes images of restrictions on personal choice. It’s often used by politicians and media commentators to criticise public health policies and interventions like the ‘milkshake tax’ and the Tobacco and Vapes Bill. Against the backdrop of new data showing a worsening picture of the nation’s health, perhaps it’s time to rethink what we mean by the term ‘nanny state.’  

First, let’s take stock of the nation’s health. The latest Health Survey for England data shows a bleak picture across several measures. In 2024, 27% of adults were classified as inactive, meaning they participated in less than 30 minutes of physical activity a week. 46% of adults aged 16 and over had at least one longstanding illness or condition, and 48% of adults had raised cholesterol. Meanwhile, almost two-thirds of adults are now overweight or obese and more than 1 in 3 children are leaving primary school overweight or obese.

These are unmistakable warning signs that make the case for bold intervention stronger than ever, not only to relieve pressure on the NHS but most importantly so people can choose to live longer, healthier and happier lives.

The term ‘nanny state’ is rooted in gender stereotypes that cast care as weakness. Yet evidence suggests that these traits lead to better health outcomes. During the Covid-19 pandemic, countries led by women had half as many deaths as those led by men, with analysis showing they acted ‘more quickly and decisively’.

And that’s not all. Despite the rhetoric, polling of the public from The King’s Fund,  Action on Smoking and Health, the Obesity Health Alliance and the Alcohol Health Alliance and the Health Foundation consistently shows that people actually strongly support many interventions labelled as ‘nanny state’. There’s overwhelming support for stricter regulations on the food industry. Measures like the phased smoking ban, restrictions on vaping, and the Online Safety Act enjoy broad consensus across age groups and political affiliations, and the British public are in favour of taxation where they can see tangible improvements to the NHS.

So the public aren’t as hostile to health protections as some headlines would like to suggest. And policies that were unpopular when introduced have since become largely accepted and even normalised, including seatbelts, car seats and the ban on smoking in indoor public places.

Another very live example is the rising public concern about social media’s harm on children and young people. The Academy of Royal Medical Colleges is calling on government to restrict the use of social media for under-16s, a suggestion backed by the Conservatives. We’ve seen new government guidance that all schools in England should be phone-free for the entire school day. These policies don’t affect the public purse like tax rises do but they reflect what people value: safety and wellbeing.

The government’s 10 Year Health Plan makes bold promises on prevention, but so far, this ‘revolution’ has not been backed up with concrete policies, for instance introducing a minimum unit pricing for alcohol. It has been reported that that this policy was initially proposed in the plan, but Number 10 blocked it over concerns about increasing cost pressures on businesses.

Yet the economic benefits of a preventative approach like this could be game changing. Heart and circulatory diseases, driven in part by alcohol consumption, cost the health care system an estimated £7.4 billion each year while the wider economic impact in England is estimated to be £15.8 billion each year. Despite the potential to unlock economic as well as health gains, any move toward this policy would almost certainly conjure up ‘nanny state’ headlines, and this might even lie behind the government’s fear of implementing such a policy.

The so-called ‘nanny state’ isn’t solely in the business of taking our joys away. It can also help create the conditions for health to flourish. Take the extremely popular Parkrun: when local and national government maintain the parks we all use and enjoy, this non-state initiative can thrive.

Reframing the term in this light could help us see these interventions not as intrusions but as investments in collective wellbeing, a social contract of sorts. And like any contract, it has two sides. If the state works to make healthier choices easier, then we as individuals have a responsibility to take them. Reimagining the relationship between people, communities and the state will help tackle widening health inequalities and untangle the fundamental challenges hardwired within the health and care system.

Let me be clear. The goal isn’t to curtail freedom, the goal is about giving people better choices so they can live a longer, happier and healthier life. It’s time to retire the caricature of the ‘nanny state’ and embrace a more nuanced conversation about care, responsibility and trust. One in which we all think a bit more like a nanny.