Would you rather be nudged or nannied? Andrew Lansley clearly thinks the first is infinitely preferable to the second. And BMJ columnist Nigel Hawkes thinks that nudging is much nicer because it assumes you are an adult rather than a recalcitrant child.
But I don’t like being nudged. I don’t like being touched by anyone whom I don’t know well. I regard it as an invasion of my personal space. And it assumes that I am slow on the uptake, that I need to be steered in one direction or another, as if I don’t know my own mind.
I also don’t like talking in metaphors so I will stop this silly comparison. But behind it is a serious point. People do not like the idea of politicians or “experts” telling them what to do. Everyone feels that they have the right to live their life in exactly the way they want to, with the possible proviso that they should not hurt anyone else.
But this begs many questions. If doctors or scientists discover that smoking causes lung cancer, or that eating a great deal of sugar and fat causes obesity which increases the risk of diabetes, don’t they have an obligation to spread that message? And if someone else’s cigarette smoke exacerbates your asthma and increases your risk of lung cancer, don’t you have the right to breathe clean air?
The fact is that over the last 13 years, the Conservatives have won a lot of support from disgruntled smokers and fatties, who don’t want their freedom curtailed, or who don’t want to be reminded of the risks from their way of life. Many sections of the population have resented any suggestion that they should change their habits, regardless of whether their obesity costs the NHS a fortune or their speeding kills children.
The Conservatives have been able to benefit from the feeling of persecution that the Daily Mail (the chief scourge of Nanny) has encouraged in smokers, speeding drivers and drinkers. But now they are in government, the Conservatives realise that they would rather leave a legacy of lower levels of heart disease, diabetes and road deaths rather than a nation of cancer riddled fatties.
So they have to re-discover a new way of encouraging people to live in a healthy way. Thus they have invented the nudge.
So although Conservative sports minister Hugh Robertson has announced that Labour’s scheme for free swimming for the under 16s and over 60s has to end because England can no longer afford it, the Conservatives have been talking about GPs giving out swimming vouchers to people in certain groups. And while Labour passed a law saying that tobacco packets should not be on display (which the Tories may not implement), the Conservatives have suggested that cigarettes might have plain packaging.
Can you tell your nudge from your nanny? I must admit that I can’t.
Annabel Ferriman is the news editor of the BMJ.