Elsevier

Public Health

Volume 129, Issue 8, August 2015, Pages 1038-1045
Public Health

Mini-Symposium
Informed choice and the nanny state: learning from the tobacco industry

https://doi.org/10.1016/j.puhe.2015.03.009Get rights and content

Highlights

  • I examine informed choice and nanny state rhetoric used by the tobacco industry.

  • I analyse how this rhetoric has impeded policy adoption and implementation.

  • Marketers of other risk products are drawing on tobacco industry rhetoric.

  • Public health researchers have an opportunity to reframe the nanny state.

  • State intervention does not remove free choice, but may be a prerequisite to it.

Abstract

Objectives

To examine the ‘nanny state’ arguments used by tobacco companies, explore the cognitive biases that impede smokers' ability to make fully informed choices, and analyse the implications for those working to limit the harmful effects of other risk products.

Study design

A critical analysis of the practices engaged in by the tobacco industry, the logic on which they relied, and the extent to which their work has informed approaches used by other industries.

Results

The tobacco industry's deliberate strategy of challenging scientific evidence undermines smokers' ability to understand the harms smoking poses and questions arguments that smoking is an informed choice. Cognitive biases predispose smokers to discount risk information, particularly when this evidence is disputed and framed as uncertain. Only state intervention has held the tobacco industry to account and begun ameliorating the effects of their sustained duplicity. Evidence other industries are now adopting similar tactics, particularly use of ‘nanny state’ claims to oppose proportionate interventions, is concerning.

Conclusions

Some marketing strategies have deliberately mis-informed consumers thus directly contributing to many public health problems. Far from removing free choice, government policies that restrain commercial communications and stimuli are prerequisites necessary to promote free choice.

Introduction

Neo-liberal discourse presents people who smoke, or who consume too much alcohol or food, as making informed choices to engage in actions with harmful consequences, lacking in personal responsibility, or both.1, 2 Tobacco companies thus currently claim that people who smoke have made informed and free choices, knowing the health risks they face.3 By contrast, food manufacturers rely more heavily on personal responsibility arguments and deflect attention from obesogenic environments by implying obese and overweight people have failed to exert sufficient control over their behaviour.4

The reasoning represented in these arguments relies on three important assumptions. First, it assumes individuals can access accurate and balanced information relevant to their decisions Second, it assumes people make rational and informed decisions, having undertaken a thoughtful appraisal of the risks and benefits associated with different options. Third, it assumes individuals can predict, understand and accept the consequences of actions they take.5 Each of these assumptions re-locates responsibility for harm away from product manufacturers and marketers to individual consumers. As Brownell notes, the concept of personal responsibility ‘evokes language of blame, weakness, and vice, and is a leading basis for inadequate government efforts’ (p.379).1

Ironically, at the very time consumers are exhorted to display greater personal responsibility, governments have become more likely to eschew policy interventions that might support healthier behaviours. Governments attempting to recognize and address structural inequalities, for example by providing better access to robust information or removing impediments to ‘free choice’, often attract derision as interfering ‘nanny state’ behemoths.6, 7 Failure by governments to create settings where consumers may access valid information and act without commercial coercion means people are left in the invidious position of being expected to consider their long-term interests in environments that predispose short-term priorities.8

Decision contexts dominated by corporate discourse leave individuals poorly placed to navigate choice environments, particularly if these are unrestrained by proportionate and protective policies.9 To explore the assumptions outlined above and their implications, I begin by examining how one corporate group – the tobacco industry – shaped and manipulated information to undermine informed and free decisions. I then review environmental and individual factors that may impede fully informed decision-making, before examining how public health policy has been framed as ‘nanny state’. Finally, I offer recommendations that governments could adopt to foster free and informed choices.

Section snippets

Consumers' information environments

Marketing aims to modify or reinforce consumers' behaviour so individuals' actions align with an organization's objectives, which typically focus on profit maximization. Despite the striking similarities between many competing brands, marketing communications aim to create points of differentiation that stimulate trial among non-users, instil a regular purchase pattern, and encourage and reward repeat purchase.10, 11, 12 The long-term viability of a brand depends on repeat purchase, thus

Cognitive biases

Many studies have reported that, while smokers may consider smoking risky, they believe they personally face fewer risks than do other smokers.58 Known as self-exempting strategies, smokers reconcile their disturbing risk awareness with the continued behaviour that exposes them to risk.59, 60 In its most basic form, self-exemption involves rejection of risk exposure, but smokers typically engage in more sophisticated rationalizations that recognize and off-set, diminish, or re-locate risk.61

The nanny state as enabler

Redefining the nanny state metaphor is vital if the public are to recognize regulation as a precursor to informed choice. Rather than depriving individuals of freedoms, state intervention maintains and defends those freedoms against commercial interests, which potentially pose a much greater threat to free and informed choice. Restrictions on tobacco advertizing and promotion have occurred alongside very large reductions in adolescent smoking and played an important role in protecting young

Conclusions

Deliberate industry interference has often created situations where consumers have access only to incomplete and inaccurate information. These contexts, coupled with consumers' inherent cognitive biases, mean truly ‘informed choices’ are an academic concept far removed from lay consumers' every day experiences. Whether the risk behaviour involves smoking, consumption of unhealthy foods or unsafe alcohol intake, individuals' actions largely reflect their commercially constructed environments.

Acknowledgements

I thank Professor Philip Gendall for his thoughtful insights.

Ethical approval

Ethics approval was not required as the study does not report on primary data.

Funding

No direct funding was received for this study.

Competing interests

I do not have competing interests but, in the interests of full transparency, note that I have received research funding for tobacco control projects that examine components of ‘informed choice’ from the Royal Society of New Zealand Marsden Fund (Grant 11/297), the Health Research Council of New Zealand (Grants

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