The ‘nanny state’ and the case for health literacy

  • Posted on 18.09.2018

The ‘nanny state’ and the case for health literacy


Denis Horgan

Executive Director, European Alliance for Personalised Medicine


For me, one of the most intriguing health policy questions of our time is how to encourage citizens to embrace healthy lifestyles. Should we tax and punish bad behaviour or empower citizens with the information they need to make their own decisions?  

An interesting ‘league table’ caught my eye recently. Entitled the Nanny State Index, it charts how EU Member States and the European Parliament deal with issues of food, alcohol, smoking and the use of e-cigarettes.  

The index, devised and compiled by Christopher Snowden of the Institute of Economic Affairs, reveals enormous variation across the EU, ranging from the highly restrictive approaches taken in Finland, the UK and Ireland, to more laissez-faire policies of Slovakia, Germany and Czech Republic.  

Of course, the real question is whether nanny-state legislation makes Europeans generally healthier. The answer appears to be ‘no’: Germans have not suffered due to their government’s reluctance to impose high taxes on unhealthy lifestyle choices in the way that their more paternalistic neighbours have.  

An alternative approach is required. At the European Alliance for Personalised Medicine (EAPM), we believe that the focus should firmly be on empowering patients. This can be done through improved education. 

Clearly, modern technology and the Internet have created new ways to put the patient at the centre of medicine. We are even seeing better communication between doctors and patients, which leads to more co-decision as patient lifestyle, work and personal preferences come into play. This can be improved further. Our annual EAPM Summer School for healthcare professionals is among our contributions.

New tools, new skills

Hard facts alone may be insufficient to trigger behavioural change. We know that patients have access to more information than ever before. What they need now is the skills to differentiate between high quality health information and the rest.  

A lack of health literacy leads to less healthy choices, risky behaviour, and, in patients already diagnosed with a disease, poor self-management of chronic diseases, lower adherence to medicines, and, inevitably, more time spent in hospitals and doctors’ waiting rooms. 

Health literacy has been proven to save money in healthcare budgets. Strengthening health literacy builds individual and community resilience, helps to address health inequities, and improves health and well-being. 

I see a strong role here for programmes that encourage regions and Member States to collaborate.

Shockingly, one recent study showed that nearly 50% of adults tested in eight European countries have inadequate or problematic skills “that adversely affect their health literacy”. This, despite health literacy being a key part of Health 2020, the European health policy framework which, in 2012, was adopted by Member States.  

We all need to up our game. For our part, the EAPM stands ready to work with all stakeholders to equip patients with the knowledge and critical tools they need to play an informed role in the future of healthcare.

At the very least, better health literacy and lifestyle awareness would provide an effective counter-balance to weigh against paternalistic legislation that some evidence suggests fails to have the desired effect.

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