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paramedics
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pharmaceutical industry
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The Nanny Paradox, income management and what public health experts think of it all

I have written a piece for Crikey today about the Nanny Paradox – how “Nanny” has been strangely absent from public discussions about Federal plans to extend the reach of income management.

Those who usually scream “Nanny State” whenever there’s talk of public health action to tackle problems like obesity, binge drinking etc have kept Nanny firmly in the cupboard since news officially broke about Jenny Macklin’s plans.

What does this tell us? That’s the question I put to a number of public health and policy experts. Here is what they said:


Associate Professor Tim Gill, Principal Research Fellow, Institute of Obesity, Nutrition and Exercise, University of Sydney:

Good luck with your attempt to address the incongruities in the way the term “nanny state” is applied.

Unfortunately I do not feel there is any rationality in the way the term is applied and so I try and avoid arguments over its application.  Like all pejorative terms, it does not have a clear definition and is often applied indiscriminately  to describe any action that the user disagrees with, feels aggrieved about or more likely disadvantages them personally.

It is a vague term that conjures up feelings of resentment and unfairness (like the tem un-Australian) and is often used to disguise another agenda.

The negativity around the tem is highlighted by recent research which has shown that its use peaked around election time in New Zealand and the UK, indicating a belief that it is a simple label which can discredit governments without the need for specifics on policy shortfalls.

As your article indicates there are incongruities in how the term is applied to government interventions.  There does appear to be huge inconsistencies in regard to the issues on which the community or commentators demand intervention from government, particularly as it relates to children.

There is a demand that governments, through the education curriculum take responsibility for teaching our children ethics, sex education, sport and are held responsible by society for imposing firm discipline that controls children’s behaviour – all of which would appear to be the firm domain of parental responsibility.  However, providing an environment that teaches and supports good nutrition is attacked as interference with the right of parents to decide what a child should eat.

Part of the problem may reside in a poor understanding and agreement on the function of the state and the role of governments which undertake these functions. If states are established to represent the common interests of their subjects as a whole, then governments are required to make decisions and impose structures which may disadvantage some individuals or sectors whilst protecting the interests of all society (present and future).

This is akin to the grand paradox of public health that Geoffrey Rose raised in his statement of the need for population strategies that bring health gains to society but unfortunately may sometimes impose a burden on the individual. Deciding when that burden to the individual is too great to justify the return to the community or when the return to the community is too small to justify a burden on the individual is difficult but it is the job of governments to make these decisions.

Sometimes they overstep the mark and impose unnecessary regulation that creates injustice. But more often than not they err on the side of inaction as the most resourced and powerful sectors of society are very adept at preventing challenges to their position.

**

Public health expert Associate Professor Peter Sainsbury:

“The term ‘Nanny state’ is not based on any considered political analysis, it is a purely self-serving propaganda statement. People who use the term do so principally to ridicule in a memorable sound bite a government program rather than offer any serious critique of it.

Their purpose is the protection, selfishly and/or misguidedly, of a threatened ‘freedom’ – selfishly because the reduced freedom threatens their economic interests and misguidedly because it is usually a freedom to do oneself and/or others harm, for instance the freedom to drive a car without wearing a seatbelt or whilst under the influence of alcohol, or the freedom of producers, advertisers, broadcasters and parents to allow children to watch junk food ads on television.

Like ‘the politics of envy’, use of ‘the nanny state’ seeks to create in the recipient an image of an earlier society where governments allowed citizens to lead uncomplicated, unrestricted, personally fulfilling lives – the ‘good old days’ … where people smoked themselves to death, were sacked on a whim, were unrepresented in court or failed to receive needed medical care because of poverty!!

Freedoms to suffer harm through your own ignorance or the carelessness or, worse, exploitation of others are not real freedoms; they restrict your opportunities in life and they certainly do not need protecting.

The freedoms that do need protecting are those that increase people’s opportunities in life (freedom to a good start in life; freedom to have a good education; freedom to live in a healthy environment; freedom to access health care when you need it, etc.) and freedoms that guarantee and respect basic human rights (freedom of speech, freedom to express dissenting views, freedom to be treated fairly by the legal system, freedom to live in safety, freedom to utilise your own resources as you wish – all with the proviso that the similar freedoms of others are respected).

Regarding the use of income management in the intervention in the NT, the fact that the income is coming from the government, and hence the rest of society, is irrelevant.

Do we tell other pension recipients how to use their pensions? And do we make income management less discriminatory or more appropriate by widening the groups it is applied to – No.

All we do is treat more people less like equal Australian citizens and more like social incompetents. We entrench their dependency. This is not to say that governments should do nothing for people who are suffering violence, poor health, etc. but it is to recognise that undermining their human rights is not an effective part of any long term solution.

In some ways those who cry ‘nanny state’ when a false freedom is undermined are acting perfectly consistently when they endorse the removal of a real freedom or the undermining of a human right. They are demonstrating their lack of analytical ability and their priority on maintaining their privileges.

It’s simply a 21st century version of the 19th century ‘lady’ visiting the poor to hand out advice, old clothes and left over scraps.”

***

Health policy analyst, Dr Yvonne Luxford, writes:

“That (your Crikey piece) certainly seems like a reasonable argument although I guess it could be just as easily turned back upon those who want ‘health taxes’ as they are mostly against income management which the government claims is having some positive effects.

I am looking forward to seeing the results of the evaluation of the NTER carried out by the Australian Indigenous Doctors Association to get a better idea of the effectiveness of income management. It is clear that some groups find it valuable, but this is surely not a reason to enforce it upon everyone. A volountary scheme would be more appropriate, with clear education regarding the benefits or otherwise of the scheme.

I understand that the expansion of the scheme will allow individual exemption through application. I am unaware of this being available to the Aboriginal and Torres Strait Islanders of the NT currently subject to the scheme, meaning that the expanded scheme does not escape racism. If the original scheme does allow individual exemption this has certainly not been either widely advertised or made easily available.”

***

Wayne Hall, Professor of Public Health Policy, School of Population Health, University of Queensland, writes:

“This is a very good angle for a story. Double standards are always worth exposing especially on the role of government and this is an especially conspicuous example.

There is related example of double standards on alcohol and cannabis policy of which the same suspects are guilty. Christopher Pyne, when parliamentary Secretary with responsibility for alcohol and drugs, derided any proposals to increase taxes on alcohol, reduce outlets or more tightly regulate advertising as incursions of the “nanny state”.

He saw no contradictions in arguing for a return to a policy in SA that would (nominally) imprison people for using cannabis, a drug that largely only harms the user! The latter was responsible government policy.”

**

Stephen Leeder, Professor of Public Health and Community Medicine, University of Sydney:

“Yes, well, we know that ideology trumps evidence, just as the non-rational traduces the rational, at every turn!  We may lament it at times, but that is the way life is, politics in a democracy is, and policy in a democracy is!

Those who wish to be conservative in regard to their own freedom to buy what they want without government let or hindrance will also be conservative when it comes to the use of their taxes for income supplementation of others.  That’s ideology.

There’s no clear boundary between financial accountability for using taxes in welfare payments and being prescriptive about how those taxes should be spent by the recipients.  It is blurry.  So, too, is the extent to which government wishes, and finds itself able, to control the behaviour of the general public.  Even laws will not  succeed without popular acquiescence, unless people agree that stopping at red lights is a good thing as well being legally required.”

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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
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Population Health Congress 2015
2016 conferences
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#cphce2016
#CPHCEforum16
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2017 conferences
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Australian Palliative Care Conference
2018 conferences
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