A few months ago I attended a debate at the Barbican in London on the pros and cons of international aid and the debate veered into one of individual autonomy and the problems caused by state intervention. A colleague also recently told me that prisoners can only be encouraged (not told) to visit the gym or attend rehabilitation classes and that a smoking ban would be a violation of their rights.

At the same time, tobacco companies persist in calling for the rights of smokers and I’ve been drawn into many debates about the food industry, portion sizes and food labelling and the rights of consumers to choose what and how much they want to eat.

Suddenly libertarianism is everywhere and wherever I go, I hear arguments about autonomy, individual rights, freedom of choice and the problems of the nanny state. So why do people call upon this notion of freedom and is it all as libertarian as it initially seems?

Sinister undertones

The call of “the nanny state” is often, and most simply, a reaction to change. Whether it is seat belt laws, changes to licensing hours, Sunday shopping or even variable speed limits, the immediate reaction is often outcry to government intervention and resistance to change.

Sometimes the call for libertarianism genuinely reflects an ideological viewpoint and the belief that intervention does harm. Much as I regularly donate to my favourite charities I found the arguments at the Barbican that ongoing support to developing countries can engender dependency and undermine local initiatives quite convincing. And perhaps prisoners have had enough of their freedoms removed without telling them how they can and can’t behave while in prison?

But, more worryingly, this call for freedom of choice often seems to have more sinister undertones, used by those with vested interests in people having the choice about how to behave and the hope (and expectation) that they will choose to behave in ways that are bad for them. The tobacco industry may dress their arguments up in libertarianism but in essence they want people to be free to kill themselves by smoking their cigarettes. Food manufacturers argue that the consumer is in charge and should be free to eat (or not eat) whatever is available, while knowing full well that most people will be unable to ignore their grab bags, duo bars or supersized portions.

And perhaps “getting” prisoners to therapy groups and “making” them take exercise or even “banning” smoking in public places inside prisons (as it is outside) is more about lack of staff, ease of management and keeping the peace than any grand ideological position.

With all this opposition how do changes ever happen that actually make a difference to everyone’s lives for the better? And how can we outmanoeuvre those industries who only have their own interests at heart?

Follow the evidence

First of all we can sit out the storm. Time is a great healer and after a while, new things like seat belt laws and even Sunday shopping becomes the norm and life without them would seem strange. And when it really is a genuine ideological debate about harm we should gather evidence and leave it to the experts to work it out.

But what can we do when it is really just vested interests dressed up as libertarianism? How can we reclaim the debate and beat them at their own game? I think the answer is a matter of freedom, but it’s about whose freedom we are talking about.

Smoking was first linked to lung cancer in the 1950s but it took more than 50 years before governments started to introduce smoking bans. And the catalyst for this shift was passive smoking. Smokers may have had the right to smoke and even to die if they so chose but suddenly they no longer had the right to harm others. Passive smoking undermined the “freedom of the individual” argument. If smokers had rights then so did non-smokers and the ban could be introduced.

Similarly, seat belts in back seats were seen as an intrusion until campaigns showed how they protected not only the wearer but the person in the front from being hit from behind, and we are even in the process of banning smoking in cars to protect children and non-smoking passengers. Now there is also talk of banning drinking in pregnancy to protect the unborn baby, and an Appeal Court case set to hear whether a mother should pay compensation for a child born with foetal alcohol syndrome.

‘Passive obesity’

And then there’s obesity and the food industry. People have the right to eat what they like and become obese if they want we are told by the food industry. But what if their weight starts to harm others? What if there were “passive obesity” and a cost to those around them? What about these others’ freedom to be healthy or their rights to choose?

The biggest group of others is the general public – those who pay taxes and others who need to use health services. Obesity costs the health service millions each year for the treatment of heart disease, cancer, diabetes and joint trauma which takes away from the resources available for other services. This is a cost to others.

Obesity is a form of social contagion; the weight of our friends and those around us is a powerful predictor of our own weight in the future. This is also a cost.

But more powerfully, obese parents have a cost to their children. Obese parents are more likely to have obese children who may well have health problems in childhood such as social anxiety, diabetes and asthma. These obese children are also more likely to have health problems as adults, including all of those that their obese parents might have. There is even some evidence that suggests that even in the womb, unborn babies of obese mothers can become malnourished and more prone to many illnesses later on in life.

We can’t all be free

The libertarian argument is a powerful one in a modern world where the rights of the individual loom large. And the call of the nanny state and the dangers of government intervention rings true for many, particularly when history has so many examples of when this has been abused. But change is necessary sometimes. And sometimes the government could intervene more than it does. So if passive smoking has done it for smoking and “being killed by someone you know” has done it for seat belts then maybe it’s time for “passive obesity” to do it for obesity.

Freedom is a good idea in the abstract but we can’t all be free. And perhaps only by highlighting the impact of one person’s behaviour on another’s can we be free from many health problems – even if we are no longer free to do exactly as we would like.