Is a ‘nanny’ state a ‘healthy’ state?

It didn’t get much buzz in America, but across the pond Britons are still talking (so we’re told) about a BBC commentary made last month by Dr Alan Maryon-Davis, the President of the UK Faculty of Public Health.

In it, Dr. Maryon-Davis says that public health has become a significant enough social issue that the government must intervene at far more significant levels to ensure participation and effectiveness.  Sound like a “nanny state?”  Yes, says Maryon-Davis, it does:  and that’s not a bad thing.

“Is the government ‘nannying’ us too much” to help prevent killers like heart disease, strokes, and cancer?  Maryon-Davis writes.  “Is it trying too hard to micro-manage our health?  I say firmly – no.”

Here at Saybrook, many faculty have been advocating a changing governmental role in health care for years:  Mind-Body Medicine faculty member Marie DiCowden, for example, has overseen public hearings on the way the government – at all levels – can encourage best practice. 

But at the same time, DiCowden says, the idea of “nannying” doesn’t seem to get it quite right.

“Although I think some incentives for good self care can be built in, I have some issues with the government playing ‘nanny,’” DiCowden says. 

Other Saybrook health experts agree:  while they see enormous potential for the government to help reform and improve the health care system, they cite the “50/50” rule of Mind-Body Medicine:  fifty percent of a person’s health can be cared for by their doctor and health care system, but the other fifty percent is up to them. 

Based on their own experiences with patients and health care systems, they say that while government restrictions (like smoking bans) have a role, the best thing the government could do would not be to tell people what to do so much as create the conditions and relationships in which people could more easily choose to be healthy – and make that choice count.

“If we add in an abundance of social supports, loving relationships, and effective forms of stress management, most human beings could extend their lives and reduce their illness and suffering,” said Don Moss, who directs Saybrook’s Mind-Body Medicine program.  “Much of the curriculum in our new Saybrook Mind-Body Medicine degree addresses strategies to assist human beings to make positive lifestyle changes for their own wellness.”

Lisa Mastain, who is teaching Saybrook’s new course on life coaching, says that in her experience the ability to put health in the context of a supportive relationship is the key to sucessfully making lasting lifestyle changes.

“I encourage my clients to learn as much as they can about the health or wellness concerns they have, but more importantly I empower them to make lifestyle changes using accountability, affirmations and structures to support and monitor their progress,” she says.  “Change takes time to implement. Lasting change also depends on the creation of a solid support system. That is the beauty of a coaching relationship – it provides the ongoing personal support and accountability that so many of us need to stay on our path of wellness.”

To do that effectively, DiCowden emphasizes, will involve reconsidering health care – emphasizing not just good information, but changing the way it is disseminated, shared, and acted upon.

“In revamping the delivery system one thing that works well — and for which there is some, albeit scant literature — is the effectiveness of working with patients in groups,” she says.  “Just like it is more difficult to go to the gym alone unless an individual is committed to meeting someone else there … just so it is easier to follow good health habits if there is group support and people are sharing expectations and issues of behavior change.  However, to get to this place we have to reform the delivery system and norms.”

That involves creative thinking, and support – but maybe not nannying.  Nannying, after all, doesn’t involve choice:  while health very much does.