Last week the nation’s favourite grandmother, our Queen, entered her tenth decade. She is riding a wave of popularity, it seems, for her unstinting sense of duty and, in recent times anyway, for doing the right thing. Of course, it helps to be a grandmother. Among the firmament of strong brands, granny does take some beating in our affections but I was reminded recently of one elderly lady who does not enjoy such an adoring fan base, namely Nanny State.

Debate has raged for many years on whether she is a good person or an interfering busybody. In the field of public health, camps have formed around opposing views on whether government policies which intervene in the lives of the population can be justified. By and large we all want to lead longer and healthier lives but we also want a society that supports individual freedom.

Where does the balance lie?  In truth there are several shades of grey between the two camps: libertarians will accept some forms of state intervention, recognising that this creates a framework for individual freedoms; interventionists will draw the line at some activities of the state, believing that they undermine individual rights and liberties.

Few people would dispute the merit of historic interventions which resulted in clean water, a sewerage system and the end of choking smog in our major cities. These were infrastructural issues that individuals could do little to address.

More recently, while the first reports linking smoking with lung cancer and the seatbelt debates caused huge controversy, there is arguably widespread comfort with the personal and social advantages of the legislation we now have in place.

Today, there are different issues still and opinions appear extremely divided. And whereas, since the turn of the millennium, governments have tended to avoid the risk of a nanny-statist label, this administration seems to be on a mission to get people healthier, leading BBC health correspondent, Nick Triggle, on 28th March, to pose the question: ‘Dawn of the nanny state?’

He cites announcements of supervised gym sessions for people at risk of type-2 diabetes, the unveiling of a sugar tax and tough new guidelines on alcohol consumption as evidence of “a remarkable change in tack” from the early years of the coalition. Triggle’s conclusion, however, is that, regardless of where the burden of our unhealthy lifestyle lies, there is a darker purpose. By smoking, by drinking and eating excessively and by exercising too little, we are costing the NHS £11bn a year. By 2020 this will leave an enormous shortfall and “this is where…tackling unhealthy lifestyles come in.”

In navigating these choppy waters, my guiding principle is a simple one – what works? Inevitably, this is not a simple matter either. But I was pleased to read an interesting article, ‘The force is not with you’, in the Lent 2016 CAM (Cambridge Alumni Magazine) by Professor Theresa Marteau, Director of the Behaviour and Health Research Unit.

Much of Marteau’s work has focused upon how to change the behaviours which cause the majority of premature deaths worldwide. In this endeavour, her team has explored the impact of individuals receiving personal risk information, based on genetic tests, of, for example, cancer or diabetes. What they found was that, on average, this did not change actual behaviour.

Marteau’s research then shifted away from information-based interventions towards less conscious routes, involving the redesign of environments to cue healthier behaviour. The results here were more promising. From a review of 61 experimental studies, “we estimate that removing larger sized portions, packages and tableware would reduce the daily intake in UK adults by 16 per cent.”

And then the killer point, except that it seems to extend life!  “Realising environments that enable healthier behaviour across populations…requires some level of public support. Evidence is emerging that public support for such interventions increases when a risk to health is perceived…”

In other words, having previously regarded risk information as a poor means for changing behaviour, Professor Marteau now sees “a vital new role for effective communication about disease risk and its reduction, this time focused on increasing our support for interventions – often by government – to forcibly change environments to make easier the healthier behaviours that many of us prefer but still find difficult to achieve.”

So, if governments can successfully stimulate public demand for such interventions then they have a role in this vexed space which can be both legitimate and effective. And, as the public, by demanding environments that enable healthier behaviours, we can all help the state to be the kind of grandmother we are proud to call nanny.

Werther’s Originals all round!