Have you ever been in a conversation that left you at a complete loss for words? And have you ever had all the perfect ‘should’ve saids’ come back to haunt you hours later when you were trying to fall asleep?
Turns out a blog is the ideal soporific in this situation because anything that you failed to say becomes fodder for a ranty post. Et voilà, this is what you are reading right now – the outpourings of my sleepy brain one night a few months ago when I couldn’t get over a colleague’s throwaway comment during lunch.
And this is how it went:
The current overwhelm of the National Health Service in the UK is due to people having been infantilised by an over-caring British nanny state, which makes them seek out medical treatment for minor ailments.
Chocking on food, spitting out water, an incredulous snort – all of these would be appropriate reactions to that comment in my books. The key idea here is that of the ‘nanny state’. In the UK, it has been a trope for shutting down conversations about state interventions since 1965, when Conservative Member of Parliament, Iain McLeod first popularised the term. As in the comment above, it is used to voice criticism at government policies, especially health policies, that are perceived to treat adults as children by strongly recommending or prescribing certain behaviours, treatments or check-ups. A famous intervention that was critiqued as nanny-statist includes Mayor Bloomberg’s 2012 attempts to limit the portion size of soda served in New York. His opponents ran ads with Bloomberg dressed as a nanny to express how infantilising they thought his proposal was. Or take these headlines from UK media opposed to state measures tackling obesity rates, such as the so called ‘sugar tax’:
‘A nanny state that dictates what we drink will soon be telling us how to think’ (Daily Mail, 28th December 2012)
‘Better fat than the Nanny State, Freedom is All-You-Can-Eat’ (The Telegraph, 15th October 2017)
To someone from Germany where citizens are regularly ‘pampered’ with health regulations and preventative medical check-ups, the UK system is anything but nannying. But instead of verbalising that during the aforementioned lunch break, the first response my brain produced was the vision of a boob-shaped sticker rising in front of my inner eye only to slowly fade away through the silence and into the distance together with all the things I should have said.
And my silence in that moment bothers me because, true to my post-structuralist discourse theory convictions (#LaclauandMouffeForEver), I believe that how we talk about policies matters because discourse turns into opinions that shape votes and ultimately reality.
Motivated by a similar concern, Professor John Coggon at the University of Bristol Law School carried out an analysis of nanny-state discourse to understand what exactly we’re up against. According to his article, nanny-state accusations against health policies usually follow one of three rationales: economic libertarianism (markets are best placed to look after people’s health), philosophical libertarianism (an individual’s liberty to choose is more important than their health) or coercive healthism (health is a subjective value and as such the state is in no position to define it or prioritise it over other values on behalf of its citizens).
However, I am neither a political scientist nor a public health professional. And I imagine that a discussion on philosophical or economic grounds by a bunch of half-informed colleagues (me included) would be painful to stomach, especially when taking place during lunchtime. So how could I have responded in a way that fosters empathy rather than further alienation?
Well, the only thing that my mind kept returning to was that bloody sticker. Because whichever way I look at it, nothing epitomises the absence of the ‘nanny state’ more tangibly than the boob-shaped stickers plastered all over public and university toilets in the UK.
Allow me to elaborate:
My first encounter with the sticker was on a freshers’ night out. Summoning all my focus to hit the toilet after one-too-many Cactus Jack shots (I was young and didn’t know any better), I looked up from my hovering position (I did NOT anticipate that so many of my posts would make reference to peeing! How is that a thing and what oh what does it say about me?!) to find a sticker of a boob cupped by five finger prints right in my line of vision. Part of the ‘Coppafeel’ campaign, it shared instructions for checking your breasts for lumps. ‘How great!’ I thought, love the breast cancer awareness. However, my appreciation faded as I learned over the following years that these stickers constituted a replacement for the professional breast cancer checks that I had been enjoying during my regular visits to the gynaecologist while living in Germany.
What does it say about the state of the healthcare system today when the V-shape my legs make when having my vagina professionally examined feels like the ultimate victory pose?
Over here, the reactions to my increasingly desperate attempts to have my breasts examined made me feel as if I would sooner be arrested for harassing people at my GP practice than have a healthcare professional come anywhere near my chest. You must know that on these mystic Isles, gynaecologists are a bit like unicorns: most people have heard of them, but only few have actually seen one and those who have, had to endure a series of trials that mainly involve reaching deeply inside themselves (sadly, I mean this literally) to check the position of their coil, choose and administer thrush medication correctly and take swabs (all procedures that you can perform by yourself on yourself, apparently) until you discover something that sounds so obviously, alarmingly wrong when you describe it during your umpteenth phone consultation that you are finally invited to sit on the throne of all thrones aka the gynaecological examination chair. I wish during those teenage gyn appointments, my timid self would have known how privileged and, yes, regal, I would feel one day when exposing my insides to a stranger with my feet up in the air somewhere around their ears.
But back to the nanny state and the sticker. I am all for personal liberty and people’s right to choose. But if I ever discover a lump in my breast, I don’t want it to be on a public toilet, staring at some sticker, catching a fungus from collapsing back onto the dirty toilet seat in tears, frantically checking my symptoms on Google. I want to be in the presence of a person who has seen these a million times and can calmy advise me on the next steps before I spin into a panic. And if that means that we will have prescriptive ‘nanny state’ guidelines for regular breast examinations, please, bring on the nanny state already!
I usually come to a somewhat productive conclusion with these posts but at the end of this text I still feel like yelling. I guess the only sensible and actionable takeaway here is that the next time someone makes a throwaway comment about the nanny state, I have a great way to fill the silence: I’ll start by cupping my breasts while simultaneously throwing my legs in the air to adopt the regal gyn chair posture. That should silence my audience sufficiently for me to catch my breath and explain how this pose is a valid counter-argument to the libertarian undoing of what little remains of the ‘nannying’ national healthcare service.
Resources
Coggon J, The Nanny State Debate: A Place Where Words Don’t Do Justice (London: Faculty of Public Health, 2018)
Greenacre M. Defending public health policies from objections of paternalism. Univ West Ont Med J. 2016;85(2):50-2.
Gostin LO. Bloomberg’s Health Legacy: Urban Innovator or Meddling Nanny? Hastings Cent Rep. 2013;43(5):19-25.
Hoek J. Public Health, Regulation and the Nanny State Fallacy, Partnerships, Proof and Practice. International Nonprofit and Social Marketing Conference. 15-16 July:University of Wollongong; 2008.
Jochelson K. Nanny or steward? The role of government in public health. Public Health. 2006;120(12):1149-55.
Magnusson RS, Griffiths PE. Who’s afraid of the nanny state? Introduction to a symposium. Public Health. 2015;129(8):1017-20.
Magnusson RS. Case studies in nanny state name-calling: what can we learn? Public Health. 2015;129(8):1074-82.
Wiley LF, Berman ML, Blanke D. Who’s Your Nanny?: Choice, Paternalism and Public Health in the Age of Personal Responsibility. Journal of Law Medicine & Ethics.2013; 41: 88-91.
Leave a Reply