Higher alcohol taxes, halting 24-hour drinking, banning smoking in people’s homes and adding fluoride to water supplies are justified intrusions to improve public health, senior academics said yesterday.

A report by the well-respected Nuffield Council of Bioethics concludes that the Government and industry are not doing enough to prevent binge drinking or obesity and should promote healthy lifestyles through stricter measures and deterrents.

The authors, a group of doctors, lawyers, philosophers and other experts, argue that the much-maligned “nanny state” should be replaced by a new, more sensitive idea of “stewardship”. Campaigners described the report as a potential manifesto for a bully state and industry groups bristled at the prospect of tighter regulation.

The council, which considers ethical questions raised by advances in medical research, looked at alcohol, obesity, smoking, infectious disease and fluoridation of water. It identified alcohol consumption as a huge public health problem and said that the Government could do more. “Increasing tax on alcohol and restricting hours of sale have been shown to be effective in reducing alcohol consumption,” its report states. “Yet the Government’s alcohol strategy has focused on public information campaigns and voluntary labelling schemes, measures that have been shown not to be effective.”

Lord Krebs, who chaired the report committee, said yesterday: “People often reject the idea of a nanny state but the Government has a duty to look after the health of everyone and sometimes that means guiding or restricting our choices.”

The central concept of stewardship differed from the nanny state by being “more sensitive to the balances between public good and individual freedom,” he said. The report concludes: “The stewardship model provides justification for the UK Government to introduce measures that are more coercive than those which currently feature in the National Alcohol Strategy.”

Lord Krebs said that ministers should revisit the decision to introduce 24-hour licensing laws in 2005. At a briefing yesterday in London, he said: “The Government should implement tougher measures to tackle excessive drinking. There is also an urgent need for an analysis of the effect of extended opening hours on levels of alcohol consumption, as well as on antisocial behaviour.”

He added: “When 24-hour drinking was introduced, it was suggested to create a continental-style café culture. If you walk down any of the main streets of Oxford at 11 o’clock — one is known as ‘Vomit Alley’ — we all see a conspicuous absence of continental café culture.”

The report, in preparation since February last year, recommends that producers and sellers of alcohol should take more responsibility for preventing harm to health. It also says that the arguments used to justify banning smoking in enclosed public spaces would “also apply to banning smoking in homes”. This would be extremely difficult to enforce, but local authorities and the courts could preside over exceptional cases where children with a respiratory illness could be at such a risk that intervention may be ethically acceptable.

The Nuffield report comes as a coalition of 21 organisations headed by the Royal College of Physicians prepare to form a new Alcohol Health Alliance, which plans to lobby for a 10 per cent rise in alcohol taxes and tighter regulation of the drinks industry. Details of the Alcohol Health Alliance are expected to coincide today with a conference organised by the college on reducing the harm caused by alcohol.

The UK Public Health Association welcomed the report, saying that it represented an evidence-based approach that could counter health inequalities, but Simon Clark, director of the smokers’ lobby group Forest, said: “Politicians should take care not to overindulge in social engineering. Potentially, this report is a manifesto for a bully state in which people are increasingly forced to behave in a manner approved by politicians and evangelical health campaigners who want unprecedented control over our daily lives.”

Jeremy Beadles, from the Wine and Spirit Trade Association, added: “The people clamouring for an increase in taxes and regulation on the drinks industry ignore the fact that alcohol consumption is actually falling. Increasing the cost of alcohol will just hit the vast majority of people who enjoy a drink in moderation.”

Dawn Primarolo, the Health Minister, said that the Government’s strategy to tackle harmful drinking was comprehensive and included an independent review of alcohol pricing.

Bullying or encouragement? How we could be more protected

Obesity
— The food industry should be encouraged or compelled to improve labelling and health information on products
— Town planners and architects should be trained to design buildings and public spaces that encourage people to lead more active lifestyles. This could include segregating walking and cycling routes from heavy traffic, and maintaining more public parks and children’s playgrounds

Smoking and alcohol
— More coercive measures on alcohol abuse, for example taxes on alcoholic beverages could be increased
— “The general ethical and scientific arguments that apply to banning smoking in enclosed public spaces also apply to banning smoking in homes”
— The policy of 24-hour licensing laws should be reviewed
— NHS treatment should be witheld or delayed for those for smokers or heavy drinkers unless they seek help

Fluoridation
— Voters should decide whether fluoride should be added to local water supplies, currently only available to 10 per cent of Britons. Increasing the practice is controversial because of a lack of good-quality evidence on the potential benefits and harms

Infectious disease
— Anonymised data for assessing and predicting trends in infectious disease can be collected without consent, “as long as any invasion of privacy is reduced as far as possible”

Source: Nuffield Council on Bioethics

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