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This paper argues that the latest UK government white paper on public health, Choosing Health , 1 is vulnerable to criticism as paternalist despite its emphasis on "informed choice". I begin with a description of the background to the white paper and its focus on choice. Choice is invoked by the white paper in order to absolve itself of charges of paternalism. I suggest that the white paper's view of choice reflects a Kantian account of autonomy. This deems acts to be autonomous only when they are fully rational. This is seen most clearly in the white paper's conflation of informed choice with the right, healthy choice. The idea is that an informed (autonomous) person would only ever make a healthy choice. It also lays the foundation for paternalist interventions aimed at bringing out the autonomous person (the inner citadel) that lies behind the currently non-autonomous person who is making irrational, unhealthy choices. For this reason, an emphasis on informed choice is consistent with paternalist interventions. In the concluding sections I suggest some responses to this point.
BACKGROUND
Since 1997 the UK has had a centre left (Labour) government that has been active in developing public health policies. It has been mindful of the criticism that, prior to 1997, such policies focused too greatly on individual behaviour and not enough upon broader social factors affecting health. An earlier centre left government produced a white paper entitled Prevention and Health: Everybody's Business , which condemned people's "overindulgence and unwise behaviour". 2 This emphasis remained under the Conservative Thatcher government. Under the Labour government, by contrast, the white papers started saying such things as,
We believe that the social, economic and environmental factors tending towards poor health are potent. 3
The latest white paper, Choosing Health , maintains this change in emphasis. It also tackles a further criticism that has emerged over the last twenty years, particularly from libertarians. They accuse public health policies of generating a "nanny" (paternalist) state that, for our own good, attempts to prevent us behaving in ways we desire. The white paper believes it can avoid this criticism through an emphasis on informed choice. Ethically, this seems reasonable. People are to be given information that will help them make choices; they...