The Government and industry are not doing enough to help people live healthy lives, says the Nuffield Council on Bioethics in a report on public health ethics published today. The report, which highlights the importance of reducing health inequalities, looks specifically at alcohol, obesity, smoking, infectious disease and fluoridation of water.

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

The Council identifies alcohol consumption, which has become a huge public health problem in the UK, as a particular area where the Government should do more. Increasing tax on alcohol and restricting hours of sale have been shown to be effective in reducing alcohol consumption. 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.

“The Government should implement tougher measures to tackle excessive drinking,” said Lord Krebs. “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 anti-social behaviour.”

The Council also recommends that producers, advertisers and sellers of alcohol should take more responsibility for preventing harm to health. They should not understate the risks, or exploit the desirability of drinking, particularly in ways that appeal to young people.

Excessive drinking is associated with major health problems and also affects third parties, for example through drink-driving and violence. The high level of drinking among young people is of particular concern. The annual number of deaths due to medical conditions caused by alcohol in the UK doubled from just over 4,000 in 1991 to over 8,000 in 2005. In 2004, the Government calculated that the cost of alcohol-related harms in England was £20 billion per year, and that alcohol misuse was involved in approximately half of all violent crimes (1.2 million violent incidents).

A selection of further recommendations made by the Council is below. In each case, the Council considered the responsibilities of the state and others in improving public health and reducing health inequalities.


Obesity in children and adults has increased dramatically over the past decade in the UK and is associated with several serious health conditions. Currently a major study is looking at whether front-of-pack labels on food packaging contribute to healthier choices. When the results are published, the Council recommends that the food industry should adopt the most effective labelling scheme, and if it does not, there would be ethical justification for the UK Government to enforce it through legislation.

We increasingly live in ‘obesogenic’ environments, which are less conducive to exercise in the daily routine. The Council recommends that town planners and architects should be trained to encourage people to be physically active through the design of buildings and public spaces. This could include segregating walking and cycling routes from heavy traffic, and maintaining more public parks and children’s playgrounds.


It is inconsistent for tobacco companies to claim they are socially responsible, and yet apply different standards for protecting consumers in different countries, depending on local laws. The Council recommends that policies on selling and advertising tobacco that provide the greatest protection to consumers should be adopted by companies worldwide.


In the UK, infectious diseases account for over 10 percent of deaths and around one in three GP consultations. As vaccination programmes are voluntary in the UK, people can choose not to get their children vaccinated. After weighing up the evidence and ethical considerations, the Council concluded that introducing more stringent policies for childhood vaccination (for example, penalties for those who do not comply) would not be justified at present in the UK.

Infectious disease across borders

New infectious diseases are currently emerging at the historically unprecedented rate of one per year. Global surveillance of new and existing infectious diseases is vital, particularly for those that could lead to worldwide pandemics such as new strains of influenza. However, surveillance can be compromised when countries do not have the capacity for effective monitoring or where they decide not to fully cooperate with international surveillance efforts.

The Council recommends that the UK Government should help to improve the capacities of developing countries to effectively monitor infectious diseases.

Fluoridation of water supplies

Fluoride has been added to the water supply for over 50 years in some parts of the UK, with the aim of improving dental health. There has long been debate over whether this should be rolled out in other areas of the UK. This is controversial because fluoridation schemes do not provide each individual with a choice and because there is a lack of good-quality evidence on the potential benefits and harms.

The Council concludes that the most appropriate way of deciding whether fluoride should be added to water supplies is through regional democratic decision-making procedures. This should be supported by better and more-balanced information for the public and policy makers.


These conclusions and recommendations have been published in a report by the Nuffield Council on Bioethics called Public health: ethical issues. The report was prepared by a Working Party established in February 2006, which included members with expertise in health economics, law, philosophy, public health policy, health promotion and social science. To inform discussions, the group held a public consultation and met with representatives from relevant organisations.