Smoke Free? Public Health Policy, Coercive Paternalism, and the Ethics of Long-Game Regulation

Abstract

Contemporary public health advocacy promotes a ‘fifth wave of public health’: a ‘cultural’ shift wherein the public's health becomes recognized as a common good, to be realized through concerted developments in the institutional, social, and physical environments. With reference to examples from anti-tobacco policy, in this article I critically examine the fifth-wave agenda in England. I explore it as an approach that, in the face of liberal individualism, works through a ‘long-game’ method of progressive social change. Given the political context, and a predominant concern with narrow understandings of legal coercion, I explain how efforts are made to apply what are presented as less ethically contentious framings of regulatory methods, such as are provided by ‘libertarian paternalism’ (‘nudge theory’). I argue that these fail as measures of legitimacy for long-game regulation: the philosophical foundations of public health laws require a greater – and more obviously contestable, but also more ambitious – critical depth.