Analysing the reasons behind people’s lifestyle choices is a tricky business since it involves a complex mix of a person’s personal preferences, their home environment and available resources, their existing knowledge and education, and the influence of others around them.

Psychology often comes into it too as sometimes people turn to things like smoking to gain pleasure or to help cope with the stresses of everyday life.

The role of the government and other health/education professionals in shaping (and controlling) people’s health choices is a hotly debated topic.

Smoking is a particularly interesting case as public perception has changed over time as we have gained more understanding - through medical research - of the health risks it presents.

Such research has led to changes in UK law. In 1991 all tobacco TV advertising and sponsorship was banned. This was extended in 2005 to ban all forms of media advertising including the internet, radio and at sports events like Formula One racing. Smoking was also banned in all enclosed work places in 2007 to protect employees from the health risks of breathing in other people’s smoke (passive smoking).

But what can the government actually do to help? Is there a right answer? 

In short, no. Especially since many people think the government shouldn’t get involved in the first place. After all, it’s our life and isn’t it up to us to live it as we wish?

But others think it’s the responsibility of those in power and who have relevant expertise (e.g. doctors, health charities, teachers) to educate and give guidance and support to enable people to make the best lifestyle choices possible. Helping us to live long and healthy lives. Here are a few steps that can be taken- but which one do you think is best (if any)? 

1. Bans - so an extreme measure would be to ban cigarettes altogether. That way, people wouldn’t be able to (easily) get hold of them and cause themselves harm. In philosophy, we call this a consequential argument- where you’re not interested in someone’s reasons and motives for doing something (i.e. smoking) just the outcome of taking another action (i.e. a ban would, in theory lead to a healthier population with less smoking-related deaths). But in doing so, aren’t you just pushing people to make different and sometimes worse choices? Will they be tempted to buy cigarettes illegally instead - products which might not have been quality-checked and could be unsafe?
2. Increased taxes - another option is to tax people more on buying cigarettes. This might put some people off and help their health improve but many people don’t like being told what to do. So – like with banning things- an increased tax may force some people to look for cheaper and perhaps worse alternatives. For example, many people in the UK have turned to vaping (e-cigarettes) which although doesn’t contain the same poisonous chemicals as traditional smoking, there's currently very little research to indicate the long-term effects of this type of smoking. 
3. Nudges - This is another word for actions aimed to make it harder for people to make unhealthy decisions, or offering support to encourage them to make better choices. For example, changing a supermarket layout so that the healthier foods are seen more easily by more people with the naughtier foods tucked away. But what about if people aren’t made aware of these interventions? Some argue that by hiding an intervention, you’re restricting people’s freedom and preventing them from being themselves. One study at the University of Oxford has taken a slightly different approach by giving participants health recommendations based on an analysis of what they recently bought at the supermarket. The researchers highlight to participants their top three fattiest food purchases and suggest healthier alternatives. When it comes to smoking, a lot of work has been done to try to put people off buying cigarettes by placing unappealing wrappers on cigarette packs. These either give details about medical risks or show gruesome images of body parts destroyed by smoking. Do you think this is enough to change people’s minds about smoking? 

So these are a few of the strategies the government can take but many health professionals believe that the most worthwhile thing you can do is to give patients real choices. A large part of this is about offering honest explanations, and realistic and achievable ways to improve their situation.

Say for example a patient is struggling with obesity and requests to have a gastric band operation (where an adjustable ring is placed around the top of the stomach making a person eat less and feel full quicker). This is major, life-changing surgery which may affect their ability to eat normally forever more. Some argue that if a doctor didn't share this information and simply followed the patient’s request, this wouldn’t be respecting them fully. It’s better to offer honest explanations (where they are told about the long-term issues) and some alternative possibilities to change their lifestyle before heading to an extreme option such as surgery.

Choice vs. Desire 

Another thing to consider is how many of our choices are determined by our motivations and desires, and how sensibly/clearly people can actually think when they're addicted to something like the nicotine in smoking.

Plus, how much are these choices shaped by our thoughts about the short term v.s. the long term consequences of our actions? Say, for example, you see a delicious-looking but fattening chocolate cake in a shop window, there are several ways of thinking which may or may not lead you to eating it: 

First order desire: 'I want it so I will buy it and eat it now.' 
Second order desire: 'I won’t eat it as I will ruin my appetite for later.'
Third order desire: 'I won’t eat it as I want to feel healthier.'

A particular concern when it comes to children is that they tend to be led by first order desires and so would often benefit from the guidance of a supportive adult.

And more generally, people have been shown with things like smoking to give more weight to immediate benefits (i.e. stress relief, enjoying social smoking with friends) rather than looking towards the future health risks.  

This is clearly a sensitive topic with no easy answer. But what do you think? Should the government take some responsibility in helping us make better health choices? Or should this be left down to us? Should you have to live with the consequences of your actions? 

This article was written in discussion with Dr. Andrew Papanikitas (Nuffield Department of Primary Health Care Sciences) and Tena Thau (Department of Philosophy) - both based at the University of Oxford.