The giants of excess: a challenge to the nation's health

Summary. Sir William Beveridge in his famous report wanted to eliminate the five giants of want, squalor, idleness, ignorance and disease: the giants of too little. However, the problems facing welfare states are more the giants of too much: the giants of excess. For health in particular, excessive behaviours of various kinds contribute significantly to the major sources of morbidity and mortality in our society, including cancer, heart disease, stroke, diabetes and kidney and liver diseases. There are few good theories about why individuals engage in excess behaviours. But it is clear that one of the main problems that face both individuals and the government or other agencies tasked with improving health is that the costs of most unhealthy activities impact in the future, whereas the benefits from them occur in the present. Policies have to be developed that either bring some of the costs from unhealthy activities (or the benefits from healthy ones) back from the future, or reduce some of the benefits from unhealthy activities (or reduce the costs of healthy ones) in the present. To avoid the danger of the ‘nanny state’, they should also not impact too greatly on individual freedom or autonomy. Promising ideas that meet these criteria, which are derived from the philosophy of libertarian paternalism, include smoking permits and exercise hours.