Introduction

As Jane Austen might have observed, it is a truth universally acknowledged that a government in pursuit of its role will seek to influence the behaviour of its populace. She might have added that this includes behaviours affecting the safety, health and wellbeing of individuals, communities, workforces and society at large. Governments exercise their influence in a variety of ways: through regulation by passing laws; persuasion using social marketing campaigns; incentivisation using fiduciary instruments and other financial inducements; education providing knowledge and skills; the provision of services; ecological changes to the physical, social and economic environments; and many others. Some of these levers are applied at national or international level, others at regional and local level. Many are discussed – and often criticised and questioned – during the various chapters of this book.

This chapter explores some of the ways in which governments use legislation to directly regulate individual behaviour in order to safeguard and promote the health of the people. We consider how the public responds to this approach, and we weigh up some of its benefits and pitfalls.

An historical perspective

Public health and regulation targeted at individuals are familiar bedfellows. They share a long history. Enforced restrictions on personal freedoms have historically been seen as a relatively quick and simple way to ensure changes in behaviour to protect the health and wellbeing of individuals and communities. The earliest examples were almost entirely concerned with health protection, personal and community safety, avoidance of environmental hazards and the prevention and control of communicable disease. In ancient times, religious rites about hand and foot washing and disposal of the dead through burial, embalming or funeral pyre had spin-off benefits for hygiene and health. In ancient Babylon, religious rules forbade the digging of wells near burial grounds and midden heaps. Throughout the Middle East and Europe, lepers were forcibly confined to closed colonies from the earliest times. During the Black Death that swept Europe in the 14th century, bubonic plague sufferers were compelled to stay in their homes, as indeed they were even more forcibly during the Great Plague that ravaged Europe two centuries later.