Cayce Hook

Questions about freedom of choice are central to debates over public health policy. Some of the policies with the largest impacts on behavior are those that change the choices available in the environment–yet these policies often invite criticism and concern over an encroaching “nanny state” that unduly limits individual freedom of choice. Historical examples suggest that perceptions of what constitutes an unfair infringement on freedom may be malleable, however: the introduction of seat belt laws in the 1980s, for example, generated heated debate about government overreach, with legislators holding up copies of George Orwell’s 1984 and warning of ‘violent’ reactions from angry constituents. Yet today, compliance with seat belt laws is widespread and the idea that these laws unduly restrict freedom receives little mention.

In this project, I examine the role of bias towards the status quo in shaping perceptions that a given policy infringes too much on freedom. Examining policies like nutrition requirements for vending machines, limits on the sale of flavored tobacco products, and healthy defaults for fast food menus, I find that policies are less likely to be perceived as infringing on freedom if they are imagined as already being in place. In contrast, when these policies are described as being under consideration, yet not yet part of the status quo, they are perceived as more threatening to freedom, less likely to be beneficial, and receive weaker public support.

These findings suggest that people may be initially reluctant to change the status quo, but that evaluations of a policy, and its effects on personal freedoms, may become more positive after it becomes part of a new status quo. In future work, I plan to examine whether explicitly teaching people about status quo bias, and encouraging people to imagine what the world would be like under a future status quo, can reduce defensiveness towards proposed health policies.

Although research suggests that a penny-per-ounce tax on soda and other sugar-sweetened beverages (SSBs) would effectively reduce the health and cost burdens of diabetes and heart disease, proposals for such measures have frequently been met with public resistance. In American culture more generally, public health measures designed to curtail or influence individual health-damaging behaviors—including mandatory seat belt and motorcycle helmet laws, compulsory child vaccination, restrictions on the sale of alcohol, and bans on smoking in public places—have historically been decried as “nanny state” measures that subvert individual autonomy and displace personal responsibility for health. My research investigates whether traditional public health appeals for a soda tax are resisted because they activate “nanny state” concerns, and whether there are ways to describe an SSB tax without activating these concerns. I also examine whether public health appeals may backfire by encouraging counter-arguing, ultimately resulting in people becoming more entrenched in the belief that responsibility for protecting health lies within individuals and not with the state.