Merit of nagging policy makers as part of a comprehensive campaign to effect change.

McCartney raises several important points on the futility of nagging patients to be more physically active.1 Her alternative to nagging patients is to nag policy makers. This strategy has merits, particularly if part of a comprehensive campaign.

Examination of any guides on how to influence policy finds that relationship building is key. The public health and medical communities have come a long way from the idea that the cold presentation of facts will hold sway—undoubtedly a positive sign. Although progress may be slow, reverting to nagging alone is not the way forward.

Recent public health successes, such as legislation on standardised packs for tobacco (passed in England in March 2015), have relied on multiple elements of the public health community coalescing around a single goal. The campaign was built around constructive dialogue with policy makers, haranguing from the side lines, and the building of public support. Current campaigns such as Action on Sugar and the subsequent Scientific Advisory Committee on Nutrition recommendations on halving sugar intake illustrate the potential of nagging policy makers combined with constructive engagement. Further evidence comes from Smith’s summary of Hochschild’s excellent book Bury the Chains on the campaign to abolish slavery.2 Key elements of that campaign included a business-like strategy, constant action on many fronts, and cooperation between policy insiders and external agitators. The MP William Wilberforce was a friend of the prime minister and acted as a powerful insider to complement Thomas Clarkson, an activist who travelled the country giving powerful public speeches and vociferously agitating for change.

Nagging policy makers alone is unlikely to be enough, but is a good start, especially when part of a comprehensive campaign involving vision, strategy, and tactics.