Ever since the news officially broke last week that Jenny Macklin and co are planning to broaden the reach of income management, I’ve been waiting for the usual suspects to start screaming “nanny state”!

By the usual suspects, I mean those who trot out this much abused and overused term whenever there is any attempt to take public health action, especially when it involves taking on powerful interests such as the tobacco, alcohol, and junk food industries.

But, surprise, surprise, nanny has been keeping an extremely low profile.

Yet income management — unlike efforts to create healthier environments for all people — is in fact the ultimate in nannyism as it means taking away some fundamental rights.

One type of policy action — restrictions on advertising of tobacco, alcohol, and junk food, for example — is about making healthier choices easier for everyone; the other is about bloating bureaucratic power and taking away the choices and freedoms of some individuals.

The public health policies that are so often derided by the nanny-pushing naysayers are usually based on sound evidence that they will improve the population’s health.

On the other hand, some of Australia’s leading health equity experts have warned that there is not strong evidence to support the health or social benefits of income management, and believe there is real potential for it to cause significant harms.

Some in the public health field, such as the University of Sydney’s Professor Stephen Leeder, see the nanny paradox as a reflection of ideological differences. He says: “Those who wish to be conservative in regard to their own freedom to buy what they want without government let or hindrance will also be conservative when it comes to the use of their taxes for income supplementation of others. That’s ideology.”

But perhaps it also comes to down to an “us” and “them” mentality. It’s OK for the state to intrude roughly into the lives of Aboriginal people and disadvantaged groups.

But the rest of “us” are quite able to manage our own lives, thank you very much, and don’t need any help with problems such as obesity, binge drinking etc (although the stats show that quite obviously we do). And, of course, it’s only those “others” who ever do dreadful things such as abuse their children.

Then there’s the issue of political power. It’s far easier for governments to impose tough sanctions on the powerless than on the powerful industries whose healthy bottom lines come at a cost to the community’s health.

Recently at Croakey, I wrote a plea for us to bury nanny in order to enable a smarter, more sophisticated public debate about health.

Please don’t think that I’m now arguing she should be revived. Rather than invoking nanny, let’s at least have an informed discussion about income management rooted in some sensible analysis of its potential benefits and costs, including the likely harms.

• For the views of leading public health experts on nanny and income management, see Croakey.