You can get garden variety health advice from the daily newspaper, the "health" section of most book stores, and of course thousands of web sites. I'm hoping to present thought provoking and maybe change provoking thoughts about individual and community health. This blog is not just what to do about health, but how to think about it. I'm looking forward to an exchange of ideas with readers. July, 2010


Wednesday, July 27, 2011

Health Promotion and Freedom

This morning I was exercising on a step machine, and among the screens in the TV bank in front of me was one showing the Bill O'Reilly show.  He was arguing (as he usually does) with a "wellness advocate" whose name I don't remember, but who other wise made a powerful impression on me because she was able to hold her own against the usual bullying and ridicule from Mr. O'Reilly.  The topic was whether or not we should tax junk food, such as sugared drinks, french fries, donuts, and so forth.  The advocate was framing the issue as a way to protect the nation's health, while O'Reilly spun it as a matter of freedom from government interference.

What do you think?  For people who have professional concern for promoting the nation's health, what is the right balance between complete laissez fair and dictating everyone's food choices?  Up until perhaps 20 years ago, the primary public response to advancing nutrition-related health was school and public education, with the idea that an informed public would make food choices in the best interest of their health.  There were two problems.  The first was that a lot of the responsibility for nutrition education rested with the U.S. Department of Agriculture, that had a conflict of interest, because their primary purpose was to promote U.S. agriculture, and particularly meat, dairy and field crops like corn and soybeans.  With that central mandate, it has been hard for USDA to be honest about encouraging people to make their diets centered around vegetables, fruits, beans and whole grains, with meat and cheese proteins as more of a garnish or an occasional selection rather than a dominant portion of diets.  The second problem with government-sponsored food education is that even at its best, it has been completely swamped by mass media from the junk food industry.  We never saw an ad for the Food Pyramid during a Superbowl, but rather, Doritos, Coke, and MacDonald's.

In more recent years, health advocates have assertively moved toward policies and regulations to support healthier food choices.  The government has some limited restrictions on health claims made by foods and beverages, and terms like "low fat" and "enriched" are scrutinized by the Food and Drug Administration.  In addition, packaged foods are required to post ingredients and basic nutritional information on labels, so that consumers are able to inform themselves when shopping.  More recently, health promoters have begun to suggest calorie information be posted on menus and menu boards in restaurants, and putting restrictions on the content of school lunches. Some of these new policy proposals are as yet unproven, but time will tell what contribution they make to America's health.

The issue on O'Reilly's show was the imposition of what once was called a "sin tax" on nutrient-empty foods.  This idea circumvents trying to motivate people to choose better foods, but instead, provides economic incentives to do the right thing.  Such taxes have been shown to be effective for tobacco and alcohol.  If you make something more expensive, people will buy less of it.  The other justification is that the price exchanged from the buyer to the vender does not cover the social cost of using that product.  The consequences of the obesity epidemic are imposed on society at large; junk food makers do not get the bill.  Imposing taxes is a way to recoup the cost to our health care system.

While I agree with maybe 3% of O'Reilly's views on anything, I think it is a fair question for us to think about the benefits of using social policy for health promotion versus imposing restrictions on people against their will.  What is fair and balanced with this issue?