David Satcher, US surgeon general from 1998-2002, began his “Call to Action” report with “Overweight and obesity ha[s] reached…epidemic proportions.” In 2004, the new U.S. Surgeon General Richard Carmona, said that childhood obesity is “every bit as threatening to us as the terrorist threat.” A congressionally commissioned report from the Institute of Medicine published in the fall of 2004 called for massive government intervention to stave off the crisis. One author said we need “nothing short of a revolution.” The World Health Organization warned “If immediate action is not taken, millions will suffer from an array of serious health disorders.
Last year the United States Public Interest Research Group (USPIRG) agreed. The United States is going through an obesity epidemic. Contemporary culture, habits, and education has strongly contributed to the current health conditions in the United States. The question is whether the country’s cumulative physical health has reached a juncture where stricter government regulations need to take place.
Typically epidemics would necessitate government intervention, especially in matters of public health. But a disease that is as multifaceted as obesity does not come with a simple antidote, despite what late night infomercials may try to tell you. Bills and initiatives have come from some in the government, but are generally rebutted with critiques surrounding their economic unfairness, their inconvenience, and mostly about how it’s none of the governments business.
New York Mayor Michael Bloomberg grabbed national headlines with his proposal to ban soft drinks greater than 16 ounces. The outcry over the proposal came from various directions, but centered on the resentment of an authority figure seeking to legislate what is generally considered a private issue. The libertarian may agree with the thought that drinking a soda in excess of 16 ounces may not be healthy, but not in the perceived overreach of power. Hence, the dilemma of whether a mayor should act paternally in the heath interest of the city’s citizens or to let the people decide on their own. In a city where “34 percent of adult New Yorkers are overweight and 22 percent are obese” it may have been time for a drastic measure
Bloomberg is not alone in attempting to legislate over his constituents’ consumption habits. Richmond, CA is attempting to pass similarly controversial legislation. In this instance, they are seeking to implement a tax of $.01 for every ounce of a sugary carbonated beverage. Likewise, Hawaii is attempting pass legislation to tax the distributor for every gallon of it sold. All these proposals come from a view that it is the duty of the government to drive consumer behavior.
The government has altered consumers’ behaviors by either taxing or restricting perceived vices. Until the Harrison Narcotics act in 1914, cocaine was still a legal remedy for many diseases. Prohibition of alcohol and its repeal, the 18th and 21st amendment respectively, is the most notable example of direct government intervention to a health problem claimed to be plaguing the nation. Recently, there have been efforts to demonize smoking cigarettes as a way to discourage the behavior, by funding commercials and educational efforts the federal government has targeted the problem. The issue with food and the looming obesity associated with poor health habits is that as Health Affairs notes, it does not yet have the mass outrage needed to encourage government action.
Prior to 1999, with the release of Fast Food Nation by Eric Schlosser, critiques of contemporary food production had not received the attention it deserved. In it he comments on the ethical failures of the fast food industry, claiming they have “trashed the American country side, widened the gap between rich and poor, reconstructed the entire meat-packing industry, and cynically fed an obesity epidemic. The result is “emotional pain,” “low self-esteem,” and widespread illness and death. After the release of the gruesome findings, American legislators as well as regular citizens have been more receptive to further critiques. Notably, the enormous popularity of Super-Size Me and Food Inc. have come through as viable mainstream critiques of current practices.
Criticism of the industry and demonization of unhealthy living are invalid without further examining much of the root issues with an unhealthy lifestyle. The New York Times breaks down the increase in food production to the increased portions Americans have become accustomed to eating. M.I.T Professor Carson Chow points to the fact that not only do Americans consume larger portions than ever before, they also waste more food than at any time prior. Though it may not be the food production that’s the issue behind the weight gains, the abundance of it at retailers and restaurants would sever many of the ties connecting its production to its preparation. Of course, at a time when many Americans still go hungry, it would seem counterintuitive to restrict farmers from cultivating more products to deliver to markets.
However, the availability of food is highly dependent on location. A notorious issue with obesity is its propensity to be around lower-income neighborhoods. The so-called food desert problem refers to the absence of grocery stores with adequate selections. The USDA charts these locations with statistics including the number of children without proper access. These occur both in desolate urban areas as well as in the rural counties with large distances to the nearest retailer. Instead of proper grocery stores that are seen routinely in the suburbs and higher-income urban areas, there are either fast-food restaurants that serve as a cheap substitute for sustenance or small convenience stores that do not have the selection of healthy products, if they have any at all, like the common grocery store. As a result, obesity is much more prevalent in low-income areas. Overall 7.5% of pre-school age children are obese, but that number doubles to 14% in children of low-income families.
California has taken a measure to attempt to prevent the creation of these deserts, and improve access across the state. However, market forces do not necessarily dictate change without some legislative incentive. CA AB581 would create a “California Healthy Food Financing Initiative Council” to work on preventing this issue in the future.
Illinois is approaching the issue from another perspective. Instead of finding ways for grocers to come to the people, they would encourage the people to find the grocers or otherwise create a vacuum for healthy food grocers in low-income areas. HB 1399 is meant to limit what the Food Stamp Program, now known as the Supplemental Nutrition Assistance Program, can be used for within the state. As it stands, the assistance can be used to purchase most food products as long as they have not been already prepared. What HB 1399 was meant to accomplish, had it gotten out of committee, would be to minimize the amount that can be allocated to the pasteurized, sweet, or otherwise non-nutritious foods or drinks that are common causes for obesity.
Both the Cato Institute and the Heartland Institute however do not buy into the necessity of government intervention for several reasons. An overlying idea behind the rejection of any government action to encourage healthy behavior or, as some see it, punish unhealthy behavior is that obesity may not be the problem that it has been claimed to be. Radley Balko, a policy analyst at the Cato Institute, comments on how with current medical improvements, obesity no longer holds the public health risk it was once known to have. Furthermore, he makes his overarching claim regarding government action in that “the freedom to risk, indulge, and “sin” are essential to preserving individual liberty and a free society. Governments of free people aren’t authorized to ensure good health, they’re charged with securing liberty, which most certainly includes the liberty to hold bad habits.” The Heartland Institute writes that “any number of legal products and services can have negative effects if used in excess, but that doesn’t mean heavy-handed government intervention makes for good tax policy.”
The Brookings Institute offers a significantly different take on the issue. Ross Hammond, director of the Brookings Center on Social Dynamics and Policy, views the health problems of an individual as a problem for the greater society. He notes that an individual that “relative medical costs for the obese are estimated to be 36 to 100 percent higher than for Americans of healthy weight.” In his report he notes other key figures:
- Childhood obesity alone is responsible for $14.1 billion in direct medical costs annually
- Nearly 21 percent of all current medical spending in the United States is now obesity related
- Medicaid spending would be almost 12 percent lower in the absence of obesity
- A 5 percent reduction in the prevalence of diabetes and hypertension would save almost $25 billion annually in medium-term health care costs
So, when a city like Richmond, CA makes an effort to punish unhealthy foods it draws the ire of the American Beverage Association who have spent up to $70 million in lobbying fees to kill the proposal. Mother Jones has had excellent reporting regarding the situation in Richmond. They note that a town of 105,000 has truly struggled with their collective health. 52% of children in the city are either overweight or obese and 58% of adults are in the shape.
City Councilman Courtland “Corky” Boozé, one of two councilmen who voted against putting it on the ballot, argues that the tax will burden the city’s poor residents, doesn’t deal with more important problems in the city like unemployment and crime, and will only be used to address the city’s budget deficit. The local teamsters that have come out against it as well based on the idea that it works as a regressive tax, affecting lower income families much more significantly; though that may well be the point, especially if it does significantly alter behavior. The USDA found that a 20 percent increase in cost of sugared beverages could spur an average loss of 3.8 pounds a year for adults and 4.5 pounds a year for kids.
A policy issue that has been a topic of debate for the nation as a whole is the subsidy policy for corn and its byproducts. The government subsidies toward corn producers have incentivized food producers to use corn syrup as a sweetener. Though high fructose corn syrup may be unfairly maligned at least compared with sugar sweeteners, it still possesses many of the poor attributes common amongst artificial sweeteners. New York has put forth a bill that though is still in committee would ban all high fructose corn syrup products from stores and restaurants. The federal government has taken notice, as part of an overall reform toward ethanol and the whole agricultural subsidy program House Bill 2307 removes government subsidies from corn producers. The likely result will be that corn will rise to the price of other crops, and thus remove the incentives toward using high fructose corn syrup.
In order for the local or federal government to promote healthier living, they may have to remove some of the choices from the people. Federal legislation would be a fairly radical change for a very large industry. If the American peoples’ beliefs coincide with those of the US Surgeon Generals and do consider the issue as an epidemic, then it may be more conducive for the administration to pass sweeping reforms. Until then, programs designed to change the peoples’ opinions without regulations may be even more prevalent in the future.
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