This month’s American Journal of Public Health brings us a primer (abstract here; subscription required for full text), written by lawyers supported by the Robert Wood Johnson Foundation, teaching “policymakers to avoid potential constitutional problems in the formation of obesity prevention policy.”
The article isn’t exactly a Steal This Book for the anti-obesity crusaders, but the authors’ stated aim is to help those crusaders skirt legal challenges to statutes that might, for instance, ban fast foods or require the posting of accurate calorie counts on restaurant menus: “This primer is meant not to deter obesity prevention efforts but to foster them,” the authors adumbrate.
Of course, the anti-obesity crusade is well on its way to using the law to tighten the control of behavior already. And the failure of restaurant calorie counts to show any effect on eating patterns isn’t dampening enthusiasm, it seems.
Brian Elbel of NYU and colleagues just reported in Health Affairs that the calorie counts now posted by law in New York (another piece of legislation backed by our bluenose mayor) don’t affect how much people eat, based on a study of over a thousand New Yorkers from minority neighborhoods (abstract here, full article here). At Freakonomics, Stephen Dubner surmises that this sort of program only helps people “who are already the most vigilant about their health and well-being.” But it’s hard to find anyone in public health who is opposed.
They should be. The public health industry, which likes to claim its main interest is human dignity, should be lobbying for less regulation of human appetites, not more.
But public health is often the pre-eminent paradigm of control in our society. Rename the acts or traits you find morally repugnant as diseases, and you can hand them to the health sector for management. Once you say you’ve got an epidemic on your hands, you can count on the public health industry to respond. Alcoholism, addiction, smoking, obesity, social anxiety… there seems to be a big supply of epidemics that used to be moral offenses or threats to the social order and are now opportunities for your doctor or your health commissioner — not your clergyman — to tell you how to act.
The neat thing about the control exercised through public health is that you never have to sermonize, read Bible verses, or prophesy Apocalypse. The rhetoric of risk is a lot easier for the self-professed progressives in public health to swallow than religious sermonizing would be. Even when the sermon and the risk rhetoric have the identical goal: wiping out the moral offense.
From Junkfood Science, we learn that
Employers will now perform random tests of employees for evidence that they’ve smoked outside of work and will weigh employees in the workplace and report their BMIs to the state. Employees deemed noncompliant with the State Health Plan’s employer wellness initiative, will pay one-third-more for health insurance. Employers believed that eliminating smokers and fat people would lower health costs.
And from WSJ Health Blog, that the CEO of pharmaceutical corporation Schering-Plough agreed (at a meeting at the Cleveland Clinic) that people with unhealthy behavior should pay more for health insurance. Sure — you certainly wouldn’t want the wealthy to pay more.
That’s not the only problem with the public health industry’s vigorous embrace of behavioral control, but it’s a big one. Start classifying people based on how they behave, and you begin discriminating against the ones who don’t act right. But the ones who you think don’t act right are almost always the ones society was already discriminating against — the poor, most of all.
And even when the poor aren’t getting shafted in the crusade against the unhealthy, inquiry about how a just society should work is going down the tubes. The profound moral-philosophical questions of what is the right way to live a life, the right way to raise children, the nature of liberty, and so forth, are surrendered in the public health paradigm – replaced with the simple dichotomy: healthy vs. not-healthy.
This entry was posted on Sunday, October 11th, 2009 at 5:19 pm and is filed under Behavior, Disease, epidemics, Health Professions, obesity, Physicians, public health, Risk, Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.