More rhetoric on restricting the choice of the poor

I see that leading Stuff today is an article on New Zealand’s “obesity epidemic”, and how we must changes some things because we are “killing ourselves”.  The policy suggestions are:

In a report published today, the association calls for drastic cures for the bulge, including taxing or minimum prices for sugary drinks, restricting food advertising aimed at children, and taking fast food out of schools.

I’ll be honest, I can see a reasonable justification for everything except the minimum price.  I can see a good justification for changing policies around children, based on habit formation.  This isn’t the point.  The point I’m touching on involves the inappropriateness of quotes like this:

Otago University health researcher Professor Jim Mann said he supported the report’s recommendations, particularly a fizzy drink tax. Kiwis were becoming so big that they were almost blind to obesity. “Parents can’t even identify when their children are overweight or obese. Obesity is fast becoming normal.”

New Zealand’s poverty rates, particularly among children, and cheap access to fatty tasty foods were largely to blame, as was a lack of political will. “There is this obsession with the nanny state, that we shouldn’t be telling people what to do.”

A couple of points before the main game, “poverty” is too blame for the fact households can afford more calories then they would even need – ok that is a relatively ridiculous statement.  Furthermore, what exactly is the problem with the normalisation of obesity among people – we need a little more than “it will shorten their life”.  If anything, I have a problem with us trying to stigmatize people ALL THE TIME for things and placing a cost on them – this gets very close to bullying (in fact, I find some of the anti-obesity stuff that comes out to effectively be bullying).

But ignore that as well (I know it’s hard).  There is nothing wrong with doctors giving advice and “telling people they should do” something.  But there is a big problem with doctors being able to impose what they believe people should be doing on them – and the difference is constantly missing in this debate.  The individual has a property right on their body – not society.

When I hear claims creeping towards saying we should force people to do things for their own good, and when I hear “externalities” justified on “lost productivity”, I hear this song:

It isn’t a particularly exciting track – and I seem to see stories that cause me to hear it every day.  This is a negative externality from this sort of story, so let’s tax it 😉

Anyway, why do I say this is rhetoric around restricting the choice of the poor again?  Look carefully at the policies, blaming “poverty rates” and yet setting minimum prices, taxes, and cutting out types of food.  When it comes to habit formation with children this is reasonable – but when we start treating adults like children without thinking about WHY they are making choices, we aren’t being helpful.  This is a point that I tried to flesh out more in the comments here when discussing this on Sciblogs.

In the case of “poverty” and “food” the mechanism could be status good competition.  But increasing prices doesn’t necessarily help this, and may just make the associated competition and psychosocial stress worse!  It isn’t enough to say we have a cause, the policy needs to be predicated on the cause!  What makes this hard is the fact we often can’t observe these causes – which is why we have to make our value judgments about the individual behaviour involved, when discussing the policy, VERY VERY clear.  Otherwise we may tacitly assume very stupid, unfair, or ridiculous behaviour – this is a lesson economists learnt the hard way 40 years ago 😉

Notice it isn’t most of the suggested policies I’m against – it is the way we are describing individuals, and especially the poor.

I am sure that there are a number of people who read this and say one of the following:

  1. You are just a free choice zealot who won’t listen to reason
  2. Sure whatever, but it is important to make strong claims to sell policy
  3. It is difficult to describe nuanced policy, so we have to explain it in simple but powerful ways to sell it

Each of these three views is based on good intentions – the best even.  However, by ignoring why individuals make choices and how policy relates – whether in making policy or in discourse – these good intentions don’t imply good outcomes.  I have (differing) issues with each of these three positions.

And in each case, I fear that those we hurt most are those who are most vulnerable and most excluded in the first place – the poorest among us.

Note:  I want to repeat something I said earlier, so I’ll do that here “I find some of the anti-obesity stuff that comes out to effectively be bullying” – I don’t see this cost being included in policy announcements.  And it also makes me very very angry – a modern society is supposed to be helping individuals become more, not bullying them until they conform to some idealized norm.

11 replies
  1. Daniel J. Taylor
    Daniel J. Taylor says:

    To be fair, Stuff has (as usual) made a meal (no pun intended) reporting on the wider issues discussed in the actual reasearch by focussing on headline winning quotes; poor people = fat people, this is bad so lets fix it with x, y, z incentives. From what I’ve read (disclaimer: I am not a public health expert), the wider international research makes good attempts at measuring “quality of life, adjusted years”, and correlating this (using epidemiological magic) to a series of lifestyle indicators (which unfortunitely link obesity with “poverty”). It is however stated in a fair whack of papers that educational initiatives (as always) should be the first and best course of action. Seem’s to me that Stuff is leaping on the more drastic “nanny state” initiatives suggested (ie. suger tax etc).

    • Matt Nolan
      Matt Nolan says:

      Many of the public health experts would recommend these initiatives using the same types of arguments (as noted in the previous “rhetoric” post) – and the quote about the nanny state is directly from one.

      However, your point is a fair one – and doesn’t change my concern about this type of rhetoric. It is still very uncomfortable and inappropriate 😉

  2. VMC
    VMC says:

    I agree with much of what you say, to a point. If the obsese folk expect the rest of us to pay for their ill health in later years, maybe we have a right to tell them how silly and selfish they are; especially when it turns out that while they might like the Coke Cola now, they will not like kidney failure and diabetes later on. But on the ” “poverty” is too blame for the fact households can afford more calories then they would even need” point – there is a difference between calorie and nutrients. Good nutrition tends to cost more than calories so if you are hard up I can see why you might opt for certain food choices. Still this is a difficult problem and I think people like Jim Mann are just trying to help folks avoid an unnecessary miserable old age. But I do wish I could be as thin as he is.

    • Matt Nolan
      Matt Nolan says:

      Yar, make it a user-pay scheme through a tax perhaps. But there are a couple of things here:

      1) Good nutrition costs more than bad nutrition
      2) Jim Mann means well

      On the first one, I’m not sure that this is the case. And if it is – well then we have a question of income adequacy. Making people poorer doesn’t change that!

      One the second point I don’t disagree – hence why I said at the bottom I am certain that this comes with the best of intentions. But intentions and outcomes aren’t the same thing, and imposing costs on the poor to make them “do what we want” because it is “for their own good” is a touch uncomfortable.

      People make poor life choices, sure. How much is the individual responsible for this, and how much is the rest of society responsible? Can we really justify violating people’s property rights over their own bodies/choices about their own bodies because we don’t think they are making the right choices.

      These questions are very hard when considering children and mental and physical disabilities – very hard. When considering all of society they are also very hard questions. The best we can do is to make the choice judgments very very clear – and this sort of rhetoric simply hides them, and takes away agency from individuals. I am very uncomfortable with this.

      • The other Neil
        The other Neil says:

        I am all for information and education, provide people with the information they need, help them understand why it matters and then let them make their own choices.

        There is a general undercurrent, maybe not even undercurrent, that people who make what other people think are poor choices are not paying their way, not doing what is in their best interest etc. I actually think a lot of it smacks of intellectual snobbery and elitism.

        Whilst not wanting to come across preachy, ‘let he who is without sin cast the first stone’ (pun intended).

        I think the general level of debate, reporting and analysis in the MSM is very poor.

        The humorous quote used recently in the Herald about alcohol, ‘if alcohol were a communicable disease, a national emergency would be declared’, is a classic example (as was the article). No balance. no counter view, no investigation, just repeating the communication objective of the originator. I directed the reporter to Eric’s blog to see some alternative analysis and reporting. Whether this changes future reporting, who knows.

        As a parent, I teach moderation to my child, Coke is fine, MacD’d is fine, just not every day. Exercise is great etc.

        I like personal responsibility and informed decision making. We should be promoting that not taxes and bans.

    • Eric Crampton
      Eric Crampton says:

      Ok, VMC. What happens then if we find that it’s those healthy exercise people who cost the system more, on the whole, because they live longer (costing the superfund) and consume health services over a longer period?

      Be careful wanting to tax all the fiscal externalities. You might not like where it leads.

  3. Kimble
    Kimble says:

    Well if they knew what was good for them, they wouldnt be poor, now would they?

    ~ thought often, never said

  4. Geoff Simmons
    Geoff Simmons says:

    Interesting blog Matt. I am not quite sure what your point is, but i will respond to what I think you are saying 🙂

    I have the same problem as you with the poverty conversation and Spirit Level – separating correlation and causation is pretty difficult. With food, it isn’t actually more expensive to eat healthily, you just need the skills and time to prepare food. It is the cash poor and time poor I feel for most, and there are a few of those.

    You have said you don’t really have a problem with the policies, but I want to touch on them briefly. Education, better labelling and no advertising to kids is a no brainer for a functioning market in my opinion – the old perfect information condition. That isn’t happening now and IMHO is a complete travesty that is overlooked by the media (in part I have been told by contacts because of a conflict of interest – media can’t discuss advertising bans!).

    Where the ethics of this gets difficult is on the tax. You can argue that if people want to kill themselves, they should be allowed to do so. With smoking society tries to stop them – I see no difference with junk food. I see it as much closer to user pays, given we have a public health system. Of course, then you can argue that unhealthy people save us money on super… meh. Essentially it comes down to your perspectives on freedom of choice. But at least be consistent – if you oppose a tax then you should apply the same approach to cigarettes/ alcohol, and you should probably back a privatised health system (which is dumb for a whole host of reasons). To me a junk food tax is the best approach, in the world of messy second best options.

    As for the stigma, I agree but for a different reason to the one you put forward. And this relates to the ‘freedom of choice’ point above. All the evidence suggests that once people are adult they have very little ‘choice’ over their size. Two people can eat the same thing and their bodies react differently. Powerful hormones dictate energy intake and expenditure, and these are set by genes, time in the womb and early experiences/ habits. So by the time someone is an adult they can only control their weight within a given range. This is why losing weight is so tough, and why 80% of diets fail. So I agree we should not stigmatize fat people, because they have little choice. We should point the stigma to modern fake food which makes us eat more (bigger portion sizes, increased energy density, lower levels of fibre and protein, higher levels of refined salt, sugar and fat, greater convenience). This is why I think we should tax junk food, not fat people.

    • Matt Nolan
      Matt Nolan says:

      Hi Geoff, great to see you here 😉

      My first point is that communicating genuine concerns about obesity in the way noted in the above quotes from Stuff is a mixture of misleading and bullying – I walked into my coffee shop to be greeted with a front page story stigmatizing people on their weight, rather than positively describing how we can help individuals improve their wellbeing. As Dan notes in the comments, this is largely the way of the media – which is a pity. However, the way public health discusses these issues – by stretching the definition of externality, communicating idea about the responsibility as being in the hands of the state, and ignoring benefits – doesn’t help matters. Think I accidentally communicated that point more clearly here (and it is a point that holds for all discussion using aggregates)

      The second point, which I should have gotten too more quickly, was that the policies chosen and described are specifically about imposing restrictions on the poor – I am uncomfortable with doing that, especially if we haven’t discussed what is going on to reduce wellbeing, as they are the most vulnerable group.

      Given your response I believe you figured this out even if I wasn’t clear 😉

      Yar, it isn’t just the Spirit Level guys who are at fault – economists own obsession with measures like “GDP” or “productivity” can be equally as unhelpful if they are communicating trade-offs in a way that gives the public misinformation about said trade-off. I have written similar posts about all these types of aggregates, and it is a bit of a pet hobby horse of mine.

      Fully agree on education, and the ethics of the tax – ultimately, I can imagine society saying they support a tax on junk food even if the measured externality is negative (due to early death) because they view it as a “choice” to become obese and so don’t want to subsidise health in the way they do for genetic conditions! Not saying this is my view, but I think it can be justified.

      That takes us to the stigma though – your description involves people’s genetic predisposition driving their choices and whether they become obese (and how quickly they metabolize food). In that case, having social insurance through standard healthcare appears more “fair”, and the user pays argument gets a bit harder for me.

      I’m a big fan of these types of discussions, and fleshing out causes – and how government can provide mechanisms to help people improve their wellbeing (when I get a chance I want to do a post on that). I am just concerned that the way we describe these issues in public, and the way we sell them, leads to an increase in social stigma, and inadvertent punishment of the poor – in the worst case scenario this sort of thing can lead policy makers towards overly simplistic policy prescriptions that are heavily focused on the “easy to catch” poor, eg the very high tobacco taxes we have now that have gone well beyond any semblance of an externality tax.

      The ultimate target is wellbeing, rather than a level of obesity or a type of behaviour. It is just so important we make sure policy is pinned to that root issue of wellbeing and capability, rather than claiming victory from shifting statistical aggregates around.

  5. Simeon Pilgrim
    Simeon Pilgrim says:

    Education: Really, if we asked people eating McD’s “is this good for you” or “smokers” or “coke drinkers” is that good for you? I would bet none of them not one you answer yes. People know “it’s not good” but they make calorie rich choices because it feels good. I’m carry more weight than and want, and yet when I’m glum, eating makes part of me happy, I swim 1-2km everyday, still overweight.

    To lose weight I have to sit/work/play and be hungry at the same time, for a couple hours a day I need to experience hunger. Now if I’m fun stuff time flies, but when I’m bored, or grumpy your super aware of hunger, so it’s “fixed” by eating.

    Will the price of food change much, nope. I’ll still be unhappy when I’m unhappy. Maybe if prices doubled/tripled for junk food I’d rethink. But I suspect they not thinking of the much tax.

    So now the “poor/fat people”, are we trying to help them, or just help our future selves from perceived costs of “those poor people”.

    We all make different life choices, and sometimes the hand we are given are not the best, but I heard an really interesting EconTalk about Education, but the point was that the Education researcher where the type of person that can sit still for years working hard to get good grades, and do a doctorate program then move on to research positions, these people have a huge amount of self control, and I assume the same is true for Health researchers. So as a person with mild self control, I find it funny the solutions are Information, and tilting the decision process, and then people will do the right thing, yet this only makes sense if you have good self control in the first place.

    It’s the same funny BS as the first home buyers problem, people have been parting for 5+ years, and then think ‘time to by a house’, and have no money for a deposit, so cannot get one. Verse how much money/deposit was consumed while living the high life in their twenties, verse acting in there best longer term interest and saving.

    So my points, I’m not sure, but maybe it’s related to when at school 20+ years ago, there was talk that some people were getting fat due “too many pies” so pies might get dropped from the school food shop, which super annoyed me, because when I, once a month got to buy my lunch a “god dam super fatty pie” was what I wanted because it was a treat for me.

    So when as a “normal user” of a service, it is made worse to protect others from themselves, I get mad at the “wise caring saviours”. So a lot of health policy I see from Otago winds me up.

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