Trans-fats and Reframing the Debate on Public Health Issues

Trans-fats, or those in partially hydrogenated oils, have been in the news a lot lately. New York City has taken the bold move of banning them in restaurants and Massachusetts is considering a statewide ban. As usual, when things like this happen, we hear drivel like this:

Cities should respect local businesses and allow the free market to continue to adjust to consumer demand. Instituting a New York-style ban would needlessly shock the market, triggering higher costs for consumers and removing flexibility for restaurant owners.

Ah yes, the free-market, performer of more miracles than Jesus or the Flying Spaghetti Monster. It's done a wonderful job with healthcare and affordable housing too, hasn't it? Anyways, when public-health legislation like this pops up (such as smoking bans in public places), the free-market fundies and certain libertarians love to pile on with the 'protecting us from ourselves' argument, calls of the 'food police' and the inevitable 'Big Brother'. And sadly, a lot of people buy into this crap.

I've always been a believer in the premise that, by and large, many Americans often don't do the right thing until we have no other choice. Many of us tend to be unable to grasp a 'bigger picture' in that we seem unable to grasp how our individual actions and choices affect the world around us. Unfortunately, because of the powerful industries pulling the governmental strings, the right thing doesn't get much of a chance. Consider fuel mileage standards, for example. Every time legislation is introduced to mandate higher mileage standards, we get the typical argument from the auto industry about how 'the market' is not calling for more fuel-efficient cars. 'People love their SUV's, so they're obviously not concerned about fuel efficiency'.

Know what? They are 100% right, many people don't really give a damn. So, by that logic, the hell with global warming, mideast oil wars and such? That's when the idea of the 'common good' needs to come into play. It blows my mind that, no matter what, the right of someone to make money always seems to trump my right to clean air and water or pristine wilderness or not having every corner of my mental environment cluttered with advertising.

The Difference Between Europe and America

Ok, so back to the trans-fat debate, and the common good. Truth: Americans are a bunch of fat-asses. (disclaimer for the PC thought police: the author himself badly needs to drop twenty pounds - so said my dietician) Obesity is a major, serious health problem in this country. The Center for Disease Control:

Overweight and obesity and their associated health problems have a significant economic impact on the U.S. health care system (USDHHS, 2001). Medical costs associated with overweight and obesity may involve direct and indirect costs (Wolf and Colditz, 1998; Wolf, 1998). Direct medical costs may include preventive, diagnostic, and treatment services related to obesity. Indirect costs relate to morbidity and mortality costs. Morbidity costs are defined as the value of income lost from decreased productivity, restricted activity, absenteeism, and bed days. Mortality costs are the value of future income lost by premature death.

According to a study of national costs attributed to both overweight (BMI 25–29.9) and obesity (BMI greater than 30), medical expenses accounted for 9.1 percent of total U.S. medical expenditures in 1998 and may have reached as high as $78.5 billion ($92.6 billion in 2002 dollars) (Finkelstein, Fiebelkorn, and Wang, 2003). Approximately half of these costs were paid by Medicaid and Medicare.

So, basically you and I are paying for people to have the 'right' to stuff their faces with a Big Mac. And that is where we need to focus our public health arguments, how peoples' poor choices affect all of us. The next time a right-winger frames as a 'freedom' issue, we need to turn around with statistics like these to illustrate this important principle. First, even though people have the 'right' to make their own food choices (or car choices or whatever), statistics such as the above show that they are clearly choosing the wrong choice in terms of the things that affect all of us (even those who go out of their way to make the right choices), time and time again. So there goes their argument that people know what's best for them. Some do, some don't, and some do but just don't care. Then, it is vital to point out the economic costs of the problem, and how that is affecting my economic freedom, because I'm having to pay for someone else's poor choices. Which is the greater harm?

If framed properly, even though it's not going to convince all of the right-wingers (it's really all about the money to them anyways- their profits, not our personal incomes ), it will shift the public perception of how those issues are framed, and hopefully we can make some progress. I thoroughly support people's choices to engage in harmful behavior; I engage in it quite often myself. But I don't support having to pay for someone else's poor choices, nor do I expect you to pay for mine. And the right-wingers seem to be all about rewarding what they see as good behavior (savvy investment choices, staying off welfare, abstaining from sex until marriage. whatever). Why shouldn't they support this? Well, like I said, ultimately it's about freedom, the freedom to make money. And although important, it needs to be kicked down a few notches on the 'ladder of freedoms', certainly below the rung of public health. They have controlled the debate for so long in this country that much of their bullshit is taken as conventional wisdom and to hell with the facts. It's time for us to change that.

ADDENDUM: I didn't think of it as I was writing this morning, but in the crosspost of this over at Daily Kos, the alternative idea of taxing instead of banning came up. Of course, it would still get attacked with the same arguments as a ban, but again, could easily be justified in the sense that, sure, you have the freedom to behave badly, but you're going to pick up the tab for it, not society. I could get behind that. That's why I support cigarette tax hikes, as long as the money is used to offset the public health costs. And as far as the argument that these kinds of takes are taxes on the poor, I don't buy it. Considering that the poor have some of the highest smoking rates and obesity rates, perhaps if they couldn't afford to behave unhealthy, they would do it less.