chickenfeet

I spend a lot of my time working on issues related to chronic disease and the first things one learns about chronic diseases is that they are incredibly common, have a massive impact on individuals, families and the broader society and that the probability of becoming chronically diseased is profoundly influenced by smoking, drinking, diet and exercise. I don’t much care for tabloid language like “obesity epidemic” but it’s pretty clear that, at a population level, more people are fatter than in the recent past and that this is a factor in the increased incidence of a broad range of diseases.

Now, one of the more immediate consequences of the current economic crisis is that the profits of fast food and confectionery companies are rising. This makes me wonder about what the long term impact of the recession will be but also causes me to observe that here is proof positive that lifestyle “choices” are not made in a social or economic vacuum. This is crucial because at the moment the principal public health intervention related to obesity is the generation of vast numbers of preachy messages.

This is really annoying and stupid because everyone concerned with public health and the determinants of health knows that preaching is spectacularly ineffective. Not only is it ineffective as a public health intervention it causes people to get very defensive which is understandable but not helpful. The classic case study on just how ineffective preaching is is smoking (or as we insiders call it, tobacco cessation strategy). Warning messages just give politicians the warm fuzzies. They have no impact at all on smoking behaviour. We have decades of evidence to prove this. We also know what does work; economic incentives (1) and changing environments.

Now it strikes me that “obesity strategy” today is very much where tobacco strategy was fifty years ago. Back then, everyone who cared to look at the science knew there was a problem but nothing was done about. Producer lobbies (tobacco farmers, cigarette companies, the hospitality industry) had government by the short hairs and by a combination of economic FUD and spurious civil rights arguments ensured that governments restricted themselves to utterly ineffective propaganda campaigns. Smoking began to decline sharply only when it became more difficult and expensive to smoke.

Fifty years on we are in the same boat with obesity. We know that it would be of societal benefit if people ate better and exercised more. We also know how to make that happen. It’s not rocket science. The diet piece is probably easier than the exercise one. Direct and indirect subsidies to agri-business need to be realigned to promote healthy eating. Right now they have exactly the opposite effect. In fact, where I live, virtually every component of a cheeseburger is massively subsidized(2). The exercise piece is more complex and, perhaps, more interesting. Recent research in Canada shows that people who live in the inner city exercise more and are lighter and healthier than people who live in the suburbs. Going down a level shows that this is largely a function of people walking or biking to do things that suburbanites use cars for (this is a good example that shows that lifestyle choices are very much not made in some sort of environmental vacuum). So we can see that a really effective public health intervention would be to make it easier for people to live in cities without a car.(3) Where does government stand on this? Governments at all levels in Canada continue to subsidize the suburban lifestyle by direct subsidies to the auto and lumber industries and by building roads and other infrastructure that, together, make the suburbs profitable to develop and artificially affordable to live in. Obviously there are other useful exercise related initiatives that governments could take and they don’t include pumping out pro exercise propaganda while closing school swimming pools. The whole situation is not helped by a political system that is systematically gerrymandered to reduce the influence of large cities.

Why then do governments pursue policies that cost the economy billions and curtail millions of lives? It’s essentially the same story as with tobacco fifty years ago. Again we have a producer coalition that desperately wants to rubbish the public health agenda. This time the producers are even more powerful. They include farmers (4), processed food companies, the auto industry and the property development industry. All of these groups are politically incredibly influential. Property developers pretty much own local government in Ontario for example.

What will it take to break the cycle? I don’t know. I’m not sure that the research has been done on what finally tipped the balance of forces against the tobacco lobby. I suspect that we could learn a lot from such a study.



(1) A very distinguished public health physician once pointed out to me that raising the price of a pack of smokes by $1 had more impact on mortality than all the advances in cancer treatment of the last 30 years.
(2) I remember a senior executive of McCain’s back when NAFTA was first signed complaining that his US pizza competitors who got export subsidized Canadian wheat flour, tomatoes and cheese would now be able to re-export them back to Canada, tariff free, as frozen pizza.
(3) This would probably be the most effective way of reducing carbon emissions too.
(4) Why are farmers so powerful? They are a small group of corporate welfare bums but the public loves them. I don’t get it.