Posted on 01/13/2014 at 03:39:21 PM by Student BloggerBy Lindsey Smith, MPH
Despite protracted efforts, public health advocates and policymakers have achieved limited success in enacting programs and regulations aimed at promoting better diet behaviors and reducing obesity. Policies aimed at reducing access to unhealthy foods, like New York's big soda ban, policies to ban trans fats, proposed soda taxes, and introducing nutritional requirements for children's fast food meals have proven especially contentious.
But why are these proposals so controversial? According to a recent article published in the International Journal of Health Policy and Management,(1) it is because both sides are deeply passionate about making sound ethical policies. Even more, both sides have arguments that stem from deep concerns about equality and autonomy. The key issue arises over disagreement about which elements of these moral concerns should be emphasized and whether it is acceptable for the government to restrict one element at the expense of another.
For example, some argue that obesity prevention measures like soda taxes disproportionately affect low-income populations by taking a larger proportion of their income, and therefore are unfair. Yet others argue that such taxes are favorable because they actually alleviate unfairness. The proponents argue that such taxes could reduce health disparities, such as higher rates of obesity among the poor, specifically because of their disproportionate impact on low-income groups. In both cases, advocates are interested in the fair distribution of resources, but one side cares more about the fair distribution of income, while the other side cares more about the fair distribution of health.
A second example involves concern about autonomy, or put simply, self-rule. Generally, autonomy is considered ethically valuable, regardless of whether such freedom leads to good or bad choices. However, there are multiple elements of autonomy that must be addressed: freedom from control by others, the psychological capacity to make choices, and understanding the available options and their potential consequences. Food autonomy should allow people the ability to make food choices that are pleasurable, healthy, and consistent with personal values. Yet, the value of food autonomy can fuel arguments both for and against an obesity prevention policy when said policy increases autonomy in one area while decreasing it in another. For example, the overturned New York City big soda ban, which banned sales of sodas and sugary beverages over 16 ounces in restaurants and corner stores, was criticized as compromising autonomy by diminishing freedom from control by others. Yet, others argue that the ban actually increases autonomy by increasing individual's capacity to make good choices. These proponents argue that soda companies are so pervasive and so powerful in their marketing strategies, that consumers often choose reflexively, without really considering financial or health costs, or their true preferences. The soda ban, they argue, actually enhances freedom of choice by allowing consumers the opportunity to consider their preferences. If consumers decide they want to purchase more soda, they can still buy two 16-oz containers, but at least they are permitted the opportunity to consider the tradeoffs involved.
The authors finish by suggesting that the recognition of these common ethical considerations might ease tension on both sides, paving the way towards a speedier and more harmonious resolution. However, the real battle will be in deciding which of these ethical elements deserves priority.
1. Barnhill, A; King, KF. Ethical Agreement and Disagreement about Obesity Prevention Policy in the United States. International Journal of Health Policy and Management 2013:1(2),117-120.