Tackling Obesity – Should The Public Pay?

The demand by AMA Victoria that the State Government fund bariatric surgery for the chronically obese is no doubt motivated by compassion, but illustrates some of the ways the debate about obesity has become severely distorted. Obesity is not a public health problem and should not be treated as one.

Until relatively recently, the phrase “public health” indicated health problems that were actually public problems – sanitation, the control of epidemics, water quality, airborne pollution and so forth. But increased obesity is not a public health crisis like an outbreak of bird flu would be. Obesity is not contagious – when one person overindulges on fast food, their colleagues and neighbours aren’t put at risk. And, in 2008, nobody orders pizza without being fully aware that cheesy crusts can lead to weight gain.

For these reasons, obesity is too often tragic, but it is first and foremost a private problem. Medical campaigners who seek to redefine the parameters of public health are eliminating the crucial policy distinction between public and private health concerns. When every health problem becomes a national crisis, no medical treatment is ineligible for government funding. Bariatric surgery may be an important, even necessary, tool to treat obesity, but it does not automatically follow that it should be paid for directly by the taxpayer.

Of course, the most common objection to this line of reasoning is the simple calculation that the cost of treating obesity now is far less than the cost of treating the consequences in the future – resolving heart disease and diabetes may be more expensive than bariatric surgery.

All public policy should be subject to economic assessment. But this is a slippery slope. Britain’s National Health Service shows what can happen when the government makes all health problems its business – those calculations rapidly lose their compassion and become cruel assessments of moral, rather than medical, questions. Last week British PM Gordon Brown hinted that individuals whose lifestyle choices had created their health problems – obesity is the classic example – may be refused treatment in order to cut costs.

The only way to avoid this trap is to drop the conceit that all medical problems are public problems, and to reintroduce the idea that individuals should be responsible for their own health.

No Street Cred For Council Party Poopers

When the State Government offered councils a $6000 grant to develop street party kits last year, it was no surprise that they jumped at the opportunity. Not only is writing complicated protocol documents a major highlight of working for local government, but the Byzantine regulations that the kits were to help navigate were imposed by the councils themselves.

One part of government bribing another part of government to do what they should be doing anyway has become a staple of Australian politics. Why should councils miss out on all the fun?

The resulting street party kits are a grand monument to the bureaucracy and red tape that is impeding social and community life in Australia. These elaborate bundles of forms, rules and recommendations demonstrate clearly how the steady accumulation of seemingly trivial regulations can quickly become a restraint on community activity. The regulations aren’t those that apply to major festivals on the scale of last weekend’s Johnston Street Fiesta – they apply to small neighbourhood barbecues.

Certainly, many of the issues covered within the kits are, on the face of it, sensible. Washing hands before handling food probably isn’t a bad idea – it would be poor form to poison your neighbours while you were trying to get to know them.

But, as the City of Whitehorse demands, having to provide party volunteers with comprehensive food handling information in the form of written instructions is taking this a bit too far. Nobody wants a reputation in the street as the guy who loves to produce paperwork.

And don’t bother trying to sell any food or drink. Children’s lemonade stands are only possible if those children are able to fill out Community Amenity Local Law No. 1, Schedule 3 (Parts A and B) and Schedule 7.

The City of Stonnington’s 25-page safety plan appears to require the party organiser to assume responsibility for the safety of all guests – planning evacuation and ambulance routes, assembly areas and marshalling points, memorising emergency announcements, and strategically placing fire-fighting equipment around the party location.

Some rules are completely ridiculous. Stonnington requires party organisers to keep an incident kit close by at all times. This should contain a fluoro jacket, gaffer tape, torch, area map and sunscreen. They also require party organisers to nominate a communications liaison to negotiate potential clashes with local event venues, and to retain an electrician on call, just in case.

Street gatherings are not known for being rowdy. Nevertheless, the Moreland City Council insists that sound levels do not exceed 65 decibels. This exhilarating volume is just louder than a humming refrigerator and a little below a hair dryer. It is also above a quiet conversation. As a result, laughter, which surely ranks high on the list of attributes of a good party, is essentially prohibited within the People’s Republic of Moreland.

Presumably, the 65-decibel limit is also why many street party kits, when recommending that CDs are played at a street party, specifically nominate acoustic music. If you anticipate your street party may exceed the 65-decibel limit, you may be required to hire an independent acoustic engineer for the duration of the party to monitor your guests’ volume.

Councils and the Victorian Government recommend that a street party be held on the street itself. To do so, six weeks before the party is to occur, an application for road closure must be submitted to the local government. Forms demonstrating that the road closure has the support of more than 75% of the street’s residents must be submitted. A traffic management plan to be jointly prepared with a council traffic engineer must also be submitted, along with all the necessary fees and charges required to navigate the bureaucracy. This kind of ridiculous red tape is a major roadblock to community life.

The State Government-funded street party kits also raise another question – whose job is it to actually sit down and write them? The kits contain pages and pages of tips on how to have a good party. For instance, Whitehorse recommends that guests introduce themselves and recall the funniest thing they ever saw on the street. Developing topics for small talk is hardly a core role of government, and yet state taxes are being funnelled to council bureaucrats to do just that.

And the condescending advice that neighbours should share power tools and wave to each other when they pass on the street should make everybody wonder how stupid councils think their residents actually are.

Local governments enjoy dramatically less media scrutiny and voter interest than their state and federal counterparts. As a consequence, they are free to impose far more absurd rules than other levels of government. Local governments are adamant that they are trying to encourage street parties, but if they keep putting up these obstacles, they may not get invited to them.

While You Weren’t Looking, Freedom Went Up In Smoke

Are we freer today than we were half a century ago? That question is surprisingly hard to answer. The state control over the economy that characterised Australia in the 20th century is quickly being replaced with nanny state controls.

Barriers to trade have been mostly eliminated, and state monopolies eradicated. But accompanying that has been explosive growth in social and environmental regulations. There are now more pages of Commonwealth legislation introduced every year than were passed in the first 40 years of federation.

In our social lives, freedom has both advanced and retreated. For example, restrictions on the sale of alcohol have eased. But they have been replaced by nanny state measures such as smoking bans. In the future, cigar bars will be as distant a memory as the six o’clock swill.

Since smoking bans were enacted this year in Victoria and NSW, sales growth in pubs has dropped significantly. Hotel patronage may return to former levels – international experience seems to indicate that it will – but when smokers return to the pub, they will be less free than they were in October last year.

Unquestionably, advocates of individual liberty and personal responsibility have lost the battle on smoking. That’s not surprising – smoking is reviled by everybody who doesn’t enjoy it. In a liberal state, that disagreement would be sorted out by negotiation; before the bans, many restaurants and hotels already enforced non-smoking areas or disallowed it entirely. But in a nanny state, such negotiations are replaced by force of law.

Similar sentiments lie behind restrictions on poker machines. The gaming industry is a political football to be kicked around at every state election, while individuals who value their freedom to enjoy the pokies are ignored.

In a nanny state, the government morphs into an over-eager insurance company, assuming the role of risk-manager for its citizens. Any risky or unhealthy endeavour has to be eliminated – individuals cannot be trusted to assess the risks themselves.

The next target is food. Numerous proposals are on the table to tackle our expanding waistlines, including banning certain types of fats, banning junk food advertising, and even taxing fatty food.

Earlier this year, the Labor Party hinted that it was considering banning the use of licensed characters such as Shrek in junk- food advertising, should it win government. Last week, the Cancer Council of Australia came out in support of a general ban on junk food ads aimed at children.

However, there is little evidence that such bans work. Both Quebec and Sweden have tried them, but neither have seen any reduction in childhood obesity. There are twice as many overweight children in Sweden as there were 15 years ago, even though the Scandinavian country has had a ban on all advertising aimed at children since 1991.

Furthermore, politicians hurrying to make political capital out of medical problems such as obesity and lung cancer rarely think through the unintended consequences of their policies.

Swedish advertising bans have not reduced obesity, but they have had other results. Losing the revenue from the highest-paying advertising has reduced the quality and quantity of children’s television programs. Similarly, restricting the advertising market has raised the cost of toys in Sweden to 50 per cent above the average European level.

The Australian Government’s hard line on tobacco has had similar consequences. Smokeless tobacco products have been swept up as the nanny state tries to purge society of everything that meets its disapproval.

It is unfortunate that Australia lacks a strong intellectual history emphasising individual liberty and personal responsibility. Our “she’ll be right mate” attitude is easily swamped by our calls for government to intervene in personal decisions.

Laws are passed with little reference to how they will affect our freedom. As a result, individual liberty in Australia is slowly being eroded by neglect.

You Are What You Chose To Eat

It is a tribute to Australia’s prosperity that people in poverty are more likely to be overweight than underweight. But rather than a celebration of the achievements of economic growth, this has instead led to cries of an “obesity epidemic”.

For instance, Ross Gittins argued (Opinion, 28/6) that this is a case of market failure that we need the government to remedy.

It is clear that the average weight of Australians is increasing. But obesity is a complicated area, and health advocates would do better to analyse the long-term causes and effects before rushing into calls for government regulation.

Using the standard measure of obesity, the body mass index (which, in simple terms, compares weight with height), obesity is on the rise. At present, 21 per cent of Australians are classed as “obese”.

However, the medical literature is highly sceptical of the validity of this measure that takes no account of body composition, such as muscle or bone. It may be that many people now classified as obese are, in fact, “big-boned”.

Our consumption habits also tell a complex story. OECD data shows that daily energy consumption per Australian has actually decreased since the early 1960s by about 125 kilojoules. Similarly, our sugar consumption has also gone down. Many nations, including the United States, have seen increases along these lines, but these figures indicate that Australian consumption is getting more, rather than less, healthy.

Even more surprising: a study from the Centres for Disease Control in the United States found that “overweight” people had a lower risk of death than those of normal weight. Not only that, but this lower risk partly cancelled out the increased deaths from obesity.

But we are getting heavier. Part of this is to do with the composition of our diet.

As the millions of supporters of the Atkins diet will argue, what we eat now is radically different from what our ancestors ate 50 or 100 years ago. But it is also true that what those ancestors ate is radically different from what their ancestors ate. Food consumption has been one of the biggest changes brought about by our centuries-long process of globalisation.

More recently, technological change and supply-line innovation in food manufacturing has drastically reduced the cost in time and money of food preparation. It is arguably a wise economic decision to eat out rather than in, especially when factoring in the time of shopping and cooking a meal.

As the quality and variety of manufactured food has gone up, its price has gone down.

But most of the recent growth in weight is not directly attributable to our food.

A study by the economists Darius Lakdawala and Tomas Philipson found that only 40 per cent of weight gain since the 1970s is due to changes in diet. Rather, the large part of our weight increase can be attributable to changes in lifestyle and work practices.

Contrary to what Gittins has argued, this is not an opportunity for government to intervene.

First, government regulation doesn’t seem to work. Sweden has every program on the book to combat childhood obesity. Advertising aimed at children under 12 is banned. Sports programs are heavily subsidised. Healthy cooking is part of the curriculum. But the number of overweight Swedish children has tripled in the past 15 years.

The market is remarkably good at educating people on the negative consequences of their decisions. Balancing against the advertising for high-sugar snacks, television programmers have provided shows like What’s Good for You and The Biggest Loser.

All of these programs have been produced not by government, but by corporations eager to maximise their ratings, and therefore their profits.

In fact, data from the United States indicates that the number of food and restaurant commercials viewed by children has actually declined over the last decade.

Consumers are becoming more aware of the consequences of fatty and unhealthy food. This change in demand goes far past the salads at McDonald’s. Juice bars, wheatgrass shots, bioengineered food and even sushi were unheard of to Australians 50 years ago.

The notion of a government regulating to protect people against obesity used to be unthinkable, used as a parody of anti-tobacco legislation. Unfortunately, it shows us how far the political debate has moved from personal responsibility to government responsibility.

But is there a clearer area in which individual responsibility must take the fore than when choosing what we eat? Government regulation is not the solution to the obesity crisis.