This excerpt from the New York Times article, Los Angeles Stages a Fast Food Intervention,1 not only describes the latest example of a government taking action to nudge its citizens toward better nutrition but also succinctly summarizes analogous efforts in the recent past:2
I especially admire that wording of the fundamental issue,
eating one style of food stops being a personal choice
and becomes a public health concern.
I don’t have an answer, but I am convinced that the preceding question, adjusted for other healthcare issues, deserves far more attention on a national scale.
Until a consensus is reached, the determining factor in such decisions defaults, it seems, all too often to the individual or group who has become invested in a cause to the point of promoting – or coercing – that program. For example, consider Arkansas Governor Mike Huckabee’s interest in passing regulations to halt obesity that was triggered by his personal 100 pound weight loss.3 His efforts may be well intentioned and the resulting laws and resolutions may even be good policy, but depending on the enthusiasms, prejudices, and political motivations of powerful leaders hardly makes for an organized approach to the underlying problems.
And, until a means of distinguishing between personal choice and public health concern is reached, dietary regulations, restrictions on tobacco and alcohol use, mandated mental health treatment, directly observed TB therapy, … will continue to be passed and enforced erratically. And, it will continue to be difficult to provide a scientific explanation why, for example, banning trans-fats is viewed as an acceptable exercise of government while no one appears to be pushing obligatory exercise.
Finally, how about this scenario: The newly elected Governor of Illinois, desperate to keep his campaign promises to hold down state healthcare costs stumbles across the AlignMap web page outlining the costs of medication noncompliance. The Governor checks with the Director of Public Health who explains that the state has long passed laws and regulations regarding, for example, treatment of communicable diseases, including mandated, observed treatment for some disorders. The Governor extends this principle in a bill that mandates total treatment compliance for all patients covered by state run or managed programs under penalty of permanent disbarment from the program. By tying the compliance regulation to anticipated improved health for those covered, the Governor cowes the legislature into passing the bill.
Scary, eh?
On the other hand, as long as we continue the hodge-podge sysemn (or lack of system) now in place, we certainly don’t have to worry about those nasty hobgoblins of consistency (whether foolish or not)
Credit Due Department: The hobgoblin pictured above, I find belatedly, is employed, when not illustrating Emersonian expressions, as mascot for The Wychwood Brewery, producers of Hobgoblin Ale.
Footnotes
- Los Angeles Stages a Fast Food Intervention by Kim Severson, New York Times August 13, 2008↩
- OK, I’m disappointed that the list didn’t include Chicago’s recently overturned foie gras ban, but otherwise it’s a representative listing↩
- See Schools, Healthcare, & Dietary Regulations↩
