More rhetoric on restricting the choice of the poor

By Matt Nolan 10/06/2014 16


I see that leading Stuff today is an article on New Zealand’s “obesity epidemic”, and how we must changes some things because we are “killing ourselves”.  The policy suggestions are:

In a report published today, the association calls for drastic cures for the bulge, including taxing or minimum prices for sugary drinks, restricting food advertising aimed at children, and taking fast food out of schools.

I’ll be honest, I can see a reasonable justification for everything except the minimum price.  I can see a good justification for changing policies around children, based on habit formation.  This isn’t the point.  The point I’m touching on involves the inappropriateness of quotes like this:

Otago University health researcher Professor Jim Mann said he supported the report’s recommendations, particularly a fizzy drink tax. Kiwis were becoming so big that they were almost blind to obesity. “Parents can’t even identify when their children are overweight or obese. Obesity is fast becoming normal.”

New Zealand’s poverty rates, particularly among children, and cheap access to fatty tasty foods were largely to blame, as was a lack of political will. “There is this obsession with the nanny state, that we shouldn’t be telling people what to do.”

A couple of points before the main game, “poverty” is too blame for the fact households can afford more calories then they would even need – ok that is a relatively ridiculous statement.  Furthermore, what exactly is the problem with the normalisation of obesity among people – we need a little more than “it will shorten their life”.  If anything, I have a problem with us trying to stigmatize people ALL THE TIME for things and placing a cost on them – this gets very close to bullying (in fact, I find some of the anti-obesity stuff that comes out to effectively be bullying).

But ignore that as well (I know it’s hard).  There is nothing wrong with doctors giving advice and “telling people they should do” something.  But there is a big problem with doctors being able to impose what they believe people should be doing on them – and the difference is constantly missing in this debate.  The individual has a property right on their body – not society.

When I hear claims creeping towards saying we should force people to do things for their own good, and when I hear “externalities” justified on “lost productivity”, I hear this song:

It isn’t a particularly exciting track – and I seem to see stories that cause me to hear it every day.  This is a negative externality from this sort of story, so let’s tax it ;)

Anyway, why do I say this is rhetoric around restricting the choice of the poor again?  Look carefully at the policies, blaming “poverty rates” and yet setting minimum prices, taxes, and cutting out types of food.  When it comes to habit formation with children this is reasonable – but when we start treating adults like children without thinking about WHY they are making choices, we aren’t being helpful.  This is a point that I tried to flesh out more in the comments here when discussing this on Sciblogs.

In the case of “poverty” and “food” the mechanism could be status good competition.  But increasing prices doesn’t necessarily help this, and may just make the associated competition and psychosocial stress worse!  It isn’t enough to say we have a cause, the policy needs to be predicated on the cause!  What makes this hard is the fact we often can’t observe these causes – which is why we have to make our value judgments about the individual behaviour involved, when discussing the policy, VERY VERY clear.  Otherwise we may tacitly assume very stupid, unfair, or ridiculous behaviour – this is a lesson economists learnt the hard way 40 years ago ;)

Notice it isn’t most of the suggested policies I’m against – it is the way we are describing individuals, and especially the poor.

I am sure that there are a number of people who read this and say one of the following:

  1. You are just a free choice zealot who won’t listen to reason
  2. Sure whatever, but it is important to make strong claims to sell policy
  3. It is difficult to describe nuanced policy, so we have to explain it in simple but powerful ways to sell it

Each of these three views is based on good intentions – the best even.  However, by ignoring why individuals make choices and how policy relates – whether in making policy or in discourse – these good intentions don’t imply good outcomes.  I have (differing) issues with each of these three positions.

And in each case, I fear that those we hurt most are those who are most vulnerable and most excluded in the first place – the poorest among us.

Note:  I want to repeat something I said earlier, so I’ll do that here “I find some of the anti-obesity stuff that comes out to effectively be bullying” – I don’t see this cost being included in policy announcements.  And it also makes me very very angry – a modern society is supposed to be helping individuals become more, not bullying them until they conform to some idealized norm.


16 Responses to “More rhetoric on restricting the choice of the poor”

  • I’m happy for people to have full agency in their decisions as long as there is no cost borne by others.

    So a part of the policy decisions we need to clear up is what agency society should retain when the costs of individual decisions are socialised.

    While healthcare remains largely socialised, while the option of income support for those with health failure due to their (admittedly extreme) dietary and exercise choices is clearly socialised then I’m afraid that I support whatever interventions reduce that cost to ME, regardless of how unempowered the individual then feels…

    Meh. Moralistic perhaps. I must be getting old.

    • Ashton, there’s a pretty good chance that a full accounting would have the normal-weight fit folks imposing the highest lifetime burden on the public purse. They impose far greater burden on the superannuation system, and can wind up costing the health system more because they consume services over a greater number of years. See http://offsettingbehaviour.blogspot.co.nz/2013/01/social-costs-of-healthy.html . I don’t know how the numbers would stack up in NZ. But as thought experiment, would you be happy taxing healthy fit people if it really is them who are costing the health system more in the long run? If not, why?

  • “poverty” is too blame for the fact households can afford more calories then they would even need – ok that is a relatively ridiculous statement. Furthermore, what exactly is the problem with the normalisation of obesity among people”

    I think it is more accurate to say that those on limited incomes seem more inclined to buy high carbohydrate/sugar and high fat foods which overall are less nutritious (but contain much higher calories) which contributes to obesity.

    The problem with “normalisation of obesity” is that obesity carries with it a range of health concerns including diabetes. We are not talking about people who are a little heavier than what is considered optimum weight who may be carrying around an extra 15, 20, 30 kg’s of weight which will have an effect on the heart, joints etc.
    In some ways soft drinks are an easy target – water with a large amount of sugar dissolved in it plus flavouring – very little nutritional value.
    I think education is the key, however, why not tax high calorific foods such as soft drinks, if that money was used to lower the cost on more nutritious foods? Cigarettes and alcohol have had a high tax on them due to the harm they cause, why not do the same with soft drinks and similarly poorly nutritious foods?

  • Matt,
    “I find some of the anti-obesity stuff that comes out to effectively be bullying”
    I can see what you are saying here, do you also think the anti-smoking measures, advertising and policies around New Zealand are bullying as well?

  • I’m in full agreement with Ashton & Michael on this.

    ““poverty” is too blame for the fact households can afford more calories then they would even need – ok that is a relatively ridiculous statement.”

    Why? Particularly when – to use a well-known example – it’s actually cheaper to buy fizzy drinks than milk. (Yes, we could argue that people unable to afford milk should drink water – but then of course your ‘choice’ position comes into play!) Similarly, fast-food purveyors (Maccas, I’m looking at you, among others) offer ridiculously cheap deals on burgers, such that it would really work out cheaper than buying the ingredients & preparing your own. Yes, we probably need more education in this area, but some form of fiscal intervention may also be needed.

    “Furthermore, what exactly is the problem with the normalisation of obesity among people – we need a little more than “it will shorten their life”. ”

    *cough* healthcare costs *cough*. As obesity-related diabetes rates rise we will see increasing pressure on the publicly-funded health system to deliver care in this area (dialysis, for example, is not cheap).

  • Eric wrote: “But as thought experiment, would you be happy taxing healthy fit people if it really is them who are costing the health system more in the long run? If not, why?”

    Isn‘t this shifting goalposts? The proposed tax is not on obese people, but on ‘fizzy drinks’. Similarly for the other suggestions. Likewise, it’s not targeted adults or the the elderly, but kids.

    “They impose far greater burden on the superannuation system, and can wind up costing the health system more because they consume services over a greater number of years.”

    Eric, I hope you realise this argument is flawed? – try instead healthcare expenditure per decade of life. (Even accepting your measure, chronic conditions, like diabetes, etc., cost a lot over time & I suspect you’d likely be wrong by your measure too.)

    “A couple of points before the main game, “poverty” is too blame for the fact households can afford more calories then they would even need – ok that is a relatively ridiculous statement.”

    It’d be good if you’d explain what you’re trying to say here, Matt. It makes no sense to me! – & I suspect others are also confused. If you mean this is what the people cited in the Stuff article are saying, it’s not what they said to my reading – I read they said poorer people tend to opt for these foods because sugary/fatty foods are cheap. If you are offering something of your own thoughts (it’s not clear to me who is offering this), then I’m not sure how to read it.

    “Furthermore, what exactly is the problem with the normalisation of obesity among people – we need a little more than “it will shorten their life””

    Obesity is associated with diabetes, heart conditions, etc. I really doubt NZMA isn’t doing this because of a stereotype or similar.

    “this gets very close to bullying”

    This gets very close to fitting a straw man on the NZMA doesn’t it? Being cheeky here an paraphrasing you to make the point 😉 I can’t see this has anything to with bullying or stigmatising. It may be putting a public health issue more plainly than some might like, but I can’t see you’d ever please everyone on that score.

    “But there is a big problem with doctors being able to impose what they believe people should be doing on them – and the difference is constantly missing in this debate. ”

    Citation needed? Where in the Stuff article has it been suggested that doctors are to impose stuff on people? It cites the NZMA as calling for “taxing or minimum prices for sugary drinks, restricting food advertising aimed at children, and taking fast food out of schools.” Nothing about GPs, etc., ‘forcing’ people to do things – as if they could. (It is not ‘doctors’ here, but the NZMA, an organisation, making a suggestion. They’re not able to ‘impose’ that suggestion either – that would be a government.)

    Or, put another way – acknowledging that there is a medical / public health issue, why not offer some solution you think is better instead of just being negative? Just a thought.

    “The individual has a property right on their body – not society.”

    You can argue this yourself: if you take this stance, perhaps you also have argue that they should take responsibility for the consequences of their choices, e.g. pay for their dialysis, etc., themselves. Public health provides a common standard of care, but it needs for the populace, or large subgroups of it, not to work against it. (Incidentally, vaccination may be a good example of this.)

    “I hear this song”

    There’s a blank space after that paragraph; I presume you meant to add a video?

    “but when we start treating adults like children”

    Moot point, surely? – the suggestion was targeted at children.

    “Otherwise we may tacitly assume very stupid, unfair, or ridiculous behaviour”

    I don’t think anyone is assuming this.

    “Notice it isn’t most of the suggested policies I’m against – it is the way we are describing individuals, and especially the poor.”

    You‘re saying your piece isn’t about science, never mind economics?

    I don’t think anyone is ‘describing’ people in the manner you make out.

    Just for thought: What science being presented here? (You said something about a lesson learnt 40 years ago – perhaps you could have presented that instead of referring to it in an empty ‘done deal’ fashion? Just a thought.)

  • Hi Eric – you seem to have missed the main thrust (and some of the detail) of my post. I’ll refer you back to my second paragraph.

    I had assumed that, if we were going back to a policy level, the various inconsistencies (including the one you suggest) would be addressed.

    Mea culpa if that wouldn’t be the case.

  • @Ashton: I’m suggesting that a lot of folks who are happy to support taxes and regs that are mainly directed at other people, and justified on basis of costs to the taxpayer, might not be happy if that same justification were extended broadly. We then might need to find tax or regulatory measures to prevent pre- or extra-marital sex because of the burden of STD treatment on the public health system, for example. Or, if healthy long-living people do impose more burden than the obese, maybe we’d need to tax bicycles and exercise.

  • @Grant: Ok, read it this way. If it turns out that the obese save money rather than costing money, put the tax on exercise and healthy food.

    And you are strictly wrong that the appropriate cost measure here is “cost per decade of life”. If the justification for restricting others’ choices, and that does include taxes, Grant, where those taxes are imposed in order to affect others’ choices, is that people make decisions that impose costs on the tax system, it’s the total present discounted value of that burden that should matter.

  • “@Grant: Ok, read it this way. If it turns out that the obese save money rather than costing money, put the tax on exercise and healthy food.”

    No offense, eh, but I don‘t see the value of your exercise. If you’re trying to make a point about targeted taxation v. broader measures, wouldn’t it be more useful to offer some measure you think is better? (Just to be up-front, I prefer people to offer alternatives rather than be negative about something but provide no alternative. But that’s just me, I guess. Don’t get me wrong here, either: I’m not taking a position on the NZMA’s tax suggestion, but on the arguments offered.)

    One way or other a solution will want to deal with the causes of whatever condition targeted.

    Note your new thought experiment talks about the people (‘the obese’) rather than the causes of the condition (sugary drinks, etc).

    The suggestions the NZMA made don’t actually target ‘the obese’, really; they target things that might led to obesity.

    Isn’t any ‘loss of choice’ in the cost of, and access to, particular types of foods (by school children)?

    “And you are strictly wrong that the appropriate cost measure here is “cost per decade of life”. If the justification for restricting others’ choices, and that does include taxes, Grant, where those taxes are imposed in order to affect others’ choices, is that people make decisions that impose costs on the tax system, it’s the total present discounted value of that burden that should matter.”

    Don’t patronise, please. I understood what you were trying to say.

    You seem to be (still) missing the point I raised. It may be that I was being too brief, if that’s the problem, in which case I sympathise, but I was expecting you’d fill in the blanks yourself, as it were.

    Your words read as if you wanted to derive something annual (a tax) from something measured over different lengths of time (you wrote “over a greater number of years”). The costs need to be annualised one way or other to make the tax. I plumped for a decade simply as it’d even out any year-to-year fluctuations.

    Could I suggest that Matt defend what he’s written? I would prefer to hear from him – it’s usual on sciblogs for the author to stand by their words and answer questions, etc.

  • Aston, yes agreed 100% – although it comes down to where we define the externality. I touch on this more in a follow up post!

    Michael:

    “I think it is more accurate to say that those on limited incomes seem more inclined to buy high carbohydrate/sugar and high fat foods which overall are less nutritious (but contain much higher calories) which contributes to obesity.”

    Certainly – hence why I come back to arguments around status goods etc later on. “Poverty” is not the cause of excessive consumption, it is a series of related factors. I left this as a sidenote in the post, but it is definitely something I could flesh out another time 😉

    “I think education is the key, however, why not tax high calorific foods such as soft drinks, if that money was used to lower the cost on more nutritious foods? Cigarettes and alcohol have had a high tax on them due to the harm they cause, why not do the same with soft drinks and similarly poorly nutritious foods?”

    Due to the external harm they cause – not the harm it causes to the individual themselves. If we start taxing someone because they are harming themselves this isn’t an externality argument – it is on much shakier ground!

    “I can see what you are saying here, do you also think the anti-smoking measures, advertising and policies around New Zealand are bullying as well?”

    Some yes. It is a fine line, but negative messages that stigmatize people’s choices (without any direct impact on others) are a type of bullying. On the post back at TVHE, people pointed out that it is more the media doing this then anyone else – and so my frustration with that should be pointed at the media. It is a pity!

    Hi Alison,

    Two things. I don’t flesh out this part of the argument, but it is about whether poverty causes excessive calorie intake – in other words, is the choice to take calories an inferior good. Such a statement is a stretch, especially when the policies involved make people POORER! When I talk about status goods later on, I am trying to make more of an argument around the ways poverty and group behaviour influence these sorts of decisions – but when I call it ridiculous I am only talking about poverty being looked upon in isolation (I am not trying to rule out that it is poor groups where the most important issues are – that would be ridiculous of me).

    With normalisation we have to ask what the “external” costs are. Normalisation doesn’t change these at all, so what does it have to do with policy. If it is “healthcare” costs then ok, cool, lets look into that – that is an issue covered in my next post.

    Hi Grant,

    Generally if you want quick comment from me it is best to go straight to TVHE – as I only pop over here now and again!

    I have touched on some of the points earlier in this comments, so I’ll leave them to the side!

    The burden of proof on “doing something” is on the suggestion to do something. Obesity is not a “problem” by itself without a relation to wellbeing, without a clear failure. So for policy prescriptions we need to define what these are.

    For a tax, we are saying there is an externality, say on healthcare costs.

    For education/labeling we are saying there is a infomation problem.

    For other types of mechanisms (gamification, support groups), there is the idea of “time inconsistency” in the choice of individuals.

    I am a fan of policies that focus on these types of costs, and I’ve stated in the post that I agree with the policies – so nifty, why do I seem to have a problem?

    My problem is with the rhetoric we use to describe the problems. The way we stigmatize individuals who are obese, and treat their actions as stupid just because they differ from what we would do. This was a front page article in the Dominion Post, which put teenagers on the cover going on about how they were obese and we needed to do something!

    The language that obesity is a problem we have to “solve” is not something I agree with – and it is a policy position filled with a lot of value judgments about the agency of the individual. Any “problem” stems from limits to individuals capability to create wellbeing – the sort of things I mentioned when talking about the failures above.

    “You can argue this yourself: if you take this stance, perhaps you also have argue that they should take responsibility for the consequences of their choices, e.g. pay for their dialysis, etc., themselves. Public health provides a common standard of care, but it needs for the populace, or large subgroups of it, not to work against it. (Incidentally, vaccination may be a good example of this.)”

    Are we really treating obesity like a communicable disease? This is a frame for looking as individual choice that makes no sense to me.

    The idea that people should “pay for the choice” to consume goods that put them in hospital is one I can buy – without it the externality tax would be a hard sell. But the comparison to vaccination is not appropriate – a flu gives a straight negative payoff to the individual and is very contagious, obesity is the result of choices (so can provide a net positive impact on individual wellbeing) and the type of contagion is different (eg it comes from a choice where people may simply be that people are more comfortable being like others).

  • Matt

    In your reply to Alison you said
    “Such a statement is a stretch, especially when the policies involved make people POORER!”
    COuld you explain what you mean by this as this may be the point of disagreement.
    Is it your interpretation that those buying soft drinks would become poorer if soft drinks were taxed more, as they would continue to buy the same quantities of soft drink?
    I think some of us would suggest that such taxes would decrease the amount of soft drinks being consumed., thereby making a small contribution to health, one that would be compounded if the monies raised were used to reduce the cost of more nutritious foods.

    • Not speaking for Matt, but you hardly need people consuming the same amount to be made poorer by the tax. Being unable to afford a bundle of goods and services that you previously could afford, because they’ve hiked the tax on it, makes you poorer. Whether consumers would have more or less cash left in their pockets after the tax (because they’ve cut back spending on soda substantially, or only a little), they’re poorer. If we expect spending on soda to be somewhat inelastic, then they’ll spend more on it in total while consuming less of it.

  • Matt,

    “The idea that people should “pay for the choice” to consume goods that put them in hospital is one I can buy – without it the externality tax would be a hard sell.”

    Not sure I follow what you meant in the quote above. Are you saying you dispute that obesity doesn’t have negative health consequences?

  • Obesity and Alcoholism.

    I have been following this discussion (and the others on alcohol policy) with interest, and I think there is much more that we can do. The discussion is framed around personal responsibility and choice, community costs through the health system and mitigating this and reducing harm by taxation. All of this is fair enough. The thing for me is that this is a limited and a limiting conversation. To broaden the discussion I have been thinking about this at systems level; specifically, using the “addiction” archetype (also known as “shifting the burden”) (5th Disciple Field Book, Senge).

    The shape of this archetype is two loops: the first a more long term healthy loop that in this case would be building healthy and independent citizens and communities. That would be the long term goal. The second loop (the addiction loop) is to short term behaviour leading to obesity or alcoholism. My view would be that this second loop is so prevalent today because of physiological and physiological evolutionary baggage (for example, our desire for sugar and fat), societal and economic pressures leading to an unhealthy lifestyle and learned helplessness. Individuals have choice; however, the overall system will either support a healthy lifestyle or it won’t. In general, when looking to manage with this archetype the goal is to minimize the addiction loop and to strengthen the healthy loop.

    How might we do this? At the community level actions to minimise the addiction loop would include: taxes to pay for the harm of drinks and other products, and policies to reduce marketing of these products; like we already have for tobacco and alcohol. I also wonder if there is an opportunity to reduce the discount sale of these products. This could be a corporate social responsibility opportunity for a locally owned supermarket. At the individual level opportunities to reduce the addiction loop include: education and healthy life advertising (not be good or you die but do this and live long and well). I understand that modeling rather than preaching work better changing behaviour. This weeks Herald suggested that the dieting industry could become more “man friendly”, certainly opportunities for dietitians and other health professionals to contribute here. Programmes like AA. Many of these reduce harm and build strength.

    To build healthy and active living at the community level we can: Use marketing for healthy living campaigns in the media. We can plan and build our cities to encourage physical activity by including, bike and walkways, and public transport in planning documents. My local council keeps sports equipment for citizens to use in the central park. That is another sensible idea. Individuals can garden, seek education and build groups encouraging each other. Another point that builds physiological health is to encourage delayed gratification.

    My point is this, framing these health challenges as individual choice against taxing harm is too limited a discussion. Tax is just one option, a comprehensive program across communities minimising harm and building strength and healthy behaviour would be more effective. But only if we do it. Talking will do nothing.

  • “Are we really treating obesity like a communicable disease?”

    No, look at the previous sentence to which that aside referred. More later. (Had a reply but browser crash took it & have had busy week since.)