The Public Nature of Health

Whenever people talk about a public advocacy campaign to change behavior, the anti-smoking initiative of the 1980's and 1990's is the standard to which all others aspire. That's because it was spectacularly successful. As Shannon Brownlee writes in the latest edition of the Washington Monthly:

The result has been a dramatic reduction in rates of smoking over the last twenty years. In 1981, 33 percent of Americans were smokers. By 2011, it was down to 19 percent. Today, actors in movies are no longer wreathed in clouds of cigarette smoke, and smoking is far less acceptable as a habit. More importantly, deaths from lung cancer have been declining since the 1980s, a triumph of public health.

Brownlee recounts that success in her review of the book Saving Gotham: A Billionaire Mayor, Activist Doctors, and the Fight for Eight Million Lives by Tom Farley, MD. It is the story of how Mayor Michael Bloomberg and the New York City Public Health Department not only won battles against the tobacco companies, but also the restaurant industry before ultimately losing a fight with the American Beverage Association.

During Mayor Bloomberg’s tenure, smoking was banned from New York City restaurants and bars; cigarette displays were banned from stores; trans fats were banned from foods; and calorie counts were mandated on the menus in all fast food restaurants. The only campaign the mayor and the department lost was a regulation that would have reduced soda consumption.

I remember all the mocking New York City took from conservatives for their attempt to ban over-sized sodas. Brownlee writes that loss off to the lobbyists from the beverage industry. But I think there was probably more to it than that. There was a strong scientific basis for smoking bans based on the dangers of second-hand smoke. And publishing calorie counts on menus is simply a matter of providing useful information. But telling Americans what size of soda they can buy was probably a bridge too far. As Brownlee points out, Bloomberg Philanthropies chose a different approach in Mexico City - a sugar tax - which was much more successful.

In the end though, there is an argument to be made about the public nature of health.

These are the battles of public health of the future: the environment around us that breeds chronic illnesses like diabetes, heart disease, asthma, emphysema, and a host of other modern plagues. Conservatives like to argue that regulations like smoking bans, soda taxes, and calorie labels are an infringement on our rights as individuals—to smoke, to drink, to eat whatever we please, and by extension to be as unhealthy as we like. It’s an argument that makes ill health entirely a matter of individual responsibility, even as the costs of individual behavior are born collectively. We all pay for the nation’s rising rates of obesity, diabetes, lung disease, and asthma in the form of medical bills and a loss of human capital.

I encourage you to read First We Take Manhattan to get the whole scoop.