The Lafayette Journal & Courier has an editorial which ties into a conversation I was having a couple days ago about an eagerness I see in some quarters to attribute health problems to moral failings such as gluttony and sloth. I was thinking about that conversation yesterday after a Legal Aid meeting where the discussion turned to how stunningly poor decision making got families embroiled in the legal system.
One thing I have concluded is that I believe in the value of personal responsibility but I am suspicious when the need for personal responsibility is cited in policy discussions. When “personal responsibility” comes up in policy discussions, all too often it’s a sort of code for “let’s do nothing, ignore the structural problems, and maybe yell at people to work harder.” Among other problems, this approach simply doesn’t fix what’s broken.
The Journal & Courier editorial is entitled “Diet, exercise are solutions for obesity.” It isn’t wrong. It even gives a nod of the head to the need for pedestrian friendly infrastructure and parks and the like, but primarily it chalks up obesity to personal lifestyle choices to eat too much, smoke, and be sedentary. I agree that the fat person in the grocery line — or any person in the grocery line — should choose something other than the Cheetos and the soda.
But, blaming the individual gives you an excuse not to really think about the ways in which structural issues stack the deck against healthy choices and in favor of unhealthy choices. It seems to amplify this sense that every generation is in decline from the one that came before it back to some Golden Age. (I’m never really sure whether that Golden Age was Eden, the WWII generation, sometime before FDR, prior to the prohibition of child labor laws, or maybe sometime before the War of Northern Aggression. I’m pretty sure there hasn’t been a generation since the dawn of time where parents thought their kids were smarter, worked harder, and listened to better music.) If you can cast blame, you don’t have to address subsidies to corn producers and the resulting abundance of products with high fructose corn syrup. You don’t have to address the number of hours parents need to work sedentary jobs to keep a mortgage paid. You don’t have to address the lack of sidewalks or places to exercise. You don’t have to address the fact that messages encouraging people to eat and drink unhealthy crap far exceed the messages encouraging people to eat healthy. Instead, you can just feel superior to those stupid, lazy people; comfortable in the knowledge that they are getting what they deserve, perhaps while you wait for the Rapture to come and reward you for your righteousness and punish the wicked.
And, still, I raise an eyebrow when I see someone obviously suffering from their poor health lighting up a cigarette, eating the Twinkies, or sucking down the soda. I know they should be making different choices. They probably do too. But, in terms of public policy, knowing that and judging them for that doesn’t help the problem. The Journal & Courier editorial doesn’t make any effort to explain why Hoosiers are fatter, exercise less, and smoke more than other Americans. Is it because we are made of lesser moral fiber than our brothers and sisters in Colorado or other healthier states? Probably not. There are other variables that we should probably be working on.
I think that one of the point you hit on would hit well with liberals and free-market people alike: corn subsidies. That is certainly a case where the government has screwed up the “natural order” of the free market, and has negatively affected the health of this country.
Walkable infrastructure is also area where government policy has influenced behavior. Sidewalks and people trails cost less than roads. We should demand more of them before anything like roundabouts, lane additions, etc are considered to relieve congestion.
Having worked on a city planning group on sidewalks, it was very clear that we, as a country, decided from 1950 to just recently that we WILL drive everywhere we want to go. Look around the roads where you live. The pre-50’s roads had sidewalks, and you don’t really start seeing them again until the road built in the 90’s or 2000’s.
My point about lifestyle previously was to point out that I don’t think we need to worry too much about providing preventive services for free. The benefit to them is less than the benefit to exercise (reference needed), and exercise IS free. Preventative services don’t put people into medical bankruptcy, major events that insurance weasels out of do.
eric schansberg says
Good people disagree on the extent to which the government should be paternalistic AND what that paternalism should look like (e.g., education vs. regulation).
But, to Jason’s point, bad decisions should not be subsidized.
While bad decisions are no everything, ignoring or downplaying the role of “bad decisions” is not helpful either. If people are immoral, then neither govt nor mkts will work as well as they could. If people are determined to live like slobs, no mkt or govt system will get them to be healthy– and they’ll suffer for it. We’ll suffer as well to the extent that we pay for their decisions– as we suffer when a firm pollutes and imposes costs on us.
One final, overarching point: education is connected to a willingness to make investments– to weigh long-term benefits against short-term costs. Some of that is presumably innate; some of it is a function of cultural and familial factors that would be difficult to change; but some of it can be altered/improved. Most notably, the failures of our govt-run, monopolistic education system extend beyond educational ignorance, social problems, lower productivity/income– to a range of other unhealthy/bad choices.
Two additional points.
Healthy food (fresh fruit and vegetables, for example) is often more expensive than those Cheetos and soda you reference and they’re harder to store and prepare in most cases. The working mother or father may choose the easier to prepare foods rather than the healthy foods to save time. The disabled and poor, who may not have easy access to transportation, may choose foods that last longer as opposed to fruits and vegetables because they “go bad” relatively quickly.
I have a friend who has a tumor in his thyroid. He is obese, in part, due to this condition. Often, when I see these arguments made, there is no acknowledgment that there are health conditions which can lead to obesity and even that genetics can play a roll. They are certainly not the majority of the cases, but they do exist and should not be ignored.
Okay, after reading Eric’s response which was posted at nearly the same time as my own, I have a couple of more thoughts.
I think that one of the things that is also overlooked is mental health and its lack of parity with physical health in funding and general acceptance. There are a variety of mental health reasons that people overeat. Stress, anxiety, depression. As a society, we don’t fund and support mental health services on the same level as physical health.
“If people are immoral, then neither govt nor mkts will work as well as they could. If people are determined to live like slobs, no mkt or govt system will get them to be healthy– and they’ll suffer for it.”
Personally, I don’t like the framing of obesity as a moral issue. I believe it is a health issue. Making it a moral issue allows for the demonization of those who suffer from obesity and gives people an excuse to ignore the problem, name call or discount those suffering from obesity. It gives the judger permission to do nothing as well as opposed to encouraging them to improve the societal problems that can lead to the problem in the first place.
“Am I my brother’s keeper?”
eric schansberg says
Good stuff from Chad!
To be clearer, I did not intend to connect morality with health in my posting. I was trying to make a similar point in two different arenas about the inherent limits of govt and mkts when we’re not dealing with perfect people.
That said, there is a moral component to some/much obesity. We should demonize people in that position, but we shouldn’t ignore the moral component as well, condoning bad decisions. (For Christians, see the response in John 8’s “adulterous woman”: don’t throw rocks, but as relevant, “go and life leave your life of sin”.) To the extent that people are making “bad decisions”, then we have to decide whether we’re going to subsidize that, encourage them to change, pass mandates and prohibitions, etc.
“the failures of our govt-run, monopolistic education system extend beyond educational ignorance, social problems, lower productivity/income– to a range of other unhealthy/bad choices”
Which government runs your local school systems? Three different public school corps operate in Lafayette and Tippecanoe County alone. All are different in their approach to education, all serve slightly different populations. Of the three, I found the students at W. Laf to have the most potential that went untapped. Those at Laf Jeff were the least challenged through low expectations.
This same story plays out in each of our counties and cities. So which government run schools are you refering to? Don’t just repeat the mindless mantra of the conservative party. They hate american institutions unless they can profit from them. In so doing, they hate America. Witness your local governer and faux news channel.
Oh, and then there would be the government run public universities.
eric schansberg says
It’s not the govt-run part that’s problematic– or the dog’s breakfast of levels of govt at which those schools are run– as much as it’s the “govt-run with tremendous monopoly power” (particularly over those with less income).
Why do people get so excited about private-sector monopolies, but don’t even blink at public-sector monopolies?
Similarly, the level of monopoly power for a university is quite modest. Along those lines, would you be ok with a GI Bill for parents of students at elementary and secondary schools?
If we’re going to be moral about obesity we have to determine whether there is an gluttony problem( a sin) or a glandular problem(biological). Judging morally without making it a personal judgment is virtually impossible ..unless we judge the whole group with one blanket judgment ,but isn’t that ‘fascism?’ ( at least that’s what fascism was back when I went to high school : the morality of any targeted group,as a group )
“If we’re going to be moral about obesity we have to determine whether there is an gluttony problem( a sin) or a glandular problem(biological).”
I would add a couple of categories to your list Lou. Along with sin (don’t like the word, but I’ll use your lanquage here) and biology, I would add mental health and socio-economic status.
For me, the problem with the moral arguments about obesity is that the “judge” too often defaults to the “sin” category without considering the other options. To an extent, this makes sense considering that obesity is something we can see and biological, mental-health and socio-economic issues are typically not. You have to actually get to know someone, in most cases, to know those things about a person.
My understanding of fascism is that it is the combination of authoritarianism and corporatism. In that light, I wouldn’t call blanket judgments so much as fascism, but I would certainly say it was compassionless prejudice. :)
Steph Mineart says
Even if you’re feeding your family 5 servings a day of fruits and vegetables, that food has less nutrition than it did 30 years ago. Agricultural trends have progressed to produce food cheaply, in abundance and that travels well on trucks and looks good, but nutrition hasn’t been a priority. And even if you are preparing food every day instead of slinging burgers and soda to your family, the prepackaged corporate ingredients and hidden processing disguises a wealth of problems with the nutritional value of food that we otherwise would consider healthy. Milk, chicken, beef products – none of these is as healthy as the stuff your parents ate and drank. Information on what actually constitutes healthy eating has changed drastically over the last 20 years and is contradictory and hard to understand.
All of these issues contribute to our health problems as well, and it’s not something that people can overcome without a great deal of self education and the time to learn and make decisions.
Eating right is simply not as easy as it used to be. Blaming people for that as though it’s some sort of moral failing on their part – as though gluttony and sloth has ANYTHING AT ALL to do with it – is just plain obnoxious and willfully ignoring the facts.
Steph Mineart says
Not to mention that lots of neighborhoods right here in our city don’t have grocery stores, or if they do, they don’t carry healthy produce. If you don’t have a car and the only place to shop for food for your family is the 7-11 or McDonalds, how do you make appropriate food choices for your family?
For Pete’s sake. My head is spinning with all this “obesity-morality” stuff. Then mix into it mental health, ooohhh. So, when it spins I fall back on my own experiences/knowledge/anecdotal info.
I feel by “mental health issues” (some of) you-all mean the mental health issues prevent people from making the right choices. Given the prejudices against people with mental health, this is getting a little close to the morality thing, I think. So here’s another take:
My sister is obese, and is suffering some of the usual health problems related to obesity. Until just a couple of years ago she was a normal, fashionable weight, if not a little underweight. Then a mental health issue raised its ugly head and after several months of treatment trial and error, she had to go on a new (to her) medication. She then gained a dramatic amount of weight in a very short time. It was/is a truly shocking transformation. Upshot: the medication actually caused her obesity by either/both changing her metabolism and biological appetite triggers. Later she found out this was a known side effect of this medicine (there may be a class action suit involving this, but I’m not sure). Of course, once you gain this amount of weight, it is extremely difficult to change back.
So, who is immoral: her for needing the medication in her fragile state, the doctor who prescribed it but didn’t monitor her much less warn her, or the pharmaceutical company who produced and marketed a drug that they know causes severe obesity? I know there are people who know her but not the story and they blame her. Tsk, tsk, what’s wrong with this person who can’t regulate her behavior?
By the way, this is not the relative I referred to in another thread about healthcare. Sorry Eric, I have TWO people in my family who mess up the risk pool.
eric schansberg says
Mary, as I used the phrase, that would mean you have TWO relatives who are quite healthy but don’t have insurance. Good for them! It’s Doug who doesn’t like that outcome.
I’d like them to have access to lower-cost insurance, through reduced mandates and a reduced but universal subsidy. But we won’t have a shot at those reforms until we get past this spate of pro-govt efforts.
Eric, govt run with monopoly power, is not much of a distinction. Again, which of your local public schools has any more or less monopoly power than you local private catholic school or say, Purdue or IVYTECH? Give them all a voucher (gi bill), it will not change the outcomes for student achievement. And the schools in demand will shortly become far overcrowded or will set enrollment criteria that will exclude those who do not fit a certain profile.
Chad posted:”My understanding of fascism is that it is the combination of authoritarianism and corporatism”.’
But the ideology of fascism is super rightwing patriotism,identifying enemies of the state in order to save the state ..in our own history McCarthyism comes to mind.And authoritarianism and corporatism do go well together in this kind of paranoia to stomp down dissent.
Above, with the obesity issue I was trying to point out we cant make group inclusive moral judgments about ‘fat people’ without sounding’ ‘fascistic’ because morality is tied to an individual act and circumstancess have to be taken ino account.
Many would argue that point probably.God destroyed whole immoral cities.
eric schansberg says
With most government/public schools, one must attend the school in your neighborhood– or the one you’re told to go to. There’s no choice– and thus, tons of monopoly power, if I cannot afford private or home schooling.
With private schools, if I have sufficient resources, I can choose from an array of opportunities– thus, quite a bit of competition. (City folk have more ops than more rural folk.)
With universities, I can choose from an even larger array– thus, even more competition.
Can you see the difference in the degree of monopoly power?
Only if you have the money. Otherwise, choice is not an option, even with a voucher. However, people with children can choose to live where they want, within limits, so they have an option. But conservatives argue that they do not and are somehow trapped in the local district. If so, how many different private schools can you choose from in Tippecanoe county if you had a voucher and they would let you use it or it would suffice to cover tuition? How many different Universities or Colleges could you attend there? And remember, higher ed, and private schools, chooses you, not the other way round.
And why on earth would one want to limit their childs education by home schooling? Ignorance breeds ignorance. And thus we have these arguments about setting policy regarding people–if we cannot discriminate on the basis of race, lets do it for disease or weight or a persons assumed cost to society. All very American and religious, of course (discrimination has a great tradition in both) but wholly unkind and amoral. Over and out.
And your assumption of public schools is that they are all bad.
eric schansberg says
Exactly…”only if you have the money. Otherwise, choice is not an option.” But generally, lower income people *cannot* “choose to live where they want”, so they don’t really “have an option”.
You’re acting like this is a conservative thing. But the movement in inner cities has been led by “liberals”. (Few conservatives care so much about the poor to stomach a fight against an entrenched special interest group.) Instead, the opponents of school choice are self-interested producers (who always love to restrict their competition), those who are statist in their policy views, and mostly, people who haven’t thought very long/clearly about this.
I don’t know about Tippecanoe County, but everywhere I’ve heard about, you can go to schools if you have the resources. Vouchers would spend as well as cash, so that’s no big deal. And even with modest resources and modest test scores and GPA, you can choose from any number of liberal-admission public universities. All this is very different than a poor person who is consigned to the govt-run elementary school in their neighborhood.
Homeschooling has pros and cons, limits and advantages. To claim otherwise is rank ignorance.
My assumption is that public schools can be (and are often) fine– but that a govt-run entity with tremendous monopoly power is likely to give us lower quality, higher costs, and restricted options.
Your belief is that a public school monopoly is likely to deliver quality, efficiency, flexibility, and so on?
Interesting read, not only yours, Doug but also the comments. I think one could sum it up by acknowledging that personal choice is certainly a factor in many bad health decisions, but government can do a lot to enable better decision making on the part of citizens.
I come to this conclusion from experience. I was a sort of pudgy teenager in the 60’s who put on an extra 20 pounds at DePauw and promptly became a svelt 118 pounds upon transfer to IU where walking was the norm and carbs were less available. I wonder how many high school girls today think that 123 pounds was pudgy?
Leaving college, driving a car, having a kid – name your poison, but no matter how you look at it, 50 years old and 235 pounds wasn’t healthy. I could blame my bad eating habits, who needed an entire bag of Cheetos. But it wasn’t until in my late forties that I tried daily exercising and counting calories with little if any weight loss. I found out that my pudgy teen years were a result of a genetic metabolic disorder and it had gone awry in middle age. So you see the answer isn’t always as simple as diet and exercise. With medication factored in, I’ve made it back to 143 pounds. It hasn’t been easy. Steroids for autoimmune problems keep bouncing my weight up and down.
But I’m less likely to instantly judge others with obesity problems. Still, I’m also the first to be really angry when I see an obese family of four at Wendy’s ordering TWO loaded triple cheeseburgers (each), super-sized fries, 32 ounce soft drinks and giant Frosties. That followed up by noticing the mother injecting insulin into her pump. And yes, I really did witness this. Sure diabetes, heart disease, cancer, or stroke may end their lives earlier; but even worse is that you and I are paying the monetary price for that junk food in higher health insurance costs. That makes obesity everyone’s problem.
It’s a team effort if we’re going to combat health issues like smoking and obesity. Doctors need to be up front with patients; never in 25 years did mine mention my weight as a future health issue. Government needs to advocate for healthy lifestyle options; even mass transportation could increase walking rather than parking close to your destination. And they definitely need to start subsidizing healthy food choices, NOT corn syrup sweeteners! Schools could banish the junk food from the cafeteria and vending machines; but that means giving up the athletic money from Coke and Pepsi. And finally, we as citizens, need to realize that patriotism isn’t saluting the flag, it’s making choices that make our country a better, healthier place to live.
With government on the side of healthy decision making (hear that Mr. Mayor and your decision to no back the smoking ban) and people working together to change their lifestyles, we could lower health insurance costs, live longer and have a higher quality of life.
“Still, I’m also the first to be really angry when I see an obese family of four at Wendy’s ordering TWO loaded triple cheeseburgers (each), super-sized fries, 32 ounce soft drinks and giant Frosties. That followed up by noticing the mother injecting insulin into her pump. And yes, I really did witness this.”
If this was a regular occurrence by the family, it was highly irresponsible on their part. What if it was a one-off event? What if they were celebrating a birthday and this was one of few times in a year that they allowed themselves the guilty pleasure of extremely unhealthy fast food? Are they still deserving of your anger? Are people supposed to eat “perfectly” every day of the year?