New York Mayor Michael Bloomberg has been on a years-long crusade against obesity, or at least against the cultural and commercial forces that promote it. In his latest step, he's proposing to ban the sale of super-sized sugary drinks by restaurants, cinemas, street vendors and stadium concessionaires. The move exemplifies the tension between individual liberty and societal responsibility that's particularly acute in the field of public health. Americans cherish their freedom to live as they choose, without "nanny state" dictates from the government. But because they're not willing to deny medical care to people who urgently need it, society has to pick up the tab for those who make heedless choices. Striking the right balance between the two will be one of the central challenges for government in the coming decades, as rising healthcare costs put an increasing strain on federal, state and local budgets.
Almost everything government does restricts the freedom of the governed in some way. Spending programs have to be paid for with taxes that leave people less money to use as they see fit. Laws limit what people can do without risking fines, lawsuits or incarceration. People tend to accept these limits without complaint when there's a clear connection to public safety and civil order, or a clear benefit from the spending that's proportionate to the cost.
The support weakens when the connection to public safety isn't so clear or the benefits are more abstract. For example, seat belt laws are widely supported: There's no question that they save lives and reduce the severity of injuries. But when the federal government lowered the speed limit on all interstate highways to 55 miles per hour in 1974, numerous states rebelled, insisting that there was no public safety reason for such a low limit in rural areas.
Similarly, the public accepts some governmental intrusion into what people eat and drink. There is an assortment of restrictions on alcoholic beverages, including a minimum drinking age, drunk-driving laws and regulations governing when and where liquor may be advertised. There are food safety standards and nutritional mandates on school lunch programs. Manufacturers have to list the ingredients, calorie and fat content of packaged foods, and local governments are increasingly demanding the same kinds of disclosures from restaurants.
But telling the average person that he has to eat X or cannot eat Y goes a step further. It intrudes on personal decisions that consumers make with their own dollars that affect just their own bodies. That's what makes even a relatively tame proposal such as Bloomberg's big-cup ban so controversial. Bloomberg's plan, which is pending before the city's Board of Health, would outlaw the sale of sweetened drinks larger than 16 ounces. But somewhat arbitrarily, it wouldn't apply to groceries or convenience stores, to calorie-laden lattes or fruit juices, or even to restaurants that offered two 16-ounce sodas for the price of one.
The mayor's initiative also rests on a shaky scientific foundation. Researchers have found that people who regularly drink soda are more likely to be overweight, and that those who increase their soda intake have a greater chance of becoming obese and diabetic. But there's little data to support the idea that a ban on large cups and bottles of sugary beverages would make a real difference in obesity, especially a ban as porous as the one Bloomberg has proposed.
With no precedents to show the effectiveness of Bloomberg's approach, a better way to balance the competing interests of public health and personal choice would be to require more effective disclosure about the calories in soda and a more aggressive effort to educate the public about the associated risks and costs. There are nearly 400 calories in 32 ounces of Coca-Cola Classic, which is almost as much as aMcDonald's quarter-pound hamburger. Raising awareness about calorie counts may also encourage restaurants to compete to offer the healthiest goods, not just the biggest portions.
Considering that 36% of the U.S. population is obese, far too many Americans aren't connecting the dots between weight and chronic disease, particularly diabetes and heart disease. And that's not just a personal health issue. Studies have shown that preventable diseases linked to behavioral choices are responsible for about half the premature deaths in the U.S. annually, and for much of the demand for costly medical care. At least some of those costs are borne directly by Medicare, Medicaid and other taxpayer-funded public programs, and indirectly by healthy people who carry private insurance.
The larger and more difficult question for the public is where to draw the line between an appropriate government effort to improve public health and an inappropriate interference with individual autonomy. If the only consideration were reducing how much taxpayers had to spend on healthcare, then Bloomberg's next logical step would be to require restaurants to serve vegetables with every food order, or to require every New Yorker to join a health club, or to ban ice cream.
He's not about to do that, though, because Bloomberg is a canny politician. Ultimately, society will decide what limits to place on individuals in the name of public health, and officials who go further than their constituents are ready to go will be tossed out at the next election. New Yorkers have given Bloomberg a lot of leeway on health issues so far, which suggests his views reflect their concerns about diet and obesity. Others who follow his lead may not find their constituents to be so tolerant.