How food became the new tobacco

In

June, 1994, R. J. Reynolds took

out ads in American newspapers that criticized proposals to sharply raise tobacco taxes. “ Today it’s cigarettes,” the company said. “Will highfat foods be next?”

Anti-smoking activists traditionally responded to this sort of slipperyslope argument by insisting that cigarettes were unique, “the only legal product that when used as intended causes death.” To suggest that antismoking measures might pave the way for attacks on cheeseburgers and ice cream, they said, was just silly.

Yet six months after R. J. Reynolds tried to scare people with the outlandish prospect of a tax on fatty foods, Yale obesity expert Kelly Brownell endorsed the idea on the oped page of The New York Times, citing the precedent set by cigarette taxes. Brownell was serious, and pretty soon people started to take him seriously.

At the end of 1997, U. S. News & World Report picked what it dubbed the “ Twinkie tax” as one of “16 Silver Bullets: Smart Ideas to Fix the World.” By 2003, TV commentator Morton Kondracke, the very embodiment of inside-the-Beltway centrism, was opining in his syndicated column that “a hefty tax based on the fat and sugar content of foods would discourage consumption, provide revenue for education programs … and recover some of the billions that obesity-related illnesses cost the government in Medicare and Medicaid outlays.” Last month, New Republic senior editor Jonathan Cohn agreed “there’s a very sensible case for taxing unhealthy food.”

How did we get to a point where what used to be a reductio ad absurdum is considered a serious policy proposal? The anti-smoking activists who insisted they were not interested in using the government to discourage overeating may have been perfectly sincere. But the principles underlying their demands for a governmentled War on Tobacco apply with equal or greater force to a government-led War on Fat.

In both cases, you have big corporations that can be demonized for using devious marketing tricks to trap children in unhealthy habits they have trouble breaking when they are old enough to know better. You have impressive estimates of diseases and deaths caused by these habits. You have the argument that government intervention is justified because unhealthy behaviour imposes a financial burden on society. Most fundamentally, you have the claim that protecting “the public health” requires the government to discourage, restrict, tax, or ban behaviour that may lead to disease or injury — an alarmingly openended license for meddling in people’s private lives.

The logic works like this: If there’s one guy with a gut hanging over his belt, that’s a health problem. If there are many guys with guts hanging over their belts, that’s a public health problem.

Through a similar sort of reasoning, public health officials nowadays target a wide range of risky habits, including smoking, drinking, owning a gun, and riding a bicycle without a helmet. Even gambling and video games, which have no obvious connection to morbidity and mortality, are matters of interest to public health researchers. In short, there is no end to the interventions that could be justified in the name of public health, as that concept is currently understood.

Public health used to mean keeping statistics, imposing quarantines, requiring vaccination of children, providing purified water, building sewer systems, inspecting restaurants, regulating emissions from factories, and reviewing drugs for safety. Nowadays it means, among other things, banning cigarette ads, raising alcohol taxes, restricting gun ownership, forcing people to buckle their seat belts, and making illegal drug users choose between prison and “treatment.”

In the past, public health officials could argue that they were protecting people from external threats: carriers of contagious diseases, fumes from the local glue factory, contaminated water, food poisoning, dangerous quack remedies. By contrast, the new enemies of public health come from within; the aim is to protect people from themselves rather than each other. In this context, it’s not hard to see why cigarette smoking was treated as a public health problem and why, as Ontario Minister of Health Promotion Jim Watson puts it, “ fat is the new tobacco.”

But treating risky behaviour like a contagious disease obscures some important distinctions. Behaviour cannot be transmitted to other people against their will. People do not choose to be sick, but they do choose to engage in risky behaviour. The choice implies that the behaviour, unlike a viral or bacterial infection, has value to them. It also implies that attempts to control the behaviour will be resisted.

The question, then, is how the government should respond to that resistance. “ The first step is persuasion,” says Jim Watson. “Let’s see how that works.” I think he has skipped a step: First we need to think a little more deeply about whether we want to live in a world where our risky habits are everyone else’s business.