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Why doesn't the Nanny state care about fat people?

Tuesday, 5 August 2008

Associate Professor Ruth Colagiuri writes:

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After the NSW Health Minister yesterday announced a $36 million strategy to tackle obesity, many people rang into radio stations to express their concerns about taxpayers’ money being used to treat what they saw as the result of lifestyle choices.

Some callers were disparaging about the Nanny State getting involved in obesity prevention measures. Funny about that because the persecution of smokers to protect them from the health consequences of their own folly will probably go down in history as taking nanny state-ism to art form status, and I’ll bet that many of these same callers were all for it.

While we’re on this subject, can anyone please tell me why does Nanny think it’s OK to ban tobacco use just-about-everywhere yet she doesn’t seem to feel it’s her responsibility to stop her charges from self-destructing on lethally fatty fast foods? And why doesn’t she intervene to modify urban environments which actively promote inactivity?

Why does Nanny play favourites? If she can act decisively and effectively to reduce smoking, why can’t she act to reduce obesity and associated chronic disease risks? What if Nanny came to her senses and wanted to rule the playground with an even hand? What could she do?

For starters, she might need to see that obesity is not purely the responsibility of the Health Minister, and that many other portfolios need to be involved.

Then she might ask Treasury to develop some strategies to help redress the health differential between those who live in affluent suburbs and those who live in disadvantaged areas. We know that poorer socio-economic areas are home to around 2.5 times more fast food outlets than their more affluent counterparts.

So, if Nanny really wanted to level the nursery floor, she could consider applying zoning laws to thin out the over-abundance of fast food outlets in high-risk areas. If the NSW Government really wants to get serious about tackling obesity, it should be examining how California is using zoning laws to make it easier for people to make healthy food choices.

And, Nanny could insist on warnings and information about calorie content on restaurant food. After all, if the nannies that guard our cousins in America, the land of personal responsibility for just-about-everything, can do it, why can’t our Nanny do it too? And, while she’s at it, maybe she could get some joined-up legislation going - the long awaited uniform national food labeling system for instance.

Nanny, what exactly are you waiting for?

Associate Professor Ruth Colagiuri heads The Diabetes Unit at the University of Sydney’s Australian Health Policy Institute and co-directs the Oxford Health Alliance Asia-Pacific Centre.

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Kay Kan Tuesday, 5 August 2008 3:56:48 PM: And when will Nanny address the issue of food manufacturers and portion size, both in restaurant food and take-away food? But who wants to take that on and convice someone that a smaller serving is better for them. Food manufacturers have a vested interest in getting as many calories into our stomachs as possible - why else do they suggest-sell and try to get us to buy more food? When I see a government tackle that, I will know they are serious about the obesity epidemic.
pmx Tuesday, 5 August 2008 5:48:19 PM: I don't care whether other people are killing themselves by smoking or getting fat.
I only care when these activities directly affect me.
Moves to ban smoking only really got moving when the harmful effects of second-hand / passive smoking were identified.
So, until there is evidence that my health is being affecting by passive fattening, I have no interest in spending tax dollars to make people eat less.
John Bryan Wednesday, 6 August 2008 2:17:51 AM: Good article. Well written. Go Ruth!
Mirek Wednesday, 6 August 2008 8:44:18 AM: Obviously, `Nanny`, or the Government, is in a quandry: there are powerful corporate interests to satisfy that stretch from the agribusiness farm gate to the Big Mac. That stretches to the authorities allowing to have a preponderance of fast food outlets to be located in working class and empoverished areas, that`s where the profits lie. This, by the way, points to the symbiotic relationship the powerful interests of Big Business and the Government. It`s in the interests of the wide population that this nexus be broken through political mass action. This was the case with tobacco industry, equally powerful and politically connected, but it took massive court cases, education and popular action, to make it untenable for politicians to support the tobacco industry. Even then it is something of a Phyrric victory, but it`s no longer `fashionable` to smoke. So it`s a long way to go, but the first aim must be to demonstrate to the politicians that it is in their own political interest to eliminate or minimise the scourge of Fast Food. The documentary Super Size Me illustrates well the toxic effects of fast food industry, and should be compulsory viewing to our politicians.
Greg Sam Wednesday, 6 August 2008 10:28:17 AM: There is no doubt some self selection bias about radio callers on this topic as well, but like most wicked public health issues Nanny is in the difficult state of needing the slap the hand that feeds it and overfeeds itself. I support a role for regulation in this but there has to be better demand management and more innovative ways of health departments not just informing communities but supporting behaviour change. Notwithstanding moves to widen car and airline seats, narrowing the entrances to health services might help.
Dr Rosemary Stanton Wednesday, 6 August 2008 11:10:59 AM: Those who whinge about the 'nanny' state expect 'nanny' to pay for the rising health care costs as the population grows steadily fatter. A wise 'nanny' will guide us away from the things that lead to obesity. The real question is whether the NSW 'nanny' will be smart enough to use her smaller budget to good effect against the 'big boys' much bigger budget used to encourage us to eat junk and stay sedentary.
Simon Chapman Thursday, 7 August 2008 2:08:44 PM: I can speak with some authority on this, having been recently crowned by 2UE's Steve Price as "academic, intellectual, self appointed chief wowser of the nanny state" . PMX's comment above hit the spot: all hell broke loose for the tobacco industry when the evidence consolidated on smokers' harming others. Prior to that, admonitions to smokers were paternalistic ("we'd advise you about this for your own good") but when smoking morphed into harming others with the rise of evidence, tobacco control rapidly moved into the ranks of public health protection (like drink driving, herd immunity via immunisation and climate control to name but a few). About a third of all news covearge of smoking in the past 20 years has been on harm to others. Smokers became widely redefined as people who were not just smelly, but who toxicly off-gassed and so their regulation was justified and their identity spoiled, as Irving Goffman would have described it in "Stigma".

So a big part of the challenge facing obesity is that state interventions of the sort Ruth names are essentially paternalistic, which invite libertarian reaction from most fair-minded people. It is easier with kids, as they are legally defined as being less capable of acting in their own interests so paternalism gets better press.

By far the most promising lesson from tobacco control is that by framing the problem as being one largely generated by the venal interests of industry, the public and politicians start to appreciate that paternalistic policies and interventions are essentially about the state helping to protect a vulnerable and choice-limited public from a predatory industry with the ethics of a cash register. This is a discourse that is compelling and tends to neutralise objections about Nannyism. Over the years I have often gob-stopped critics by pointing out that various objections being voiced are consonant with the chorus from the tobacco industry or that they serve its interests. When people see that, the virulence of their objections to paternalism is often neutralised.

I've got a new business card with "Self Appointed Chief Wowser" on it, but gee, "academic" and "intellectual" -- Price certainly knows how to twist a cruel knife.

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Why doesn't the Nanny state care about fat people?

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