Three years in the making, the Lancet Commission on Obesity recently issued a report, entitled The Global Syndemic of Obesity, Undernutrition, and Climate Change. The term “syndemic” is meant to refer to a “synergy of epidemics”, which “co-occur in time and place, interact with each other to produce complex sequelae, and share common underlying societal drivers”.
It was written by a large and eclectic group of authors. The only South African them is Warren Smit, research manager at the African Centre for Cities at the University of Cape Town. Smit’s research interests are “urban governance, urban planning, housing and urban health”. The list also includes experts in regulation, global governance, development law, social dynamics, business and marketing.
The authors admit that the commission’s mandate was obesity, but that they had a chat (sorry, a “deliberative process”), and decided to reframe the problem and expand the mandate to include lots of other stuff, up to and including climate change.
Calling their global syndemic “the paramount health challenge for humans, the environment, and our planet in the 21st century,” the commission “recommends comprehensive actions to address obesity within the context of The Global Syndemic”. These actions would, if implemented, amount to a revolutionary restructuring of the market to bring it under government control.
The report proposes to create a global framework convention, along the lines of the World Health Organisation’s Framework Convention on Tobacco Control and the United Nation’s Framework Convention on Climate Change, that “sets out the agreed regulatory and policy framework for action to create healthier, more sustainable and more equitable food systems”.
“Although food clearly differs from tobacco because it is a necessity to support human life, unhealthy food and beverage products (that is, energy-dense snacks, confectionery, and sugary drinks) are not a necessity,” the authors claim, never having worked a day of hard manual labour in their lives, nor considering that anyone might want to have snacks, confectionery and sweet drinks because they simply enjoy them.
“The commonalities of tobacco, unhealthy food and beverage commodities, and fossil fuels lie principally in the damage they induce and the behaviours of the corporations that profit from them,” they add, neglecting to shame the companies that profit from taking people skydiving, rock climbing, diving, or white-water rafting.
Having established a Framework Convention on Food Systems, the commission seeks to “strengthen national and international governance levers to fully implement policy actions which have been agreed upon through international guidelines, resolutions and treaties”. Basically, if the UN or the WHO says “jump”, our governments are expected to make us jump.
It highlights South Africa as a country in which the level of implementation of recommended food environment policies is for the most part low compared with international best practices. The UK, New Zealand, Australia and Canada do more, but even those countries fall far short of the report authors’ totalitarian wishes.
The report acknowledges the historic rise in income, wealth and living standards, but says this prosperity in some cases came at the expense of health, and therefore, companies should be forced to “create sustainable and health-promoting business models for the 21st century to shift business outcomes from a short-term profit-only focus to sustainable, profitable models that explicitly include benefits to society and the environment”.
They are not to get a say in the policies that affect them. Governments are told to “reduce the influence of large commercial interests in the public policy development process to enable governments to implement policies in the public interest to benefit the health of current and future generations, the environment, and the planet”.
There’s also a nod to “indigenous and traditional approaches to health and well-being”. We wouldn’t want to leave the sangomas, shamans and homeopaths out of this brave new world of totalitarian control.
The Lancet Commission recommendations are deeply problematic on two levels. First, they’re an affront to liberty. Second, the assumption is that governments know best how to “benefit the health of current and future generations, the environment, and the planet”.
Liberty is the quality or state of being free, including the power to do as one pleases, freedom from physical restraint, freedom from arbitrary or despotic control, the positive enjoyment of various social, political, or economic rights and privileges, and the power of choice.
Individual freedom is a founding principle of the liberal political tradition, based on the theory of natural rights developed by John Locke. In his formulation, which was strongly influenced by his perception of Native American societies, people are naturally endowed with the right to life, liberty and property.
In a state of nature, people are free and equal and at liberty to do as they wish, provided that they respect the same rights of others. The social contract is a voluntary agreement to establish a shared system of government and laws that protect the three natural rights. Thus, the power to govern does not exist because kings have a divine right to rule, but arises out of the permission of the people.
This concept of liberty underlies all Western political systems, including the Constitution of South Africa.
There is a growing tendency among governments, however, to infringe on these liberties. The ostensible reason is always that it is for our own good. However, the belief in liberty holds that an individual is, generally speaking, the best judge of their own subjective wants and needs. In the general case, nobody else is in a better position to determine what is good for them.
Moreover, even if you did know what was good for someone else, you’d have no right to force them to do it. I know it’s unhealthy to smoke, but I have no right to force someone else to quit. I know it’s unhealthy to eat too much sugar, but I don’t even have the right to admonish someone when they put three sugars in their coffee, let alone to take the sugar away for their own good.
Regulating how people ought to live, work and trade is an infringement on their fundamental freedom from arbitrary or despotic control and the power of choice.
This alone is a sufficient argument to get government the hell out of our pantries. People have different desires and different risk appetites. Some people may not mind being overweight if that means they can enjoy the pleasure of an occasional fattening snack. Some people may not mind risking cancer for the pleasure of smoking. Some people may not mind the risk of injury or liver disease, if that means they can enjoy a stiff one after a hard day’s work. Why would busybodies and do-gooders have the right to abuse the coercive power of the state to regulate or tax these pleasures, in order to deny them to people who choose to enjoy them?
More importantly, not everyone is the same. Even if there is a statistical correlation between certain dietary choices and health outcomes, that does not mean this holds true for everyone. There are plenty of people who eat fast foods, or lots of sugar, and remain perfectly healthy. There are plenty of people who follow the Lancet Commission’s preferred plant-based diet, and suffer malnutrition or disease. Genetics differ. Lifestyles differ. Why should everyone be subject to the same strict dietary regimes that might be appropriate for those at higher risk?
We have become accustomed to government taking responsibility for public health, but the nature of government’s health programmes is changing. At first, it was called upon to take collective action against epidemics of contagious diseases. This is a reasonable duty for a government premised on the need to protect life, liberty and property. The spread of these diseases poses an unnecessary and unchosen risk to everyone.
Today, government seeks to act against non-contagious diseases such as diabetes and cancer. They are called “epidemics” even though they do not spread from one person to another, to uphold the idea that government is somehow responsible for fighting them.
Modern risks, such as tobacco, obesity, physical inactivity, air quality, road safety and occupational risks are smaller than the traditional risks associated with contagious diseases. Life expectancy has risen in high-, middle- and low-income countries alike.
Many of the diseases government now targets are called “lifestyle diseases”. People take the risk of developing them because of the lifestyles they choose. Moreover, these diseases do not jeopardise the health of anyone other than themselves. There is no pressing public-interest need to intervene in the private risks people take with their own health, when those risks do not infringe on the rights of others.
The second problem with the Lancet Commission’s recommendations is that governments do not necessarily know what is best for us. We all know how the low-fat dietary guidelines promulgated by the US in 1977 and subsequently adopted worldwide turned out to be the biggest mistake in the history of nutrition.
The experts and government bureaucrats were all in agreement. Doctors recommended reducing saturated fat and cholesterol in the diet. People responded by reducing their intake of red meat, eggs and high-fat dairy products, and increased their intake of white meat and low-fat dairy. Food companies responded to changing consumer demand by introducing delectable selections of low-fat and fat-free products.
Yet they were all wrong. Instead of reducing obesity and associated diseases, the incidence of obesity rose sharply in response to the government guidelines, and just kept on rising. More recent scientific research indicates that saturated fat has nothing to do with cardiovascular disease. Nor does food containing dietary cholesterol, like eggs. It turns out an entirely different diet ought to have been recommended.
Now, the Lancet Commission recommends building “data and models demonstrating the harms associated with The Global Syndemic”, which can then be used to support demands for action.
There is, of course, no problem with conducting research into the health or environmental consequences of our choices, making that research available, and advocating that we change our lifestyles accordingly. Many people respond to such advocacy, as the response to the low-fat diet guideline proves. Some people might not care, and that’s okay too.
If they’re wrong, however, the advice would be misguided. This makes it unacceptable to force government regulation upon us all, based on such advice.
This observation points to what governments ought to do, instead of regulating, taxing, and radically restructuring the economy.
Public health and nutrition education is often dismissed for its limited effectiveness, compared to more coercive measures such as price controls and taxation, product sale restrictions or bans, and even government monopolies.
But effectiveness is not the be-all and end-all of public policy. It is true that authoritarianism is more effective than liberty at getting people to behave how the state would like them to behave, but that does not justify infringing on the basic human right of free people to make their own choices.
If, once people are adequately informed of the risks they take, they choose to continue taking those risks, the consequences are on them. It is not the role of the state to prohibit risk-taking behaviour.
Governments should invest their tax revenues in education campaigns about public health and nutrition, rather than establishing hegemonic control over the market and the individual choices it represents. Give people the information they need to make informed choices, by all means, but leave the choices up to them. DM
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