Friday, July 13, 2007

Homer Simpson: Poster Boy

Dr. Jay Bhattacharya of Stanford University Medical School has some thoughts on the obesity issue whether it is really a public health crisis:

What distinguishes a public health crisis from a large-scale private health crisis? The public health literature offers—no surprise—an expansive definition of a public health crisis. In that literature, a public health crisis arises whenever any undesirable health state becomes sufficiently widespread. By this standard, all private health issues are public, and the personal is by definition political.

The problem with this approach is that it collapses a vital distinction between diseases and health conditions that harm the health and well-being of others, and conditions that adversely affect only those with the condition. A sharp increase in the prevalence of a dangerous infectious disease like tuberculosis is no doubt a public health emergency, but the same is not true for an increase in back pain. In the case of tuberculosis, drastic public actions, including quarantines and forced treatment, may be justified; in the case of back pain, such actions would be wildly inappropriate.

A wide range of unhealthy behaviors could be framed in similar fashion. Smoking, skydiving, salting our food, motorcycling, freeway driving, and sleeping too little (to name a few) are all behaviors that increase our risk of illness or worse. If an increased risk of illness is all it takes to transform these behaviors into public health crises, then the government has a broad license to limit our freedom to do many potentially unhealthy things. Concentrating public health efforts on behaviors that hurt others, not just ourselves, lets us choose behaviors that make us happy while limiting the damage to others. If smoking causes secondhand damage, then it is a public health concern. If overeating brings only private costs, it is not.


Anonymous said...

I totally agree with your point - if overeating only brings private costs it certainly wouldn't be a public health concern. The question is - is that the case or does the obesity epidemic affect everyone financially?

Michael Wade said...

At some point, even if there is a financial impact, a line has to be drawn or we wind up with very intrusive government.