By Kenneth Rogoff
To what extent should governments regulate or tax addictive behavior? This question has long framed public debate about alcohol, tobacco, gambling, and other goods and services in many countries worldwide. And now, in the United States – arguably the mother of global consumer culture – the debate has turned toward the fight against the epidemic of childhood obesity.
It is ironic that in a world where childhood malnutrition plagues many developing countries, childhood obesity has become one of the leading health scourges in advanced economies. The World Bank estimates that over a third of all children in Indonesia, for example, suffer from stunted growth, confronting them with the risk of lifetime effects on fitness and cognitive development. Yet, the plight of malnourished children in the developing world does not make obesity in the advanced countries any less of a problem.
Indeed, though perhaps not on a par with global warming and looming water shortages, obesity – and especially childhood obesity – nonetheless is on the short list of major public-health challenges facing advanced countries in the twenty-first century, and it is rapidly affecting many emerging-market economies as well. Yet solving it poses much more difficult challenges than the kind of successful public-health interventions of the last century, including near-universal vaccination, fluoridation of drinking water, and motor-vehicle safety rules.
The question is whether it is realistic to hope for success unless the government resorts to far more blunt instruments than it currently seems prepared to wield. Given the huge impact of obesity on health-care costs, life expectancy, and quality of life, it is a topic that merits urgent attention.
The US leads the world in obesity, and is at the cutting edge of the debate. Almost everyone agrees that the first line of defense ought to be better consumer education. First Lady Michelle Obama’s “Let’s Move” educational campaign aspires to eliminate childhood obesity in a generation, though its impact so far remains unclear. Other efforts include appeals by celebrities like the chef Jamie Oliver and attempts to use peer-based learning, such as the Sesame Street-inspired platform Kickin’ Nutrition (full disclosure: the creator is my wife).
Yet, although education is essential to fight obesity, it is far from clear whether it will be enough in a food environment dominated by large corporations with deep pockets and every incentive to cultivate excessive consumption. Commercial television programs aimed at children are replete with advertising for processed foods of dubious value to human health. And, for every celebrity who donates time to fighting obesity, there are a dozen who accept large payments to hawk products, such as ultra-sugary drinks, that are arguably the tobacco of our generation. It is hard for non-profits to compete with the production values embodied in Beyoncé’s Pepsi commercial or Taylor Swift’s Diet Coke commercial.
The causes of obesity are complex, and the science of understanding human behavior is embryonic; but it is not hyperbole to call the problem an epidemic. According to the Centers for Disease Control and Prevention, roughly 18% of children aged 6-11 in the US are not just overweight, but obese.
The risks posed by this epidemic are manifold, but the main one is that childhood obesity begets adult obesity, with significantly increased risks of diabetes and heart disease. Indeed, experts estimate that more than 18% of all adults in the advanced economies are obese. Even more stunning are estimates that roughly 9% of all Americans – and a similar percentage of adults worldwide – have diabetes.
Yet politicians push back on Big Food at their peril. When the popular former mayor of New York City, Michael Bloomberg, attempted to ban large sugary drinks, public opinion – not to mention the New York State Court of Appeals – rejected the effort, despite support from medical experts. Many commentators, even those sympathetic to Bloomberg’s goal, argued that it was wrong to try to legislate consumer behavior so bluntly. Yet, when one considers other successful efforts to improve public health over the last five decades – for example, smoking bans, seat-belt laws, and speed limits – one finds that legislation typically supplemented education.
A less intrusive approach to influencing food choices might be to institute a retail tax on all processed foods – not just sugary drinks – and an offsetting subsidy on non-processed foods. In the long run, low-income families (which suffer the most from obesity) would be the greatest beneficiaries. And, in the short term, any income effects could be offset by increased transfers. Together with the medical researchers David Ludwig and Dariush Mozaffarian, I have proposed an outline of such an approach.
Obviously, some processed foods are far worse than others. A more complex breakdown is possible, and other ideas should of course be vetted and discussed. But our approach has the important practical advantage of simplicity. What must be understood, above all, is that US consumer culture is dominated by a food industry that exploits people’s natural joy in eating, and transforms it (in many cases) into something that is addictive and destructive. Any visitor to the US can readily see the pervasiveness of the problem.
The right place to start to address it is by creating a better balance between education and commercial disinformation. But food is so addictive, and the environment so skewed toward unhealthy outcomes, that it is time to think about broader government intervention. That should certainly include vastly enhanced expenditures on public education; but I suspect that a long-term solution will have to involve more direct regulation, and it is too soon to start discussing the modalities.
Kenneth Rogoff, Professor of Economics and Public Policy at Harvard University and recipient of the 2011 Deutsche Bank Prize in Financial Economics, was the chief economist of the International Monetary Fund from 2001 to 2003. His most recent book, co-authored with Carmen M. Reinhart, is “This Time is Different: Eight Centuries of Financial Folly.” © Project Syndicate.
groot says
Subtitle this, just say no to crack. The current thinking is don’t eat anything with a bar code but that isn’t really practical. Processed foods, especially those high in sugar, cause inflammation and obesity. A walk around Walmart or Planet Fitness (same thing) will confirm that Palm Coast has it’s fair share of obese folks. Reality is that education is going to work the most.
Are you serious? says
Why do we feel we must legislate ignorance?
Nancy N says
[Selected as Comment of the Day for June 17–FL.]
This proposal is inflationary and will just increase the division between the haves and have nots. It will also cost thousands of jobs.
It will significantly increase the price of travel, since eating unprocessed food means cooking at home. It will shut even more people out of affordable travel. The price of eating in a restaurant will skyrocket because of the additional taxes. All of this will mean eating out and traveling will become only the purview of the very well-to-do, or very infrequent activities of anyone else. Fewer consumers partaking of the activity means fewer jobs in those sectors, and yet another social divide between classes.
It’s also inflationary because less demand will lead to an increase in prices as restaurants have to charge more to cover their basic overhead. Fewer tables full means fewer people to cover the cost of the rent, the electric bill, the kitchen staff. There’s also a trickle down effect in the economy – do you think all of those corporations paying for travel for their executives are going to just eat that tax increase on their travel bills in lower profits? No, they are going to pass it along to the consumer in higher prices and go along their merry way.
Tom Jacks says
Tax food, tax distribution of food, tax, tax, tax it’s the only word liberals know. Same people who think redistribution of wealth is the solution to all of societies ills. How about changing the culture of welfare recipients, both white and black, into pride in providing for their own, and their family’s needs, instead of pride in gaming the system and raising generations of welfare recipients. Hard work including manual labor would do wonders for burning excess calories and reducing the amount of obesity.
a tiny manatee says
If my typical walmart experience is representative, the morbidly obese in the area seem to consist mainly of teaparty patriots
Nancy N says
I’m not exactly sure how this became about welfare, other than that it is conservatives’ favorite topic to rant about these days it seems. You don’t know any overweight people who aren’t on welfare? Because I sure do. In fact, I AM ONE.
Try looking around your grocery store and comparing prices on healthy and unhealthy options. Fresh fruits and vegetables and lean cuts of meats and fish cost many times what unhealthy processed foods do. In fact, the GOP is so outraged over how expensive some of those healthy options are that in several states they have recently moved to outlaw welfare recipients from purchasing them. So which is it…do you want them to eat healthy or cheap? Because the GOP seems to want both, and you can’t have it both ways.
Tom Jacks says
Sorry Nancy, no matter how hard you want it to be true, I am not now, nor have I ever been a republican.
Lancer says
Get government MORE involved in our lives? No thank you.
I don’t need government to tell me how to eat and exercise. This is nanny state thinking that is completely out of control. If you need this type of structure and discipline….hire a life coach! Better yet, get a gym membership and take classes to learn to craft a healthy diet. More government means less freedom.
…and Nancy, maybe you should check out the results Maine got when they restructured their SNAP program that included some performance standards…like attempting to get employed, volunteering, training or education and *GASP!* having a photo ID on EBT cards. You know, making an effort and attempting to curb fraud?
Maine had 12,000 single, non-disabled citizens on SNAP. So…Maine added that to gain benefits these people had to do one of these: 1. Work PT, at least, 20 hours a week. 2. Volunteer 24 hours a month or, 3. Be enrolled in a verified work training program.
Guess what, Nancy?? In four months…9,000 of these people were dropped from the SNAP rolls due to non-compliance.
snapperhead says
[Selected as Comment of the Day for June 18.–FL]
“Fresh fruits and vegetables and lean cuts of meats and fish cost many times what unhealthy processed foods do.” Not true…I changed eating habits a few months ago to lose weight and buy only lean chicken breast, pork, fish, green veggies, fruits, nuts,eggs,cheese,turkey bacon and burgers. I spend the same amount now as I did when I was buying frozen pizza,frozen dinners and other processed junk foods. I’ve lost 40 pounds in 5 months just by changing my eating habits. Eating healthier hasn’t cost me any more in my experience and has added benefits…I sleep better, no more acid reflux, no sugar crash/ from all the added corn syrup/starches in processed food. Food doesn’t have to be taxed nor education increased except for younger children maybe…people have more access to food information than we’ve ever had. people just need to stop making bad choices and realize food is supposed to be fuel for your body, not look pretty and taste sweet and delicious. I work with a guy that spends $7-$10 a day every day at lunch at Wendy’s or subway etc …he weighs about 325lbs….for that kind of money he could prepare something way more healthier for himself, but it’s the convenience of going thru a drive thru or take out that probably makes it his first choice.
Sherry E says
What many people are missing here is that overweight/unhealthy citizens impose higher costs on ALL of us due to increased insurance premiums and health care costs in general,etc. So, it SHOULD concern us ALL!
I also have found that eating healthier is not necessarily more expensive. First of all drink much more water, especially before and during meals. Cooking at home is much less expensive than eating out. . . even at incredibly unhealthy fast food places. Yes, cooking from scratch is labor intensive and not easy for working parents. Consider the possibility of cooking big pots of wholesome food (less meat and more veggies/beans) on the weekends and freezing meal sized portions. Veggie and turkey burgers are less expensive than beef. Bruised/overripe fruits and veggies that are slashed in price make great, nutritious smoothies and get those great foods into picky children who love “milk shakes”. . . . there are many ways to eat healthier on a tight budget.
In addition to eating healthier. . . we all need much more exercise. Just try to do things like walk across that shopping center parking lot instead of driving around and around (polluting the air) trying to find the closest parking space. Of course in Florida, in the middle of summer, is not the best time to introduce that practice except at an inside mall. . . but you get my drift. Also, try the stairs for 2 flights, instead of the elevator. . . organize a way for kids to walk a few blocks to school in groups instead of car pools. There are ways to have a day out playing on the beach or in a park instead of sitting in front of a TV or computer.
Your body. . . move it or loose it! You really are what you eat. . . do it all mindfully!!!
Anonymous says
Again Sherry, couldn’t agree more! :)