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Health, Paternalism

The Way to Address Obesity…

This past week, I had a couple of conversations with friends about a food deserts, spurred by a recent New York Times article that highlighted a few studies that questioned the validity of the argument that food deserts were a cause (the cause?) of obesity in poor neighborhoods followed by proclamations by different blogs that I read, such as “tackling food deserts, it turns out, probably isn’t going to have much impact.”  I actually agree with those that say that food deserts and access is not the only issue. Access, education, economics, human behavior all play a part.  That being said, to be somewhat dismissive of efforts to provide access seems shortsighted to me, as all legs of the table need to be fixed.

And while I agree completely that educating people as to their choices and the effects of their choices is a key factor and a goal that should be pursued with more vigor, I tend to question whether even that will do the trick (by itself).  I’ve read theories that people of all stripes view eating fast food (and eating out in general) as a form of leisure because they have little other time in their lives where they are able to relax and not have to serve someone else.  How does education (or access for that matter) address that factor?  It likely can’t.

And that conundrum – that is, we can’t actually figure out all of the reasons why people behave in certain ways – is why I think that the best way to address obesity (and any issue really) is by:

  1. Putting more of the decision-making power for addressing the issue into the hands of those that are being affected
  2. Reducing any and all artificial barriers which are preventing solutions and actually contributing to undesired outcomes

For #1, instead of generating top down solutions designed to influence behavior, this means actually working with people in the communities to determine what the solutions should actually be from the bottom up.  A few months ago, I went to a fundraiser for an organization called The BLK ProjeK, which is an organization that “seeks to address food justice, public & mental health issues as they specifically relate to under served women of color through culturally relevant education, beautification of public spaces, urban gardening and community programming.”  During the fundraiser, the founder of the organization, Tanya Fields, who is from the Bronx, related that in her experience, outsiders (with their hearts in the right place) who tried to solve issues related to obesity and food justice in the Bronx frequently did so without understanding the community, which contributed to less successful efforts.  That includes focusing on single issues (such as access) instead of holistic solutions (which she championed).  However, even within single issues such as education, she said she had seen firsthand where educators blindly proposed changing entire diets to foods that were foreign to the community (“What the hell is buckwheat?”) without taking into account their needs, desires and histories.  Subsequently, in her estimation, the community didn’t embrace the education.  Her idea instead is to work with the community to determine new recipes for foods they were already making and which took into account their economic situations (i.e., cost?  prep time? perishable? etc.), but with healthier ingredients.  And then she weaves in new ideas as well.  I think this is a great approach and am interested to see the results.

For #2, once the community is engaged in determining how to address their own issues, I think the role of those outside the community that want to help is to remove the obstacles that impede these community solutions.  This includes access and education.  But as someone with a background in economics, one area which I don’t think gets enough attention are the subsidies that are provided for the production of unhealthy foods.  These subsidies, for corn for instance, actually lower the cost of unhealthy foods which then leads to overproduction and increased consumer demand. Simply having the true economic costs reflected in the actual price of healthy and unhealthy foods would almost automatically result in a decrease in the amounts of unhealthy foods that are consumed.  If you went a step further and actually reflected true societal costs (i.e., how much does a hamburger contribute to societal healthcare costs for instance) in the price, then you would have an even greater impact.  And if you coupled all of that with solutions to access and education which are determined and embraced by the community, while it wouldn’t solve the problem completely, I think we would go a long ways in the right direction….

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