Home - society - health
31 May 2004
A "calorie tax" is not coercive; it does not force people into certain choices. Rather, it gives self-interest an opportunity that social and economic pressures might otherwise deny.
Heroin, cocaine, ecstasy, cannabis, tobacco, alcohol... food!!? Well, perhaps not all food, exactly, but food of the sort and quantity that makes you fat has joined the list of consumables that are harmful to you and damaging to society. Britain is experiencing a rapid rise in obesity, with a wave of associated illness the cost of which has only just begun to dawn.
Look at the figures. It was reported last week that, in the first half of 2003, the number of deaths in the U.K. related to cocaine use was double that for the same period a year earlier. There were 87 deaths; say 175 for the full year out of 642,000 estimated users. That's 2.7 deaths per ten thousand users. To put that in context, annual road deaths are about 0.6 deaths per ten thousand of the whole population. So cocaine users are about four times more likely to die from their habit than from involvement in a road accident.
So what about food? The House of Commons Health Committee report on obesity published last week suggests that 8.7 per cent of deaths in the U.K. are attributable to excess weight. That is about 53,000 deaths a year - about 15 per ten thousand of the 60 per cent of the population said to be overweight. So over-eating is over five times more dangerous than snorting cocaine. How come high fat, high sugar, high salt foods aren't illegal?
Of course, like all statistics, it's not quite a simple as that. Life is dangerous, and everyone is going to die of something. Smoking is still a more serious killer than fatty food. But smoking has declined, whereas obesity is, to coin a phrase, ballooning; and the real issue for society is not death but illness, and the cost of it that comes from the public purse.
When it comes to health, the liberal principle that people should be allowed to do what they like so long as it doesn't bother anybody else is almost irrelevant. With a state-funded health system, anything you do that harms your health is a burden to your neighbours The cost of treatment and care takes a chunk out of the national budget that cannot then be spent on someone else's pension, or school, or hip replacement. Projections that the treatment of obesity-related illness could swallow up a quarter of the health service budget make the point. Is that budget going to be increased by twenty five per cent, or are services in other areas set to decline?
As a public policy issue there can only be one starting point, and that is the question of will. Do people want to be obese, or even overweight? Given that 60 per cent of the population is one or the other, and that 22 per cent is actually obese, and that no one is physically forcing them to cram inappropriately large quantities of fat-laden foodstuffs into their mouths, this must be a moot issue. Nor is anyone forcing them to slob in front of the telly when they could be out training for the London Marathon.
In general, no one forces anyone to take cocaine, either. They take it because they like it at the time, and they do not sufficiently anticipate the prospect or its making them depressed or ill. In the case of both food and cocaine, therefore, it seems plausible to assume that (as with so many things) people like the experience of the moment but do not necessarily want the consequences that will follow.
If this is true, it is clear that prohibition will solve nothing. With fat, as with cocaine, making it illegal does nothing to take way the desire to consume. But the will is not all in one direction. The balance between the gratification or solace of consumption, on the one hand, and the desire to avoid consequential misery, on the other, may well be a fine one, in which the government can helpfully lend its weight to one side. The point is not to coerce, frighten or otherwise browbeat people into action that is against their will, but to influence the will itself, so that the choice that is made reflects the long-term benefit rather than the short-term desire.
Evidence that this approach works is to be found in the field of heroin rehabilitation. Here, this tension between the short-term craving for the drug and the long-term desire to be rid of it is a constant fact of life. The only contribution to the problem that the criminal justice system can make is to addicts who receive effective rehabilitation while in prison. The availability of rehab answers the long-term need by intervening directly in the "choice" process. If rehab is for real, the choice to come off the drug is a real one also - a choice that can actually be made.
Unfortunately, the government's enthusiasm for rehab is greater than the resources it is willing to provide. So vast sums are siphoned of into dealing with the criminal consequences of heroin addiction that could usefully be spent on reducing the incidence giving rise to those consequences. Meanwhile, any really successful rehab programmes are drowned in overwhelming expectation - a serially occurring syndrome whereby the operators of such programmes are required to do more and more, too quickly, and with insufficient money, which causes them to fail.
In the case of food, the criminal justice system doesn't really get a look-in. Farmers, processors and manufacturers can ladle a huge range of toxins, pesticides and chemicals into food without the need to step beyond the limits of the law. In doing so they can legitimately claim to be satisfying consumer demand - for cheap, plentiful, convenient and gratifying food that is consistent, standardised and instantly recognisable.
Against this background, education has only a limited rôle. There is something to be said for tackling blind ignorance; for example, people who don't know that fizzy drinks make you fat need to be told that, preferably on the label. But the evidence from drugs, alcohol and tobacco is that you don't stop doing something that you like just because you know it is bad for you. There has to be another reason - actual illness, for example, or peer pressure or imminent parenthood - a factor that confronts the immediate act with the longer term consequences and provides a strong enough reason for second thoughts.
For a government tasked with finding the trigger that will turn a short-term unhealthy decision into a long-term healthy one, these secondary reasons provide an important area of study. They bring together essentially social motivations of self-interestedness (not wanting to die, at least, not yet), altruism (not wanting to poison an unborn child) and social awareness (not wanting to be treated as a leper), all directing people to prioritise something that they perfectly well knew, but were previously willing to push to the backs of their minds.
These motivations make it clear that the solution to obesity does not lie with the manufacturer or producer. They can change the composition of their processed foods, but they are still bound to provide a range. Even by making their own offerings less unhealthy, they cannot force people to eat a healthy diet. The "push" factors at the government's disposal, the measures that actively direct people away from high energy food, must play upon consumers themselves, rather than the corporations that supply them.
Price is an obvious factor. From the health point of view, taxing the energy content of food is as logical as taxing alcohol or tobacco, and probably more logical that outlawing cannabis or cocaine. But although such a tax would be resisted strongly by the food manufacturers, in reality it would be no more a tax upon them than petroleum duty is a tax on the oil companies. It is a tax applied directly to the consumer who pays it.
The differentiation between foodstuffs that such a tax would establish plays directly into the social motivations that can change people's eating habits. It is not coercive; it does not force people into certain choices; but it allows them to articulate their self-interest, saving money by choosing a cheaper food that, incidentally, is better for their health. In other words, it creates opportunity for people to do something that they really want.
The juxtaposition of two foodstuffs, one boldly labelled "10p fat tax" and the other carrying a two pence surcharge, allows a choice that combines the self-satisfaction of canny purchasing, the peer approval that comes with it and the gratifying altruism associated with a socially aware decision. Put together, these create a heady cocktail, of which the direct health benefit to the purchaser may appear no more than the cherry on the stick. Like that cherry, they want it to be there, but they would never have bought it for that reason.
©Copyright Martin Whitlock 2004