24 January 2011

Unhealthful News 24 - Trying hard to avoid stooping to the phrase "food fight"

The major American public health policy story right now is Walmart announcing, with a publicity boost and endorsement from the President's wife (making it something with a whiff of official government policy, but not really such), a plan to push healthier food.  Reports about it range from the mainstream media reports (e.g., this one) where numerous reporters performed their stenography duties and reported that this must be a good thing because those announcing it say it is good to extremely skeptical critiques (e.g., this good one from an old friend of mine which links to others).  The plan includes reducing salt and sugar in Walmart store brands, pressuring their suppliers to do the same, and lowering the price of produce where they are a major source of it, implementing this all sometime over the next five years.

Debates about this plan involve questions of whether this is an important initiative or too little, a great use of the first-family's bully pulpit or an inappropriate support by a government for a weak corporation-specific plan, a bold private move to fill in a social policy gap or preemptive weak action to avoid more useful regulation, and from a different direction, whether any corporate or government intervention is unreasonable interference with what is ultimately an individual choice.

I will bet that this issue annoys those who cling to the myth that there are no such things as good and bad foods.  While there is no bright line between good and bad, and quantities often matter more than items for overweight, we obviously can distinguish broccoli from cola on a healthy-unhealthy spectrum.  The "no bad foods" myth – which traces largely to the U.S. Department of Agriculture's rhetoric, USDA being a dominant source of nutrition advice, but also a marketing agency for American-made food products (all food products) – is often embraced by the same people who like the idea of markets solving our problems.  So it is amusing watching them decide whether private efforts are good even when they are grounded in the good-vs-bad food message.

My contribution to the discussion today does not involve any conclusions about whether the new initiative is a good thing.  I am just going to clarify two issues that muddle the debate about the topic.

The arguments that have been written about this often focus on the question of whether health problems from food choice (overweight, inadequate micronutrients) are the fault of public policy, corporate decisions, or individual choice.  The answer is that all of these cause poor food choice.  Indeed, they mostly cause it via a particular causal pathway, wherein public policy affects corporate actions, and those actions affect individual choices, and the individual choices cause nutrition problems.  Of course, there are other paths – e.g., public policy directly affects individual choice via education – but this linear pathway is responsible for a lot.  As just one example, farm subsidies and free market rules that treat food little different from other goods cause companies to aggressively market junk food, and that marketing persuades people to make unhealthy choices.  Of course, some individuals still choose good foods despite the marketing and some companies escape the allure of cheap corn, so the upstream influences are not sufficient causes.  That is, they do not make the outcome happen all by themselves, regardless of everything else.  Often when someone claims something is not a cause of some outcome, they are really trying to say that it is not a sufficient cause.  So it is simply false to say "it is not the agricultural subsidies that cause companies to market junk food so aggressively, it is the fact that of shareholders are considered to be the only important stakeholders"; it is true that capitalism creates the profit motive, but the subsidies create the huge opportunity to profit from particular actions, so they are both the cause.

Sorting out all the apparently contradictory arguments is simply a matter of ignoring it when someone says "it is caused by X, not Y" and realizing that whenever someone says it is caused by government, corporations, or individuals they are right.  Everything always has multiple causes.  (They do not always follow a pathway like this, sometimes X and Y both cause something independently of each other.)

Once we get past the erroneous language about what is the cause of this problem, we run into the more legitimate language about what is the right spot in the causal pathway at which to intervene.  Educate consumers?  Encourage companies like Walmart to expand the supply of vegetables?  Impose rules like Los Angeles's ban on new fast food restaurants?  Buried in this normative language is a confusion between what would have a desired effect and what is proper to do.  The first is a scientific question that is simply about predicting or empirically measuring consequences.  The second invokes ethical claims about paternalism, freedom, protecting the weak, and what is the public interest.  Of course, everyone can agree on the answers to the empirical scientific questions and then we can debate the ethical questions, informed by knowledge of what a particular intervention will actually do.

Ha! just kidding.  That is what should happen, of course.  But this being public health, there is no shortage of people with a particular political agenda distorting the science to show that their preferred approach is most effective.  There is a lot of dishonesty about true motives in this business – no one ever seems to say, "I do not much care what is most effective at improving diets, because I believe that the proper intervention is…." (Not to pick on those interested in diet – the same is true for most policies that involve people's behavior.)  Those who want to blame corporate behavior embrace studies that show that kids are literally captivated (and by "literally" I mean literally, unlike most uses of that word) by Happy Meal and cereal advertising.  Those who favor education and individual choice point to people like me who have periodically lived in poor neighborhoods but have always eaten fairly healthfully because I knew how to do it.  Such points are somewhat accurate, but also overly simplistic and so misleading.  Parents do not have to surrender to kids' wishes, the libertarians point out, but it is also true that people who have periods of being financially poor but who are well-educated are not very similar to most poor people in terms of personal empowerment (though such examples are also used to create the myth of American economic mobility – just because my income has shifted by more than 60 percentage points within the population distribution quite a few times in my life does not mean that America has high income mobility, or that when my income is low I am vulnerable to fast food marketing).

Anyway, to summarize:  Oversimplification of causal pathways is a tactic that is often used to elevate one particular intervention over other options; by declaring that something has one particular cause you can create the illusion that all interventions must start there.  Beware of statements about what we "should" do which muddle claims of "this would work better than alternatives" with "this is the morally proper way to do things".  Do not trust news reporters' "objective" reporting of "the" "facts" about deals between the government and corporations (be it subsidizing Wall Street or Walmart's new line of low-salt kale chips) – governments lie, and so do corporations, but you will not be able to determine that if you only read what they dictate to the mainstream media. 

As for food politics, I am guessing that some particular sub-faction in this fight is honest about what the research shows overall, and I would tend to guess it is those who believe that pursuit of corporate profits is not optimal for nutrition but is better than not having a free market, and who believe in intervention but recognize that government intervention frequently hurts the public.  But I am not completely sure, even with the expertise I have, and would welcome anyone who says "read this and you will be convinced" (so long as "this" is not just a monologue of that does not even acknowledge there are opposing claims and counts on people just believing what they are told).  Even when you are right and backed by overwhelming empirical and ethical arguments, it is tough to make this this clear to people who are interested, well-read, and even technically skilled, and who want to understand which arguments are genuinely stronger, but are not expert in your particular political fight.  I am willing to be your test subject if you are willing to try to show me how it is done.

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