Map of life expectancy at birth from Global Education Project.

Tuesday, February 13, 2007

Give me liberty and Give me death

C., in commenting below on companies pushing toxic sugary stuff at kids, reminds us obliquely of the tradeoff we frequently encounter in the public health biz between what in the first analysis at least appear to be liberty interests, and our goals of population health. For example, many people object to laws requiring use of seat belts and motorcycle helmets as infringements on personal freedom. There are some highly respectable counter arguments -- for starters, brain injured people are a substantial burden on society, and my liberties are infringed when I have to pay taxes to take care of them and their dependents. You can probably take it from there yourself -- but these laws remain controversial and vary from state to state depending on local politics.

There isn't any logical place to draw the line with that argument. It seems to invite unlimited paternalism. Why not tell people what to eat, require them to get a minimal amount of exercise, ban rock climbing or diving? On the other hand, most people support the prohibition of cocaine and heroin, consumer product safety regulations, and other measures that are justified on essentially the same grounds.

The common sense view is that it's a matter of degree, of striking a balance. How serious is the infringement on the liberty of the fool or the adventurer, and how great is the risk to society and their dependents of their choices? (This calculation backfires on proponents of prohibition of recreational drugs, because the burden on society might well be less if drugs were decriminalized. But that's a digression.)

When it comes to children, however, we are much less protective of the liberty interest. We expect to practice paternalism toward children. Hardly anyone objects to laws prohibiting the sale of tobacco, alcohol, or firearms to children, even when they fiercely protect the right of adults to buy these products.

Yet it strikes me that most people would absolutely reject restrictions on selling sugary soft drinks to children -- even if we could show that these are as dangerous as cigarettes, which may indeed be the case. Of course we all drank soda as kids and many of us still do, because social norms didn't just permit it, they encouraged it. So it seems inconsistent with the culture. And of course we would, logically, have to extend the ban to candy, which we all remember as the child's equivalent of sex and a major currency that adults use to buy children's love. Furthermore, in the old days, kids were much more physically active, so most of them could handle the occasional sugar blast. We remember eating lots of sugar and we didn't necessarily get fat.

But nowadays that's changed, and a lot of kids are seriously imperiled by excessive sugar consumption. Furthermore, we're all going to have to pay for it. So why is it different from banning sales of tobacco and alchol to minors? I'm not trying to answer the question, I'm just posing it. It's just something to think about.

No comments: