Obesity Evolved from a Private Matter to a Political Issue - Essay Example

Running Head: EVOLUTION OF OBESITY ISSUE Obesity Evolved From a Private Matter to a Political Issue Relevant history of the issue surrounding the emergence of obesity from a private matter to a political issue has been studied by the review of relevant literature. Over 65 percent Americans are overweight as obesity rates have been on the rise, since a warning issued by the surgeon general in 2001. Obese people have a heightened risk of disease such as diabetes, and losses in life expectancy. Obesity in children has resulted in increase in diabetes, hypertension, and heart attacks. Obesity adversely affects lifestyle factors, such as physical activity, and friendship. Also, obesity has been associated with low self-esteem levels, and higher levels of anxiety, depression, and measures associated with impaired quality of life. The debate as to whether the obesity problem is personal or environmental or both will continue as long as the public attention lasts, and the prospect of public policy depends on continuation of publicity of the problem. The complex nature of attribution of responsibility has made it difficult for policy makers to assign blame or develop remedial policies. Even though pressure for action has been growing, the interaction of such factors has made it difficult to predict the future course of policy related to obesity. Policies to address issues surrounding obesity have all failed to pass Congress. Definition of the problem, response from Congress, administrative agencies, courts, and cultural consequences of policy debate is a familiar route for obesity as observed in tobacco and patient’s rights measure. Obesity Evolved From a Private Matter to a Political Issue Introduction Among all industrial countries, the United States has the highest occurrence of overweight condition, and obesity has become a pandemic problem with over half the population being obese. Diets, eating behaviour and lack of activity have been attributed for the rise of obesity. There has been little examination of the contribution of public policies in agriculture and economics resulting in the current agricultural and food environment. Obesity has been accelerating in the recent decades, suggesting that environmental conditions could be contributing factors in addition to individual eating behaviours and evolving lifestyles (Tillotson, 2004). Objective A study has been conducted to review and understand the relevant history of the issue surrounding the emergence of obesity from a private matter to a political issue. The study has been conducted by review of relevant literature on the matter. The study serves to identify the direction of the issue based on the prevailing debate. Review of Relevant Literature Industrialization of food supply occurred before advances in nutritional science. Advances in industrialization caused processed food to be available, ample, varied and affordable. Increasing sales by increasing demand has been a great incentive for food sellers, though food seller’s interest and buyer’s interest are divergent, resulting in a conflict between economic and public health policies. The need to govern commercial activities related to availability of food, economics, safety, wholesomeness, and public health has been a difficult task because of the lack of public health policies and initiatives (Tillotson, 2004). Reduction of obesity has life-saving and life-prolonging effects, and the quality of life could be significantly enhanced are broad grounds on which physicians urge the government to combat obesity. Obesity has been attributed to over 300,000 deaths annually. Obese people have a heightened risk of disease such as diabetes, and losses in life expectancy. Obesity in children has resulted in increase in diabetes, hypertension, and heart attacks. Obesity adversely affects lifestyle factors, such as physical activity, friendship and missed school days. Obesity has also been associated with low self-esteem levels, and higher levels of anxiety, depression, and measures associated with impaired quality of life (Kersh & Morone, 2005). A study by Oliver and Lee (2005) on public attitudes towards obesity and obesity related policy concluded that the majority of Americans were not concerned about obesity, expressed low support for policies targeting obesity, and believed that obesity resulted from individual choices rather than environmental or genetic sources. Brownell (2005) has questioned the assumptions that Americans were not concerned with obesity and that Americans did not support obesity targeted policies, based on several poll data which concluded otherwise. Obesity rates have been on the rise, since a warning issued by the surgeon general in 2001, with over 65 percent Americans overweight. Following the first report, there has been a thousand fold increase in the number of obesity related articles. The medical establishment and financial incentives in the health care system were institutional forces that helped propel the problem into public agenda (Kersh & Morone, 2005). Obesity has been perceived as a national problem since early 2002, and it has become American’s second most salient concern after cancer. Laura Lovett was among the first to explore the emergence of America’s nutritional crisis by tracing the origins of a number of motifs; numerical scores and simplified thresholds between 1910 and 1930. Rogan Kersh and Jim Monroe explained the emergence of obesity in the American political agenda, and allocation of responsibilities for addressing the problem. They argued that policy decisions would be made in judicial settings rather than legislative settings, suggesting that future policy developments and consequences would be similar to the tobacco industry. Abby Saguy and Kevin Riley have identified competing camps, described their views, and provided insight into their actions for manoeuvre and control. Advocates were few, loosely organized and had few allies in the scientific community. Eric Oliver and Taeku Lee provide a view of current public opinion; public perception of obesity, and their implications and appropriate interventions. The complex nature of attribution of responsibility has made it difficult for policy makers to assign blame or develop remedial policies. Even though pressure for action has been growing, the interaction of such factors has made it difficult to predict the future course of policy related to obesity (Schlesinger, 2005). Public health action was politically and publically underappreciated because society was less willing to save “statistical lives,” the appeal of public health services were lesser than high technology developments in microbiology and genetics, the importance of public health has been taken for granted, and the culture of individualism where personal goods were valued over public goods (Gostin, 2004). People’s risky behaviour raises taxes and insurance premiums as health care costs remain high and on the rise. In 2002, estimates of conditions, such as diabetes, heart disease, renal failure, and hypertension related to diabetes was between $92 and $117b, approximately 10 percent of all health care costs. Another $56b was attributed to indirect costs, such as lost productivity, lost wages, and loss due to premature death (Kersh & Morone, 2005). Increase in public health warnings has put the spotlight on obesity, and has attracted the attention of the White House, Congress and fifty states. As an attempt to define the problem, an unhealthy food environment has been attributed to be the cause the problem, whereas others have attributed the problem to lifestyle factors and individual choices. There has been an extraordinary increase in portion sizes, hidden content, increase in calories and relentless advertising thereby leading consumers to unhealthy choices. According to this perspective, the powerful food industries are organized and have been pushing more calories into food. Some advocates have been critical of food merchants putting soda machines and fast-food outlets in lunchrooms, and cynically manipulating children. Advocates have suggested that some people may not understand the dangers of their lifestyle choices. The industry has followed the government’s recommendations that consumers should be educated to make wise eating decisions. The debate as to whether the obesity problem is personal or environmental or both will continue as long as the public attention lasts, and the prospect of public policy emerges on continuation of publicity of the problem (Kersh & Morone, 2005). The Bush administration and leaders of the congress have encouraged self-help activities, such as smart eating and exercise. Contributions to legislators supporting the tobacco industry have been a consistent strategy deployed by the tobacco industry to influence contributing strategy. State level legislative behaviour is significantly influenced by tobacco industry campaign contributions, thereby influencing the ground rules for implementation of tobacco control programs by public health professionals (Monardi & Glantz, 1998). Efforts to ban lawsuits against the food industry have been Congress’s highest profile activity. Policies including health care reform, patient’s bill of rights, tobacco settlement, medical privacy regulations, and malpractice reform have all failed to pass the Congress. A prescription drug benefit, the most significant health care measure was likely to be revamped after severe criticism from several quarters, including the American Association of Retired Persons. The Congress has been tagged as “the graveyard of healthcare reform” by Mark Peterson. Occasional concern about consumption habits, industry practices, and condemning the crisis has resulted in negligible legislation. Senate Majority Leader Frist introduced a bill promoting nutrition education in 2003, and a bill with grants encouraging “healthy behaviour” and “active lifestyles” to combat obesity in 2004 to the 108th Congress, which subsequently failed. Proposals and rhetoric by the Republicans has kept the focus on individuals, rather than broad based environmental analysis. The Personal Responsibility in Food Consumption Act (H.R. 339) was introduced by Ric Keller in 2003 to block frivolous lawsuits against food and beverage companies. Senate Majority Whip Mitch McConnell introduced a similar measure to the 108th Congress, which did not pass. By 2005, 14 states enacted “cheeseburger bills” forbidding obesity lawsuits, and another 18 states were considering such legislation. Senators Patrick Leahy and Tom Harkin and other Democrats were unsuccessful in passing bills on expansion of Department of Agriculture authority over public school meals and regulatory provisions; the Healthy Lifestyles and Prevention (HeLP) America Act (S. 2558), on TV advertising. Expansive legislative action by the Democrats has been nonstarters as Democrats have been a minority in both congressional chambers, during the 108th Congress. Food companies and their lobbyists have played a major role in politics, and their response has been to resist all intrusive regulations. However, once regulations become effective, different sectors such as health foods, organic producers, and food companies may not be united and seek opportunities in an antifat regime (Kersh & Morone, 2005). The executive branch has multiple and overlapping jurisdictions and important responsibilities in the obesity issue. The Department of Health and Human Services has been active and has urged people to improve their health, and has focussed on local efforts to encourage exercise instead of imposing nutrition labelling or such other rules. The FDA has policy aims including nutritional-information displays, calorie counts on food labels, and encouraging healthier diets. However, it is unreasonable to expect assertive action in the near future. Class actions including managed care, tobacco, gun manufacturers, asbestos, diesel engine emissions has all been pursued in the name of public health, suggesting that courts could be centre for changes in public policy. Gerald Rosenberg and Donald Horowitz, in the limited judicial capacity have suggested that they should not because the judiciary is not capable of policy changes that are well formulated and sustainable. Critics have argued that according to the constitution, policy making must be through elected officials in the Congress, executive branch and state legislatures, and court decision making was ambiguous. Case method prevalent in the judicial process was “piecemeal” and did not consider the larger spectrum of relevant problems or provide a means for solving those. Courts were unequipped to handle the technical and specialized nature of policy concerns, as judges and litigators were trained as generalists and were poorly positioned to address complex issues on health effects and medical technologies. Also, mass-tort action in the public health arena could overwhelm the capability of the judiciary to handle the issue. As the courts focus on rights and obligations and judges being unelected officials, the judiciary influencing policy undercuts the democratic process of communal and deliberative solutions. Other critics have questioned the effectiveness of judicial activity, as not much decline was observed in the tobacco case. Implementation stage in the tobacco case resulted in fresh legal debates, further raising concerns about the effectiveness of judicial policy making (Kersh & Morone, 2005). 72 bills to combat obesity were filed in 2002. The number increased to 172 in 2003 and over 350 in 2004. State laws sought to reduce obesity rates by being tough with the food industry on one hand, and protecting them on the other. The judiciary has been considered to the most convenient venue to pursue coherent and systematic national policies. Class action lawsuits and mass torts have been the most prominent litigious approaches to public policy. In case of tobacco, the courts blocked FDA’s effort to regulate tobacco as a drug, thereby curbing its effort to extent its authority. Aggressive marketing to children and deceptive marketing by fast-food companies and packaged-food manufacturers have been considered vulnerabilities in the obesity issue, and well honed suits targeting the two could be exploited for action through judiciary (Kersh & Morone, 2005). In 2003, Act 1220 was enacted in Arkansas to address childhood and adolescent obesity, where each public school student had to have his/her body mass index assessed and reported to parents annually. The use of annualized data would help parents, schools and the state better understand the obesity epidemic and track progress (Justus, Ryan, Rockenbach, Katterapalli, & Card-Higginson, 2007). The School Junk Food Ban (SB 12) and the High School Soda Ban (SB 965) were bills passed in California in 2005 and a similar bill banning the sale of sodas and electrolyte drinks with certain exceptions, such as special events was passed in Connecticut in 2006 (Cardin, Farley, Purcell, & Collins, 2007). Politicians deliver speeches, decry sedentary lifestyles, and urge parents to guide eating habits of children. However, voting for legislation that would actually make a difference could be expensive or jeopardize relationships with the agriculture lobby and large corporations (Jacobson, 2003). Traditionally debates on issues related to health policy revolved around public issues, such as building health care infrastructure, increasing access to health care, or organizing research. There has been an array of issues including tobacco, obesity, abortion, the right to die, drug abuse, and a patient’s relationship with the organization providing managed care where there is the political urge to regulate private behaviour. A distinct political process is required for regulating private behaviour, where advocates would have to persuade others that private behaviour has important public ramifications. Since regulating private behavior is likely to get bogged down in legislative stalemate, its focus being individuals makes it suitable for judicial action. Definition of the problem, response from Congress, administrative agencies, and courts, and cultural consequences of policy debate is a familiar route for obesity as observed in tobacco and patient’s rights measure (Kersh & Morone, 2005). Conclusion Restoring trust between experts, those to whom they are accountable, and the public are necessary preconditions for managing uncertainties in population health (Colmers & Fox, 2003). Discussion has been confined to demand-side; nutrition in public policy perspectives, and has failed to consider the role of supply-side public policies. Agricultural, industrial and economic policies pay a significant role in the nature of food available and the environmental conditions under which they are presented. Thus, future public policies directed at preventing obesity may require changes in prevailing supply-side policies in addition to developing or changing demand-side policies (Tillotson, 2004). Articulations of socially and scientifically credible public health threat, mobilizing a diverse organizational constituency, and convergence of vulnerabilities with political opportunity are factors that influence the success of health-related social movements (Nathanson, 1999). Initiatives for prevention require changes in policy for broad implementation. Political will and society’s commitment are essential for securing resources for policy change. Integration of scientific evidence and community participation has an important role in the political will for developing and implementing public health policy (Lezine & Reed, 2007). The publicity might have had an impact on the obesity issue. Obesity and overweight levels did not increase in women between 1990 to 2000 and 2003 to 2004 (Foxhall, 2006). Debates on health issues are likely to be reopened, as Democrats in Congress have been gearing up to reopen them after their majority win in November (Bristol, 2006). Shifting focus away from individual risk factors and shaping the situational and environmental influences to create an environmental health is required from the law to address the problem. Advocates should co-ordinate and promote population-wide model of public health (Alderman, Smith, Fried & Daynard, 2007). References Alderman, J., Smith, J., Fried, E., & Daynard, R. (2007, March). Application of law to the childhood obesity epidemic. Journal of Law, Medicine & Ethics, 35(1), 90-112. Retrieved May 28, 2009, from CINAHL Plus with Full Text database. Bristol, N. (2006, December 9). Democratic victory could fire up US health policy debates. Lancet, 368(9552), 2043-2044. 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