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Health Is the Health of the State


PRESIDENT BUSH has named a new surgeon general, Dr. Richard Carmona of Arizona, to succeed Bill Clinton’s man, Dr. David Satcher. Satcher is the surgeon general who vowed to get us all to lose weight with his “Call to Action to Prevent and Decrease Overweight and Obesity.” As he put it, “Our ultimate goal is to set priorities and establish strategies and actions to reduce overweight and obesity.”

Those of us who wish to see limits on government power were naturally disturbed. What business is it of government if people are overweight or even dangerously obese? Most weight problems are the result of choices people make: they eat too much and exercise too little.

Where there’s an actual medical problem, there is nothing to stop anyone from seeking a phy sician’s help. There’s no proper role for government here. Satcher’s interventionist program was simply another step in a march to medicalize life’s challenges and empower the state. The tip-off came when his document called for establishing “a dialogue to consider classifying obesity as a disease category for reimbursement coding.” That was a clear sign that this is about getting someone else to pay for weight-loss services through health insurance and government programs. It’s finance, not medicine; medicine is only debased in the process.

When Satcher retired, one might have hoped that President Bush would name a surgeon general (if, alas, one has to be named) who would leave us alone and perhaps confine his attention to infectious diseases. It was not to be. Bush has directed Carmona to spearhead a national “healthy living campaign.” Bush said, “The doc and I are going to encourage all our country to either run or walk or swim or bicycle for the good of their families, for the good of their own health, and for the good of the health of the nation.”

I’m leery of that word “encourage.” If he really meant “encourage,” what would be the point? We are encouraged to exercise and lose weight every moment of the day. One can’t escape the hectoring. So I think Bush has more in mind. Carmona will very likely pick up where Satcher left off. Satcher’s plan called for programs aimed at the home, job, school, and larger community. The list of activities contained some ominous items. For example:

  • “Empower families to manage weight and health through skill building in parenting, meal planning, and behavioral management.”
  • “Educate parents about the need to serve as good role models by practicing healthy eating habits and engaging in regular physical activity in order to instill lifelong healthy habits in their children.”
  • “Establish worksite exercise facilities or create incentives for employees to join local fitness centers.”
  • Direct, heavy-handed intervention might not be what the administration has in mind (yet). Perhaps it will introduce a series of tax credits or deductions to push us in the direction of losing weight. That’s what I call soft coercion. Promising to let us keep a small amount of our own money if we engage in favored weight loss activities is not a proper activity for government.

    Suspect statistics

    This would be bad enough even if the government’s health experts were being truthful. But there is reason to doubt their pronouncements about this “crisis.”

    The great debunker of junk science Steven Malloy writes that the government’s statistics on the prevalence of fat people are based on “suspect research,” such as unverified telephone surveys and “an arbitrary definition of overweight’ based on body mass index.’” Malloy adds that the government’s estimate of 300,000 deaths a year from overweight and obesity is “unadulterated junk science.”

    The New England Journal of Medicine also finds the data unreliable, Malloy says. He also criticizes Satcher’s report because it ignores important differences between being overweight and being obese. Obesity is unhealthy, he says, “but the evidence supposedly linking mild-to-moderate overweight with increased health problems is murky, based only on flaky statistics.” Malloy even debunks the alleged relationship between childhood and adult weight problems: the evidence is lacking.

    I’m not suggesting that weight problems can’t be a serious challenge for people. But I do question whether such problems are diseases and whether they fall within the proper scope of government. Many people think so, and it might be instructive to look at one example.

    Health hazards of metaphors

    Public-health professor Tom Farley and scientist Deborah Cohen, writing in the Washington Monthly (“Fixing a Fat Nation,” December 2001), complain that we must stop treating weight as a personal matter because that approach has failed. It’s an epidemic. They provide a good lesson in the dangers of taking a metaphor literally, something Thomas Szasz has long warned of. They write,

    Individually, we beat ourselves up for lack of willpower or for choosing a night at a burger joint with the kids over a trip to the gym, dramatizing personal failure even though in today’s junk-food-laden society, it’s nearly impossible to stay thin. The desk job, the television, the Internet, suburban housing developments and their roads to nowhere all conspire against us. Yet we still view obesity as an individual problem, and so does the government. [Emphasis added.]

    It’s society’s fault that people weigh too much. They can’t help it. Call in the government. They continue:

    But the epidemic is spreading at such an alarming rate that it can no more be viewed as an individual failing than 19th-century cholera epidemics could be blamed on poor personal hygiene. Indeed, given the rate Americans are dying, we’d better start treating obesity like an infectious epidemic. Combating obesity and its many attendant illnesses will not require more cholesterol-lowering drugs or even diet books or workout videos, but rather a retooling of our environment to get us moving again and to put the doughnuts a little farther out of reach. [Emphasis added.]

    But obesity is not really an infectious epidemic. You can’t catch obesity. So why act as if you can? Because doing so is consistent with the doctrine that all problems are health problems and all health problems are the business of the government. Words are chosen not for their correspondence to the truth but for their ability to advance an agenda. Farley and Cohen acknowledge that most weight problems are not matters of genes and biochemistry: “We gain weight when we eat more fuel than we burn.” But they insist that the government approach the issue like an outbreak of cholera.

    After lamenting that diet and exercise don’t work because people won’t stick to them, Farley and Cohen unveil their secret weapon: the government. It’s time to get serious, they say. First, tax junk food. (Alas, we can’t ban it.) Then use some of the money to promote better eating and to “counter-advertise junk food.” Revenue could also subsidize good foods like fruits and vegetables, cutting the price to consumers.

    Farley and Cohen would also forbid junk-food advertising aimed at children and regulate availability of the unhealthy stuff. They write, “No one will tell Burger King that it can’t run its business, but in the middle of a killer epidemic is it really a good idea to have three fast-food joints within a half a block of a high school?” Call out the zoning boards. And don’t forget the vending machines.

    Of course the government’s schools are available for enlistment in the war against child obesity. Farley and Cohen would further regulate school lunches, toughen phys-ed requirements, and keep the kids out of the hamburger restaurants by holding them in school until 5 or 6 p.m.

    The authors tackle the question of why so little is being done to fight the “epidemic.” After blaming the bureaucracy, they locate another obstacle to government’s solving this problem

    Then there’s our cherished individual freedom. Some of our fierce individualism spills over into a vague feeling among eminently reasonable Americans that the government shouldn’t be telling its people where they can or can’t put a vending machine, and also translates into the sense that health is an individual responsibility. But history has shown that in dealing with epidemics of all sorts, ultimately collective, not individual, action radically improves public health.

    By now the authors have forgotten that they originally said America’s weight problem is “like” an epidemic. Now it is a literal epidemic, justifying pervasive government interference in our lives. Such is the danger of taking metaphors literally.

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    Sheldon Richman is former vice president and editor at The Future of Freedom Foundation and editor of FFF's monthly journal, Future of Freedom. For 15 years he was editor of The Freeman, published by the Foundation for Economic Education in Irvington, New York. He is the author of FFF's award-winning book Separating School & State: How to Liberate America's Families; Your Money or Your Life: Why We Must Abolish the Income Tax; and Tethered Citizens: Time to Repeal the Welfare State. Calling for the abolition, not the reform, of public schooling. Separating School & State has become a landmark book in both libertarian and educational circles. In his column in the Financial Times, Michael Prowse wrote: "I recommend a subversive tract, Separating School & State by Sheldon Richman of the Cato Institute, a Washington think tank... . I also think that Mr. Richman is right to fear that state education undermines personal responsibility..." Sheldon's articles on economic policy, education, civil liberties, American history, foreign policy, and the Middle East have appeared in the Washington Post, Wall Street Journal, American Scholar, Chicago Tribune, USA Today, Washington Times, The American Conservative, Insight, Cato Policy Report, Journal of Economic Development, The Freeman, The World & I, Reason, Washington Report on Middle East Affairs, Middle East Policy, Liberty magazine, and other publications. He is a contributor to the The Concise Encyclopedia of Economics. A former newspaper reporter and senior editor at the Cato Institute and the Institute for Humane Studies, Sheldon is a graduate of Temple University in Philadelphia. He blogs at Free Association. Send him e-mail.