February 12, 2004, 8:51 a.m.
Cadbury Replaces Cholera
Can government make us healthier?

By David Gratzer

With the holidays long behind us, Americans are back to their regular routines, working at their jobs — and, perhaps, still keeping their New Year's resolutions. For many, that means a familiar self-prescription: better eating, more exercise, fewer sweets. But if Americans are looking forward to a healthier year, here's the surprise: A growing number of public-health experts have similar resolutions — for you. Indeed, the latest trend in public health is making your choices their business.

Health is, as ever, a concern: Witness the rising rates of smoking and obesity. What can a man do in these troubling times? On the Canadian prairie, Jim Rondeau seeks to answer this question. Rondeau, a politician in the Manitoba provincial assembly who was recently appointed minister of healthy living, isn't exactly a household name. But then, that's not the point — in a sense, the cabinet secretary's business is what goes on in the household. During an interview with a local paper, Rondeau waxed poetic about the need for citizens to appreciate not only the health differences between a green leafy vegetable and a double bacon cheeseburger, but also to make the right choice between them. He hopes to push people in that direction.

Let's be clear. Rondeau won't be doing any random checks on Canadian kitchens, looking for evil hamburger meat or saintly asparagus. Despite his grand ambitions, there are limitations to his present job: He doesn't have a staff beyond his secretary. In other words, Rondeau's title is august while his political stature is small. But his appointment illustrates the biggest trend in public health, from the community to your house.

Not that long ago, public health meant something very different. In 1854, cholera was killing Londoners, claiming 500 people in just over ten days. A British physician by the name of John Snow mapped out the homes of cholera victims and pinpointed the problem: a Broad Street water pump contaminated with the deadly bacteria. Dr. Snow broke the pump handle — and thus the back of the epidemic, literally saving thousands of lives.

This medical heroism may be the most spectacular success in public health, but it hardly stands out as the only one. Indeed, the advances made by smart public-health initiatives in the first half of the twentieth century resulted in a greater extension of life expectancy than the dazzling medical discoveries made in the latter half. My colleagues would have you believe that open-heart surgery and MRIs are the medical miracles of the past century, but clean water and infectious-disease control deserve more credit.

Today, though, public-health experts concern themselves with much more than water and cholera. The American Public Health Association, for example, has statements on school vouchers (opposed), war in Iraq (opposed), and missile defense (opposed). In Sweden, public-health officials have convinced the government to regulate vending machines at schools, ban commercials that target kids, and require cooking classes for all 8-year-olds. When Cadbury offered to donate money to British schools where kids collected many candy wrappers, public-health experts raised such a fuss that Prime Minister Blair chaired a meeting on the issue. In October, the Toronto Board of Public Health released a poll on spanking — which, incidentally, the committee has a position on (opposed).

How is it that public health has gone from cholera to school choice? Public-health experts argue that health care is just one factor in a person's well-being. Indeed, they note, housing, diet, education, and income are even more important. Thus, public health now concerns itself with many non-health issues — and the American Public Health Association has a position on the Bush tax cuts (opposed).

The latest front in this battle is your pantry. Public-health experts are agitating for a fat tax (that is, a tax on fatty foods, rather than fat people). "By taxing fat, you're killing two birds with one stone," says health economist John Schaafsma. "You're raising tax revenue for the health care system at the same time you're discouraging the consumption of fat." In the United Kingdom, the idea of a tax on Twinkies is proving popular, and has won the endorsement of the British Medical Association. Closer to home, 17 states already have special taxes on soft drinks, candy, and snack foods. In Arkansas, for instance, each can of soda carries a two-cent tax, which goes to Medicaid; West Virginia has a one-cent soft-drink tax to fund its medical nursing school.

Of course, there are real problems here. Smoking rates are on the rise and too many North Americans exercise infrequently. Obesity in the United States approaches epidemic proportions. But the solution to these problems doesn't rest with government activism, despite the ambition of public-health officials. We don't need ministers of healthy living or a tax on fatty foods. We as a society need to subscribe to alternatives too seldom promoted by government: self-reliance and common sense.

— Dr. David Gratzer, a physician, is a senior fellow at the Manhattan Institute.

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