Whilst you may hear grumbling about government incompetence in tackling inflation and the outrageous price of Freddos at your local supermarket, at least the same government isn’t peering over our shoulders telling us we’re not allowed to eat them. 

But should they? England represents a microcosm of the worldwide struggle with obesity.  Six percent of men and eight percent of women in England were obese in 1980 (3), compared with over one-quarter of the population in 2021. This dramatic rise in obesity is worrying for several reasons. Not only does the treatment of obesity put strain on an ailing health service, but a growing body of evidence points to obesity being linked with mental health disorders, ultimately causing less fulfilling lives (1). Furthermore, evidence that sugary foods which contribute to obesity are addictive, combined with the complexities of nutrition and food science, makes responsible decision-making difficult and complicated. 

 

How can we tackle this problem? As shown by its response to the pandemic, the government bears significant responsibility for matters of public health, but does it have the right to intervene on matters as personal as what one puts into their body? 

 

Why might the government intervene?

There is precedent to forcibly restrict people’s liberty. The government institutes laws mandating seat belts be worn, restricts the sale of addictive and harmful substances and heavily taxes alcohol and cigarettes. These sorts of policies are usually justified for two reasons:  

1. Citizens are ignorant or take a myopic view of the consequences of their actions. This justification has been used to defend minimum age requirements for the purchase of alcohol and tobacco.

2. The second factor is the ‘Harm Principle’. Preferences can be overridden when their effects negatively impact others. For example, some claim that intrusions into smoking practices began only when the damaging effects of second-hand smoke were revealed, violating the harm principle.

In this article, I will explore these two factors whilst advancing the harm principle to demonstrate that public funding of obesity-related diseases is uniquely unfair.

 

Myopia

Particularly in the age of advertising and celebrity endorsements, people (especially the young) form a false impression of the costs and benefits of eating certain types of food. That notorious Snickers advert has stuck in my memory from childhood: ‘You’re not you when you’re hungry’. The idea that a chocolate bar — with a very high glycaemic index that ultimately causes increased hunger cravings — can instead satisfy hunger is blatantly misleading. Furthermore, our schooling system equips most children with insufficient knowledge about nutrition. Besides learning that I should not insert a knife into a toaster, attempting to microwave a whole raw egg taught me more about cooking and nutrition than school ever did. My experience is not unique —  most students I know entered university with neither robust knowledge of how to cook, nor knowledge of what they are eating.

What we see, perhaps, is a relatable experience of young people choosing cheap, convenient fast foods instead of nutritious whole foods with often disastrous health consequences. This ignorance can cause people to make short-sighted decisions that might cost them in the future. Preventing this outcome should be one of the government’s aims when interfering with the food we eat. A further aim in interfering with food is to reduce these self-imposed future costs which come in the form of increased risk of diabetes, heart attack, or depression. 

 

Harm Principle

The second reason the government might intervene is to reduce the costs on society of poor dietary decision-making. The annual NHS spend on obesity-related diseases is £6.5bn and the costs tied up to loss of productivity are estimated to be up to £7.5bn (Bell, 2022). Clearly, eating sugary and fatty foods imposes an economic burden on third parties, thereby violating the harm principle.

Although there are many actions that place burdens on third parties, the externalities from poor dietary decisions are not even of indirect benefit to the affected individuals. For example, my driving a car harms a pedestrian’s lungs or a construction worker putting himself in harm’s way by doing a dangerous job puts a burden on the health service. Is this a justification for the government to override preferences? I would argue not. The difference between these two examples and poor dietary decision-making, is that the third parties harmed gain something from the externality which they are not willing to give up. In the case of cars, the third party is a pedestrian, while the person ordering the parcel and the parcel delivery company are the private actors. Would the pedestrian - who is removed from the transaction requiring a car - want to ban cars? I would argue not. Fast transportation and convenience are increasingly integral to our lives. Therefore, even someone completely separate from this transaction receives a benefit from the existence and use of cars. Furthermore, a country without construction workers – because they have no safety net for occupational injuries – would be disastrous for infrastructure and the nation. Hence it appears that we consent conceptually to the institution of driving and construction working, despite the negative externalities imposed on us, because of the long-term benefits they provide. It is not clear what benefits taxpayers derive from other people’s poor dietary choices hence making this manifestation of the harm principle uniquely unfair. Given that taxpayers are paying for these treatments, the government has a duty to redress the imbalance of costs and benefits associated with poor dietary decision-making.

Food-related diseases such as diabetes are different from ailments such as cancer in that there is a clear and more avoidable cause for diabetes. Illnesses like cancer often involve a greater element of chance, and the population supports a health service to form collective insurance against such unpredictable health challenges. There is a significant moral hazard in providing a blanket safety net for a more preventable disease, and hence the government should act to address this. 

 

Why do people object?

Some argue that this constitutes a gross overreach of state powers. Firstly, the government should not interfere with the most basic and private aspects of our lives. What we put into our bodies is a personal decision and should be respected. In the absence of a National Health Service, this would be a valid objection. If individuals had to bear the full costs of their actions, then their eating decisions would be fully self-contained and private decisions. However, since taxpayer money goes towards the treatment of diabetes and other such illnesses, it seems reasonable for the government to push us toward healthier options. 

Many point to governmental ineffectiveness when arguing against this type of paternalism. Governments globally have tried, unsuccessfully, to issue advice about food. The British Medical Journal published a study investigating the national dietary guidelines for 85 nations. It found that only 2 countries had guidelines that matched health and environmental targets such as the Paris Climate Agreement and the Sustainable Development Goals (5). Governmental incompetence is the biggest barrier to the argument for increased state intervention in food. If governments are to intervene, we must rely on them to do it well. There is reason to be optimistic however; as crises become more acute, governments seem to get their act together, particularly when it affects their own citizens (look at the vaccine rollout during the COVID-19 pandemic). As obesity-related diseases become a greater issue, we can expect higher quality intervention, since after all, the government itself benefits from it. 

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How should the government intervene?

There are two strategies that I believe the government might be able to successfully implement.

Firstly, taxing food and drink with high sugar and high trans fats. The UK has already put in place a ‘Soft Drinks Industry Levy’ which taxes soft drinks with high sugar content. This has demonstrated an initial positive impact. Reports show that 50% (7) of manufacturers have reformulated their drinks as a result, leaning towards lower sugar ‘diet’ options. Whilst this tax might have been regressive, since lower-income households were found to consume more fizzy drinks, its effects will be progressive for health. Similar tough calls must be extended beyond soft drinks to redress this issue. Adopting such policies for a wider range of unhealthy foods could have a profound impact, especially on children and young adults, whose eating habits are still forming. By making unhealthy food options more expensive, these taxes can deter consumption, promoting better health outcomes.. A healthier population is crucial as the working-age demographic declines. Ensuring that future workers are in good health is vital for maintaining productivity. Implementing these tough measures will pave the way for a healthier, more productive Britain.

Secondly, the government must take more preventative measures. The Department of Health introduced voluntary food ‘traffic light’ labelling in 2013 (BBC, 2016) and mandated calorie labelling in larger restaurants in 2022 (Department of Health and Social Care, 2022). These are steps in the right direction. Consumer awareness of healthier choices has improved but more must be done to influence decision making. Given that food habits form at younger ages, the government must focus its attention here (Małachowska, 2021). They can do this by mandating that school meals for all ages be healthy and meet standards on sugar and trans fat content. The best example of policy leadership has come from the NSW, Queensland where a nutrient profiling system identifies ‘red light’ foods that can only be sold once or twice a month in schools (Swinburn, n.d.). Furthermore, students, particularly in secondary school, should be taught how to cook whole foods and learn about the impact that various types of food have on their physical and mental health. As I mentioned before, being told not to put a fork in a toaster might be handy advice, but it does not quite prepare one for a lifetime of healthy eating.

 

Only through targeting the problem at its source will we be able to sustainably reverse the trend towards increasing obesity and declining physical health. Not only will governments save valuable resources, they will also fulfil the Aristotelian ideal of helping their citizens live a more fulfilling life with better mental health, and the ability to move and utilise their bodies pain-free.

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