Wednesday, July 19, 2006

Living Large in Chicago ...

Catfish beignets, curly fries smothered in cheese, pierogies with sour cream, beer-battered artichoke hearts, and fried dough buried in berry sauce and whipped cream -- all part of the traditional Taste of Chicago and all contributing to Chicago's reputation for being one of the 'fattest' cities in the US. And if Edward M. Burke, Chicago City Councilman since 1969, has his way it will be illegal for restaurants to use oils that contain trans fats, which have been tied to a string of health problems, including clogged arteries and heart attacks.

But even Mayor Richard M. Daley, who often promotes bicycle riding and who not long ago appointed a city health commissioner who announced he was creating health “report cards” for the mayor and the aldermen, has balked at a trans-fat prohibition as one rule too many.

What do you think? I love Chicago, it's my favorite city, and I'll like to see it be more healthy -- but does this go overboard? Or is it in the same category as banning smoking in public places? It brings up a host of legal and ethical questions, what role does government play in regulating lifestyle? And if I consciously choose to smoke or eat trans fats, can I really expect society to pay for my care? I'd love to hear your thoughts on this matter...


Kevin T. Keith said...

This clearly falls into the realm of paternalistic intervention, not "protection of the innocents"-type safety regulation. That is, the prohibition is clearly intended to protect consumers from the consequences of choices they would otherwise have made, rather than to protect people from things they can't avoid through reasonable choices. (You can't control what the cook uses in the kitchen, but you can control whether you choose to order it, and it's easy to find non-trans-fat menu choices in almost any restaurant, so nobody is "imposing" fatty foods on anyone.)

Traditionally, we have balked at paternalistic interventions that limit people's options, but have been more accepting of things intended to reduce exposure to dangers that cannot otherwise easily be avoided. In fact, some proposed paternalistic interventions were rejected, only later to be enacted when the same policies were proposed as a means of reducing harm to third parties, not the autonomous adults choosing the behavior. (Motorcycle helmet laws usually fail when proposed to protect riders, but have been passed as a means of reducing the public health cost of emergency care for accident victims; smoking bans were not successful until they were proposed as ways to eliminate "second-hand" smoke, not to protect the smokers. Even Prohibition was promoted as a way to protect women and children from harm or bankruptcy caused by alcoholism among fathers and husbands.)

The trans fat ban seems obviously to fall into the former category and not the latter - it's hard to imagine what danger there could be in second-hand lipids. As such, it runs counter to the history of such proposals (which is not to say it couldn't be passed - just that it's not the type of thing that usually does get passed). As a personal opinion, I would oppose it for that reason, though I support "third-party" protections such as bans on public smoking and leaded fuel, and requirements for infant car seats.

One other factor is relevant, though I suspect is not applicable in this case. That is that there is a much stronger argument for paternalistic protections that don't interfere with the subject's liberty (such as requiring air bags in cars, which don't harm you - if you secure your children properly - whether or not you actually want one), and for public health measures that impose a minimal cost for greater benefit (such as water flouridation, which reaps significant public health benefits and which only cranks get upset about). If the trans fat ban falls into one of these categories, it could be more justifiable.

I doubt the fat ban fits the description of "nominal impact". It is certainly true that you can make (dry, mealy, rather gummy and tasteless) healthy food without them, but there is no question the ingredients that contain trans fats also make a considerable difference to the nature of the food. If the experienced quality of eating food is a good - which it is - then it's not true that you are giving up almost nothing by giving up a major part of the way many foods are traditionally prepared. And given that one can choose other foods with no increased effort or expense, this would tend to put the choice between eating foods with trans fats and those without into the realm of a tradeoff among different kinds of goods (taste vs. health), each valuable in its own way - exactly the kind of choice we think autonomous persons ought to be allowed to make.

In that case, then, do the public health benefits of trans fat reduction justify the cost in other values? It's likely that the benefits would be considerable (though it would not eliminate heart disease by any stretch). The cost, however, would be to give up an important range of popular foods. Clearly, most members of the public have already "voted with their stomachs" by choosing the fatty foods when alternatives exist and the dangers of fats, and trans fats, are widely known. Perhaps those behaviors are not ones truly preferred by the eaters, however. Weakness of will is a well-known problem both in public health and in ethics (just think of all the people who wish they could diet effectively). There may be a justification for policies reinforcing behaviors the subjects would endorse even if they do not have the will to undertake them themselves, but if so, that would seem to be the only justification for the trans fat ban. That is to say, "the people" have already indicated their preference not to have trans fats banned by choosing to eat them, and there are at least some people (no doubt) for whom the ban would represent a significant loss of goods they now enjoy, while those who benefit from it would seem to fall almost entirely into the class of people who would like to eat healthier but just can't help themselves. It's true that many people would end up somewhat healthier from such a ban, but most of those people are ones who, apparently, don't value that goal as much as they do having a broader range of eating choices; the rest are ones who do value that goal but can't make their behavior conform to it.

So, in the end, the question seems to narrow to this: Are we willing to impose a paternalistic policy that does come at a significant cost in terms of lost alternative goods, for the benefit of a subsegment of the population that lacks those goods largely through their own (possibly involuntary) failure to seek them out when they are easily available? I suspect the answer to that question is "No", though I wouldn't argue that has to be the answer.

Emilie Clemmens said...

It’s interesting that Mr. Keith mentioned Prohibition, because I struggle to see a true difference between, for example, banning trans fats and banning alcohol. It’s easy to discuss how both are lifestyle choices that burden our healthcare system, thereby affecting us all. It could be argued that consuming alcohol is, in fact, a greater threat given its potential for direct harm to others (e.g., drunk driving victims). And obviously our drink is here to stay.

In my eyes, the concept of banning trans fats is ludicrous and could be discriminatory. Still, I think it’s important that our elected officials consider ways to strong-arm fast food restaurants into replacing trans fats with healthier alternatives, and public education seems to be somewhat effective. (Have you seen McDonald’s menu lately?) An outright ban seems very paternalistic indeed.

Then again, I’m the type that wears a seatbelt but smarts at the fact that the law says I have to. I’ll take a side of onion rings with my beer, please.