David Boaz

New York Mayor Michael Bloomberg’s continuing crusade to manage every aspect of his constituents’ lives has generated another perverse consequence: Customers of Wendy’s in New York will now get less information on nutrition than they did before the newest regulations. Wendy’s has posted this notice “For NYC Customers” on its Nutrition website:

Special notice to inquiries originating from New York City:

We regret that Wendy’s cannot provide product calorie information to residents or customers in New York City. The New York City Department of Health passed a regulation requiring restaurants that already provide calorie information to post product calories on their menu boards — using the same type size as the product listing.

We fully support the intent of this regulation; however, since most of our food is made-to-order, there isn’t enough room on our existing menu boards to comply with the regulation. We have for years provided complete nutritional information on posters inside the restaurant and on our website. To continue to provide caloric information to residents and customers of our New York City restaurants on our website and on our nutritional posters would subject us to this regulation. As a result, we will no longer provide caloric information to residents and customers of our New York City restaurants.

We regret this inconvenience. If you have questions about this regulation, please contact the New York City Department of Health and Mental Hygiene and refer to Health Code Section 81.50.

A headline in the Washington Post blares:

Japan’s New Public Health Problem Is Getting Big

Obesity Has Grown, Along With Appetite For Western Foods

But no. Obesity is not a public health problem. It is apparently becoming more widespread in Japan, though still much less so than in the United States, but it remains an individual and non-contagious problem.

The meaning of “public health” has sprawled out lazily over the decades. Once, it referred to the project of securing health benefits that were public: clean water, improved sanitation, and the control of epidemics through treatment, quarantine, and immunization. Public health officials worked to drain swamps that might breed mosquitoes and thus spread malaria. They strove to ensure that water supplies were not contaminated with cholera, typhoid, or other diseases. The U.S. Public Health Service began as the Marine Hospital Service, and one of its primary functions was ensuring that sailors didn’t expose domestic populations to new and virulent illnesses from overseas.

Those were legitimate public health issues because they involved consumption of a collective good (air or water) and/or the communication of disease to parties who had not consented to put themselves at risk. It is difficult for individuals to protect themselves against illnesses found in air, water, or food. A breeding ground for disease-carrying insects poses a risk to entire communities.

The recent concern over a tuberculosis patient on an airplane raises public-health issues. You might unknowingly find yourself in an enclosed space with a TB carrier. But nobody accidentally ingests a Big Mac. And your Big Mac doesn’t make me fat. That’s why obesity is not a public health issue, even if it’s a widespread health problem. As I wrote before,

Language matters. Calling something a “public health problem” suggests that it is different from a personal health problem in ways that demand collective action. And while it doesn’t strictly follow, either in principle or historically, that “collective action” must be state action, that distinction is easily elided in the face of a “public health crisis.” If smoking and obesity are called public health problems, then it seems that we need a public health bureaucracy to solve them — and the Public Health Service and all its sister agencies don’t get to close up shop with the satisfaction of a job well done. So let’s start using honest language: Smoking and obesity are health problems. In fact, they are widespread health problems. But they are not public health problems.

There’s good news tonight:

The rate of death from heart disease in the U.S. was cut in half between 1980 and 2000 thanks to better medical treatment and a reduction in the incidence of some risk factors, a new study shows.

That’s wonderful news, the kind that ought to be celebrated. We hear about threats and dangers and cancer clusters and transnational viruses and flying TB carriers, and many of those are real concerns. But the big picture, as Indur Goklany demonstrates at great length in his new book, is–well, let his title explain it: The Improving State of the World: Why We’re Living Longer, Healthier, More Comfortable Lives on a Cleaner Planet.

But this great news about heart disease appeared on page D4 of the Wall Street Journal and on page 13D of USA Today. As far as I can tell, it didn’t appear in the New York Times, the Los Angeles Times, or the Washington Post at all, nor on any NPR program. Though on the NY Times website, you can find an article the same day on the tiny increase in deaths from West Nile virus. And the heart disease story can be found on the Post website, though not in the print paper.

More details appeared in the Journal’s Health Blog:

The decline in heart disease, reported in the current New England Journal of Medicine, saved an estimated 341,000 lives in 2000 compared with the number of deaths that would have been expected if the levels of heart disease in 1980 persisted.

341,000 fewer deaths from heart disease in one year! There’s good news tonight–even if you won’t find it in the newspapers.

Michael Cannon writes below that the health insurance time bomb that presidential candidate Mitt Romney left for Massachusetts is “becoming less universal and less affordable all the time.” It’s also becoming less visible, at least in Romney’s campaign speeches, according to two new reports. Romney often fails to mention the plan, the only real accomplishment of his four years as governor, as he campaigns for the Republican nomination.

Both stories quote the plan’s leading critic, Michael Tanner. The Washington Post notes:

“This mandate is unprecedented,” said Michael Tanner, a health expert at the Cato Institute, a conservative think tank in Washington. “It’s the first time a state has said simply because you live there you must buy a specific product. If he wants to be the Republican who embraces Hillary-care, I don’t think that’s going to go hand in hand with him trying to portray himself as Ronald Reagan’s heir.”

The Associated Press correctly identifies Cato as libertarian. AP also notes that the major supporter of the plan, the Heritage Foundation, is standing by it in a new report, which says it is “already showing progress.”

By this time next month, Heritage may be alone. Romney may well have become a leading opponent of Romneycare. After all, a man capable of reversing his views on abortion, gay rights, and gun control is surely capable of doing a 180 on a complex health care plan that rests on “abolish[ing] the laws of arithmetic.”

At last — a big story about people deciding to work together to solve a widespread individual problem without asking for taxes, regulations, subsidies, or general pestering from the government.

Spearheaded by Ian Smith, a doctor and fitness guru, the 50 Million Pound Challenge is a national campaign underwritten by State Farm Insurance Co. to improve the health of African Americans.

Heart disease and diabetes are among the leading causes of death for African Americans. If that is to change, public health experts say, people must exercise more and eat better, which is easier said than done, given the dearth of high-quality supermarkets and restaurants in poorer black communities.

With the 50 Million Pound Challenge, organizers hope to rally African Americans to trim waistlines by keeping tabs on their blood pressure, cholesterol levels and body mass index and by trimming some of the fat out of their diets.

Leave aside the reporter’s irresistible temptation to suggest that the lack of high-quality restaurants in poor neighborhoods is why many poor African Americans are overweight. I was in a high-quality restaurant last night, and it wasn’t easy to watch my diet there. (Besides, poor people presumably can’t afford expensive restaurants, even if they are in the neighborhood.)

The point is, most stories about obesity these days throw around misnomers like “public health” and call for government programs and restrictions on our freedom. In this case a doctor, an insurance company, and some popular entertainers got together to encourage individual people to improve their own health. Let’s hear it for the 50 Million Pound Challenge!