One of the biggest debates of our time is between the conservative “personal responsibility” and the liberal “it’s everyone else’s fault.” This debate rages over a wide variety of subjects, including health and healthcare, education, crime, poverty, and pretty much any other issue you can think of. The assumption of conservatives is that a poor person is poor because (and only because) of the personal choices he or she has made, as if those choices were made in a vacuum. Similarly, the liberal assumption is that poverty is purely environmental and poor people have no choices to make in the matter. I hear this over and over and over again, and it is maddening because each side is so dogmatic that they don’t realize how little sense their positions actually make.
Well, here’s a guy that truly gets it. I love this article because it explains the crux of the health and obesity problem: it’s about choices, but the environment makes those choices the most difficult options for most people. Think of it this way: in your own life’s circumstances – where you live, what you know, how much money you have, who your friends are – how easy and convenient (and likely) is it that you will exercise for at least 30 minutes and eat 6 servings of fruits and vegetables today? Now, take your likely middle-class, highly educated, suburb-living answer and subtract a car, a safe (or perceived safe) neighborhood, a real grocery store within a mile, and about half or more of your income. Tell me how many choices you are left with.
The interesting thing about obesity is that, while more prevalent at the lower socio-economic levels, it really spans the race and income spectrum. Why? Because, as Dr. Katz explains, we have designed as system of urban design that makes it difficult to get any regular exercise in both the slums and the suburbs, and good quality foods are either almost impossible to get, difficult to afford, or just not as appetizing or quick or convenient as the next greatest thing in food engineering. So, whether you are rich or poor, urbanite or suburbanite, the physical and psychological (think advertising and fear of crime) environments in which most of us live make our healthy choices almost unchoosable (I know, it’s not a word, but it gets the point across).
The point of this debate is to direct the policies that are meant to address the problem. If it is true that the environment doesn’t matter, then the correct policy is one of deregulating the environmental factors and making sure the individual feels the full weight of the consequences of their actions. Of course, even if this were true (the environment has no fault), one person’s poor health impacts his or her family’s health and quality of life and drives up the healthcare costs of everyone else, so it is not as if only that one person could actually bear the full consequences of the choices they have made. The human ecology in which we live makes the straight conservative argument of “personal responsibility” irrelevant even in the absence of the fact that it is illogical that people can make choices in a vacuum.
On the other hand, if it is true that the person has no choices to make in faulty environments, then policies should act to change the environment and bail out the individual from experiencing the consequences of their choices. But this doesn’t exactly solve the problem either because the policy just reinforced the bad decision that was made. Even if the environment changes and it becomes easier to make the good choices, operant conditioning tells us that people will still choose to engage in the bad behaviors seeking the reward they were previously offered. Psychology renders the standard liberal policy largely ineffective.
We won’t find much progress, on this issue and the others that we face, until we start marrying the two sides together and eliminating their byproducts. If we want healthier citizens and lower healthcare costs, we need to look at policies that acknowledge that a person’s choices and the environments in which those choices can be made are two sides of the same coin. We cannot separate the two (at least, we cannot if we are being honest with ourselves), so our policies must not either. We did it with tobacco use, another public health problem, by regulating the industry and heavily taxing the product; why can’t we do the same with obesity? What are your thoughts?