Analyzing Legislation: Obesity

The 2013-2014 New York General Assembly bill “Imposes an additional tax on certain food and drink items, and imposes a tax on video games, commercials, and movies” A02982, referred to Assembly Ways and Means Committee 1/22/13, by Assemblyman Felix Ortiz (D-51).

1. What is the health problem being addressed?  The health problem being addressed is the problem of obesity.  

2. What is the underlying biological process of the health problem? Obesity is a biological problem caused by excessive weight gain in the body.  This weight can be evenly distributed throughout the body or it can accumulate in the mid section.  Obesity is believed to be caused by a sedentary lifestyle combined with heavy and regular consumption of foods high in trans-fats, sugars and sodium. Obesity is defined as a body mass index (BMI) that is greater than or equal to 30 (Nestle & Jacobson, 2000).  

3. What makes this health problem a “public health problem”? Long-term obesity can cause serious and life-threatening health problems including heart disease, stroke, diabetes and certain types of cancer. According to the New York State Comptroller obesity related health costs have reached nearly $12 billion per year. 

4. What is the prevalence of the public health problem? According to published reports as many as 44 million Americans are obese. Some studies focusing on New York State report the obesity problem affects 17 percent of state residents under the age of 18 and 32 percent of the total state population is either obese or overweight (“Soaring Health Care”, 2012). Diet and cognitive exercises can help with weight loss.

5. What is the incidence of the public health problem? Unlike other illnesses, it doesn’t appear there is data regarding incidence of obesity.  As a substitute some data on childhood obesity will be used to predict potential numbers of obese adults.  As reported above 17 percent of state residents are obese.  One 2007 survey of  New York State high school students found that 62 percent didn’t meet the recommended guidelines for physical activity and 87 percent didn’t attend any school related physical education (“Preventing and Reducing,” 2008).  Most students didn’t consume the recommended five servings of fresh produce per day.  An overweight adolescent has a 70 percent chance of being overweight in adulthood and this rises to 80 percent if one of the parents is also obese (“Preventing and Reducing,” 2008).  

6. What is the economic burden of the public health problem? Obesity creates an enormous public health problem.  As reported above, state health authorities have pointed out that treating diseases related to obesity causes nearly $12 billion per year.  This creates quite a strain on the health care system of both the state and the nation.  This comes at a time when health care costs are increasing much more rapidly than the cost of living.  It is thought that this trend is not sustainable over the long term. 

7. What are the ethical issues related to the public health problem?  The main ethical issue related to obesity concerns the role of individual autonomy when weighed against public health intervention.  Individuals in a free society are free to consume whatever foods they choose and the same relates to their lifestyle (sedentary versus active).  Therefore, how far public health interventions can best proceed in treating obesity is one for further discussion among policy makers and medical professionals.

8. Are there any issues of health disparities among population groups related to the public health problem?  There are health disparities among population groups.  The CDC points out that health disparities are experienced by socially disadvantaged groups.  These are preventable differences that can inhibit the ability of health professionals to achieve optimal health outcomes for members of all groups. The CDC defines such populations by race or ethnicity, gender, education or income, disability, geographic location (rural or urban), or sexual orientation (“Adolescent and School Health,” 2012). Each one of these groups is found in the New York State population and with similar issues and difficulties.

9. What policies have been or are enacted currently to address the public health problem? In 2003, New York State enacted the legislation A.2800-A and S.2045-A, to fight childhood obesity.  The laws established state-wide programs that would develop and promote physical activity campaigns, work with school and community-based organizations to improve nutrition, coordinate obesity prevention programs across state agencies, sponsor a conference that would solicit ideas on solutions to fight childhood obesity, and allocate resources to improve tracking of obesity prevalence in the state. 

10. How would the new policy improve the current situation? The new policy recognizes that, despite existing legislation, the foods in question are still consumed by at-risk populations at high levels.  It aims to make such foods less enticing by raising the cost associated with consuming them.  It’s hoped that by increasing the price of certain foods by taxation it would make them less affordable over the long term. 

11. What are the cost issues in implementing the new policy? Assemblyman Ortiz estimates that the new taxes would raise $50 million.  However, the burden of bearing these costs will not just fall on consumers, but also on the businesses that produce and retail those goods.  This could have a depressing effect on economic activity related to fast food businesses, video games, movies and other targeted forms of entertainment. 

12. What are the legal issues in implementing the new policy? The State legislature has the power to tax economic activity within the state, so it is unclear that this law has any legal ramifications.

13. What are the political issues in implementing the new policy? This law was first proposed by Ortiz several years ago in 2004.  It has not been made into law since then.  The previous New York State governor David Paterson was a supporter of this legislation. But he was widely criticized for it.  It appears that despite whatever problems obesity poses in the state, increasing taxation in a state already mired in taxes is not a popular way to fight a public health problem. 

14. What are the health disparity issues in implementing the new policy?  The new law would affect lower income state residents more than those in higher income groups.  These are groups whose choices on food and entertainment are already limited by their incomes. It may be better to make healthier entertainment and food options more affordable and convenient to low-income consumers than to tax them over their choices.  

15. What are the expected health outcomes from the new policy? The expected health outcomes include a decrease in the consumption of high calorie, high cholesterol foods and an increase in the consumption of lower calorie and healthier food options.  If this occurs, and is maintained over the long-term, the health outcomes should see a decrease in obesity incidence in the population along with related health improvements. 

16. Would you vote to enact the new policy? Why or why not? I would not vote to enact the policy.  Food consumption, lifestyle and entertainment are personal choices that are outside the purview of government, however well-meaning, to legislate.  It can also lead to a slippery slope where since one form of public paternalism was successful, that other more pernicious forms, could also be. It also penalizes all consumers of a product and disregards that some citizens of the state do consume the targeted food and entertainment moderately.  This is simply not fair public policy.  Government should work with the producers of both the food and entertainment products, and the retailers, to promote affordable and convenient healthier options to consumers. Government should focus on positive reinforcement to affect changes in behavior and not rely so much on coercion and penalties to achieve health outcomes.

References

A02982 Summary. (2013, Jan. 22). New York State Assembly. Retrieved from http://assembly.state.ny.us.

Adolescent and school health: Health disparities. (2012, July 24). Cdc.gov. Retrieved from http://www.cdc.gov.

Johnson, Summer. (2006). Session 4: Obesity and fat taxes. In Ethical Issues in Public Health. Retrieved from http://ocw.jhsph.edu. 

Nestle, Marion, Jacobson, Michael F. (2000, Jan.-Feb.). Obesity.  In Public Health Reports, vol. 115. Retrieved from http://www.cspinet.org. 

NY A02982 | 2013-2014 | General Assembly. (2013, Jan. 22). Legiscan.com. Retrieved from http://legiscan.com.

Preventing and reducing childhood obesity in New York. (2008, Oct.).  Osc.state.ny. Retrieved from http://www.osc.state.ny.us. 

Soaring health care costs highlight need to address childhood obesity. (2012, Oct.). Osc.state.ny. Retrieved from http://www.osc.state.ny.us.