Sunday, December 30, 2012

Good Governance and Good Health: Big Government vs. Small Government

Those who argue in favor of small, nonintrusive government usually pose their beliefs within the context of a right to freedom to live as one chooses. Data is accumulating suggesting that such liberty is often associated with the tendency to die at an early age.

Certainly in the United States, but also worldwide, even in the developing nations, noncommunicable diseases have become the dominant health problem. These are usually associated with poor health habits—particularly, to poor diet choices. This trend is costly and deadly. Mark Bittman provides some context in a New York Times article: How to Save a Trillion Dollars.

"....Type 2 diabetes is projected to cost us $500 billion a year come 2020, when half of all Americans will have diabetes or pre-diabetes. Need I remind you that Type 2 diabetes is virtually entirely preventable?"

Natalie Wolchover produced an article that illustrates the efficacy of measures taken to encourage better lifestyle choices. Her example is New York City.

"While life expectancy in many parts of the United States is dropping, it has increased by 10 years in Manhattan since 1987. Researchers largely attribute that rise — the fastest in the nation — to a crackdown by the New York City health department on unhealthy behaviors."

The importance of living healthy is also demonstrated.

"Mirroring the national average, some 87 percent of deaths in the Big Apple result from noncommunicable diseases — preventable ailments such as heart disease and lung cancer — but the number of yearly deaths from those causes is steadily falling. The IHME researchers determined that more than 60 percent of the increase in New Yorkers' life expectancy since 2000 can be attributed to reductions in heart disease, cancer, diabetes and stroke."

What steps were taken to encourage better health habits?

"Lead researcher Ali Mokdad said the reduction is largely thanks to aggressive efforts by city health officials to simply take away unhealthy choices from residents. The health department has, for example, banned trans fats, prohibited smoking in public spaces and hiked taxes on cigarettes. It has also rolled out hundreds of miles of new bicycle lanes, mandated the use of calorie labels on menus in chain restaurants and plastered posters up in subways with information about the risks of obesity and the benefits of preventive health services."

A ten year increase in lifespan seems worth such a small infringement on one’s freedom.

It is popular in conservative circles to mock attempts to promote healthy eating habits for our children as silly, worthless, or even tyrannical. Sabrina Tavernise wrote in the New York Times of the effort to limit access to unhealthy foods while at school—an effort that public health experts have been pleading for.

"The study Pediatrics, found a strong association between healthier weight and tough state laws regulating food in vending machines, snack bars and other venues that were not part of the regular school meal programs. Such snacks and drinks are known as competitive foods, because they compete with school breakfasts and lunches."

The study tracked the weight of samples of children in 40 states between 2004 and 2007 as they moved from fifth to eighth grade.

"Students who lived in states with strong laws throughout the entire three year period gained....roughly 2.25 fewer pounds for a 5-foot-tall child, than adolescents in states with no policies."

"The study also found that obese fifth graders who lived in states with stronger laws were more likely to reach a healthy weight by the eighth grade than those living in states with no laws."

The laws limit access to unhealthy food for a fraction of a child’s day over three years of his life. Imagine the benefits that would accrue if limited access persisted over a lifetime.

There are some rather startling data that indicate lifestyle choices can dramatically limit longevity. This source provides a plot of life expectancy at age 50 by county for both women and men.

Life expectancies for men at age 50 vary by about 10 years; those of women vary by about 18 years. The strong regional correlations suggest that there are cultural factors at work, with southern states often indicated to be regions where obesity is high and eating habits are poor.

The sources quoted here indicate that minor changes in lifestyle could add up to10 years to an average person’s lifespan. Government intervention has been shown to be effective in improving health prospects. Unfortunately, the regions most in need of intervention are the ones least likely to welcome it.

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