Patrick Luciani2013-06-18T22:47:52-04:00Patrick Lucianihttp://www.huffingtonpost.ca/author/index.php?author=patrick-lucianiCopyright 2008, HuffingtonPost.com, Inc.HuffingtonPost Blogger Feed for Patrick LucianiGood old fashioned elbow grease.Tax Junk Science, Not Junk Foodtag:www.huffingtonpost.com,2012:/theblog//3.15244302012-05-18T14:12:41-04:002012-07-18T05:12:06-04:00Patrick Lucianihttp://www.huffingtonpost.com/patrick-luciani/paper published last Tuesday in the British Medical Journal advocating taxing junk food -- you know the stuff, sugary drinks, chips, candy bars, burgers -- by at least 20 per cent if we want to reduce obesity rates. The authors at the Department of Public Health at Oxford University, also advocate subsidizing the good stuff such as fruits and vegetables.
Not to disparage such a prestigious institution, much of the media have jumped on this study because the paper has supposedly found a causal link between taxing "junk food" and a reduction in obesity, a modest reduction mind you, but a reduction nonetheless. This same topic was covered in the Globe and Mail. News flash: this is really old news. A number of studies published over the last decade in the US have found the same results.
Here's another news item: A number of studies, of similar prestigious pedigree, have also found no link between taxing junk foods and obesity levels as measured by mass body index. Now let me ask you, do you think those studies would have enjoyed the same news coverage regardless of how well they were researched? News is only made when the results seem to fit the politically acceptable storyline. In the literature this is called 'white hat' bias, and it's common in health and environmental studies. The more politically cememted the research finding, the higher the chances these studies will be published and reported.
The problem with most studies that try to estimate the impact of price increases on the level of junk food we consume is that they're based on 'price elasticities' or how demand responds to changes in price. And that's what they are, estimates, so any results in a way are self-fulfilling and often based on simulated modeling. Increase the price of a product, demand falls and you come to the conclusion that less junk food intake leads to lower levels of consumption and hence, higher and more sustained obesity rates.
Another problem is that many of these studies make the false analogy with tobacco. They assume that high taxes on tobacco led to the decline in smoking. I won't deny taxes had an impact, but rates of cigarette smoking started declining in the mid-1960s long before taxes took hold. Besides, taxing one product such as tobacco is far different than taxing a limitless range of food products where people have almost an unlimited chance to substitute one product for another.
But even with sugary drinks people have been cutting back without taxation. On a per capita basis, Canadians consumed 82.14 litres of carbonated soft drinks in 2010. This represented a 30 per cent decline from 1999, when consumption was 117 litres per person, according to Statistics Canada. A lot of people are switching to water, bottled water mind you, but water nonetheless.
The BMJ study also gives the impression that economists are in agreement that taxes are an effective way to bring down obesity. Not so. In a sample survey of 120 economists who were members of the American Economic Association, 60.8 per cent disagreed with a tax on unhealthy foods (which included sugary beverages), 14.6 per cent were neutral and 24.6 per cent agreed. This skepticism probably arises in part because such a tax would be extremely difficult to craft. In that event, the unintended consequences may end up creating problems with a misallocation of resources.
Many studies underestimate the difficulty of using incentives such as taxation as a way to change behavior. There are millions of adults throughout North America who are on some sort of diet spending billions of dollars trying to lose weight. And most dieters are highly motivated. What makes one think that adding a few cents to a can of soda will be more effective?
The authors of the BMJ study hope that taxes raised on junk food will be allocated to anti-obesity programs, a wish shared by many groups advocating similar solutions. Governments, however, are loath to dedicate tax revenues to specific programs. This means, in the end, all taxes end up in general revenues.
But don't surveys tell us that people want to tax junk food as a way to encourage healthy eating? That's what people tell us when nothing is at stake. But try raising taxes and people have a way of changing their minds as they did in New York State recently when a modest tax on soft drinks was proposed and quickly rejected.
If we've learned anything about obesity over the last couple of decades it is that getting rid of weight and keeping it off is one of the hardest things most of us will ever do. We are just now getting a sense of how our hormones operate and often undermine our best intentions.
So what works? To be blunt, we don't have many answers. When it comes to kids there's no substitute for good parenting. Consider that one proven predictor of whether kids will become fat is tooth brushing. Not that clean teeth keep you thin, but it indicates that parents making good choices for their children lends the best hope for a healthy society.
We also know that simplistic top-down approaches such as taxation or public announcements telling us to exercise and eat our vegetables don't work. The obese and overweight get that way for many reasons and that's why more nuanced solutions are needed. What we don't need are studies that cover the same ground leading nowhere. Here's an idea. Rather than taxing junk food, we might want to consider taxing junk science.
Patrick Luciani is the co-author, with Neil Seeman, of "XXL: Obesity and the Limits of Shame," published by University of Toronto Press . The book was a finalist for the 2011 Donner Book Prize for the best book in public policy.]]>DONNER PRIZE FINALIST: Obesity and the Limits of Shametag:www.huffingtonpost.com,2012:/theblog//3.14410872012-04-23T00:00:55-04:002012-06-22T05:12:02-04:00Patrick Lucianihttp://www.huffingtonpost.com/patrick-luciani/Does the prime minister wield too much power? Is our skilled immigration policy in need of major reform? What role do museums play in Canadian society? Could Healthy Living Vouchers help in the battle against obesity? These are the questions posed by the four finalists competing for the $50,000 2011/2012 Donner Prize, the award for best public policy book by a Canadian. The winner will be announced on Tuesday, May 1. We will post excerpts from each of the finalists in advance of the prize, exclusively for Huffpost readers. Today's excerpt is from Obesity and the Limits of Shame by Patrick Luciani and Neil Seeman, with an intro by the authors.
The global public health industry weirdly takes credit for initiatives that have yielded no return on investment on the path toward reducing the burden of disease associated with excess weight and its associated toll on human health and on economic productivity. There is a conspiracy of silence in the public health industry -- and industry it is, abetted by government collusion interested in protocols that are politically expedient rather than data-driven. This government cabal is unwilling to stand up and shout loudly: We need a bold policy solution that improves the already fraying provider-patient relationship, one that incents all parties to try to fashion bespoke regimens to help patients keep to a healthy weight and/or switch course over time. To this end, we need, first with pilot projects in low-income neighborhoods, to embrace a universe of incentives -- we call them 'healthy living vouchers', i.e., otherwise taxable income available to persons 16 years of age and older -- that create a market of (self-regulated) companies to market services ethically to earn a portion of those dollars.
ON MAY 28, 2008, the U.S. Centers for Disease Control and Prevention
published a bombshell article in the prestigious Journal of the American
Medical Association suggesting that rates of childhood obesity in the
United States had leveled off. A reporter for the New York Times wrote:
'It is not clear whether the lull in childhood weight gain is permanent
or even if it is the result of public efforts to limit junk food and increase
physical activity in schools.
Could this be the public health establishment's greatest achievement
since John Snow identified the Broad Street Pump as the source of the
London cholera outbreak in 1854?
After a 25-year hike in child obesity rates, with childhood
diabetes rates shooting straight up and other diet-related complications
on an apparently inexorable climb, here was a story saying that the
obesity epidemic had perhaps reached a plateau; what's more, public
health campaigns and system-level planning may have had something
to do with it -- or so the media storyline went. In North America and
around the globe, the story was the most widely read academic news
item on obesity reported in the major media in 2008. Dr David Ludwig,
director of the childhood obesity program at the prestigious Children's
Hospital in Boston, called it a "glimmer of hope."
Can the flattening rate of growth in childhood obesity be credited to
public health campaigns -- essentially, to scattered pilot projects such as
anti-junk food posters now peeling off the walls in urban high school
hallways; recent bans on soda pop machines in some schools; and mandated
20-minute physical exercise regimens in inner-city schools?
They may have some impact among some kids, but not much, by all
accounts. A recent National Bureau of Economic Research study by
John Cawley, Chad Meyerhoefer, and David Newhouse has found that
while state physical education requirements can make children more
active, they have no detectable impact on teenagers' BMIs or their probability
of becoming overweight. Yet public health advocates will not
give up such 'get moving' approaches: recall the 2010 insight from Jeff
Levi, head of the Trust for America's Health, whose organization found
weight gain escalating across America yet who attributed one statistically
negligible annual drop in the District of Colombia to the expansion
of community recreation centres and public transit -- expansions
that have been taking place in dozens of other states without any slowing
in their obesity trend lines.
Just a year before the JAMA study came out, in 2007, the influential
Institute of Medicine, part of the U.S. National Academy of Sciences,
recommended that junk foods such as potato chips, doughnuts, chocolate-
covered ice cream, and sugary drinks be banned from all elementary,
middle, and high schools. According to the IOM, only through
mandated national standards in every single school in America could
we make a dent in the problem of childhood obesity. So how was it possible
that a year after the IOM announcement, on the heels of the widely
cited JAMA study, the New York Times was speculating on whether
public health bureaucrats had won a major battle by halting the rise in
childhood obesity? Was the public health establishment guilty of self interest
in claiming credit for 'success'?
In statistical terms, the data from the original JAMA study likely
resulted from the fact that all major ascents eventually plateau.
2008 and 2009, violent crime rates reached half-century historic lows in
cities like Los Angeles and New York. It is now generally accepted that
demographic trends -- notably an aging population with fewer young
people in the younger age category most prone to commit violent crime
-- explain the phenomenon of declining crime rates. It is rarely the case
that abrupt statistical changes in the prevalence of social ills -- from
obesity to violent urban crime -- can be attributed to policy rather than
to nature. Americans were all aging at one point and all were growing
taller, but then the rate of aging and the rate of growth ebbed. Did this
signify success in the control of 'height gain'? Even the rise in obesity
has a natural plateau.
That there are ebbs from this peak (as suggested by the JAMA data)
is statistically meaningless. There's a point at which society -- America
being a good example -- won't get fatter, but that should not be
considered "good news." Seldom reported in news articles about the
JAMA study was a quote from the lead author of the report, Dr. Cynthia
Ogden, who thinks that we may have reached "some sort of saturation
in terms of the proportion of the population who are genetically susceptible
to obesity." This is an example of how data can be interpreted
and "spun" in a variety of ways.
For instance, a National Bureau of Economic Research study by Patricia
Anderson and Kristin Butcher concluded that a 10 per cent increase
in the availability of junk food was correlated with about a 1 per cent
higher BMI for the average student. However, the effect of the junk
food appeared strong only for students whose parents were overweight.
Researchers from the Karolinska Institute in Sweden conducted a four-year
study called STOPP (Stockholm Obesity Prevention Project), in the
course of which sweets, buns, and soft drinks were banned from five
schools but not from five others. The proportion of overweight six- to
10-year-olds dropped by 3 per cent in the schools with the ban, while
it climbed by 3 per cent in the schools with no ban. This improvement
was encouraging, but child obesity across Sweden was still rising. A
review of school-based obesity prevention problems in 2008 stated that
out of 14 such studies, the evidence was weak in 10. The authors
concluded:
"Our ability to draw strong conclusions as to the efficacy of school-based
obesity prevention programs is limited by the small number of published
studies and by methodological concerns. Qualitative analysis suggests
programs grounded in social learning may be more appropriate for girls,
while structural and environmental interventions enabling physical activity
may be more effective for boys. High-quality evaluation protocols
should be considered essential components of future programs."
The only other major "good news" media-reported study to have
appeared in the past few years comes from the NPD Group, a Port
Washington, New York-based market research firm. The story, widely
circulated in the international media in 2009, contended that the eating
habits of American children were changing. "And for a change, the
news is good," celebrated the New York Times. The NPD is one of many
major marketing companies skilled at getting reporters to pay attention
to their sound-bite stories, and when it comes to teens and obesity,
reporters always pay attention. The story in the Science Desk section
of the Times was titled: "Kid Goes into McDonald's and Orders ... Yogurt?"
This is what journalists call a "man-bites-dog" story; as such, it made
news.
The NPD data found that chicken nuggets, burgers, fries, and colas
remained popular with the teenage set, but that consumption of these
foods was declining, whereas consumption was on the rise for soup,
yogurt, fruit, grilled chicken, and chocolate milk. Let's put aside the
fact that there are heavily caloric restaurant yogurts, soups, fruits (say,
with granola), spicy grilled chicken (usually accompanied by cheesy,
crouton-laced Caesar salads), and chocolate milk; are public health
campaigns responsible for this "good news?"' NPD analysts insisted
that the global economic meltdown in 2008 and 2009 (and the resultant
decline in restaurant orders for kids' meals) could not explain the shift,
since the costs of healthier foods are comparatively on the rise. Bonnie
Riggs of the NPD said that "kids' tastes and preferences are changing."
Most parents of teenagers would find this astounding.
Left out of the media stories was the fact that young people between
18 and 24 had been eating more at "fast casual" chains,
which are just as caloric. Fast casual chains had simply lowered their
prices and spruced up their offerings to draw away calorie-craving
customers from Taco Bell, Burger King, McDonald's, and Wendy's. Yet
public health opinion leaders jumped on the story as proof of the power
of big-government social messaging to promote healthy weights.
Leann Birch of the Center for Childhood Obesity told the Times: "The
food industry is always saying, 'We're giving people what they want;
that's why we're giving you chicken nuggets, burgers and fries for your
kids.' That's not really true. If kids are given different options and if
parents make them available and let them choose some of those things,
I think quite often we see you do get shifts in eating."
To be sure, kids' tastes are malleable. Parents are an important part of the equation
because what they feed their kids early on will program their taste buds
for many years to come. And what parents feed their children depends,
to a large degree, on how much money they have to spend on healthy
food. But none of this means that the public health policy establishment
has been somehow responsible for the statistical plateau in childhood
obesity reported by the NPD.]]>The Fatwa Against Fat Peopletag:www.huffingtonpost.com,2012:/theblog//3.13727722012-03-23T07:22:22-04:002012-05-23T05:12:01-04:00Patrick Lucianihttp://www.huffingtonpost.com/patrick-luciani/XXL: Obesity and the Limits of Shame. It's hard to concentrate on obesity when we're all indulging in wonderful food at a fancy hotel morning, noon, and night.
It's no surprise that most people are of the opinion that the obese should pay for their sins through higher insurance premiums or higher taxes for the food they eat. We know this from a survey of 53,000 people around the world on how governments should tackle the problem of obesity. (The survey was done by RIWI Corporation where Neil, my co-author, is the CEO.)
Only problem is, as I argued at the conference, the obese more than pay for their sins by dying earlier than most of us and thereby collecting less in government pensions and retirement income. Research also shows the obese are paid less because employers would rather hire people of normal weight. That's pure discrimination. And the non-obese may be getting the benefits of all the cardio-vascular medical breakthroughs done on the obese. Could it be that the obese are actually subsidizing normal weight people? (I have the economist Robert Whaples for this bit of insight.)
Why the change in the last 30-odd years? One convincing argument is the boom in food technology has lowered the time cost of food preparation. This finding comes from research by two Harvard economists Edward Glaeser and Jesse Shapiro. The evidence matches up nicely with weight gain from around the 1980s. Think back to the 70s when the cutting edge of pre-packed food was the awful Swanson frozen dinner. Now you can buy a range of prepared foods such as pre-cooked pasta almost as good, if not better, than you can prepare at home.
And the variety and quality is improving all the time. Economies of scale in food production have driven down the cost of preparing foods. That's why restaurants and fast food joints are super-sizing your meal. They could charge less, but it's better business to load up your plate with fries and pancakes.
One of the biggest technologies is the microwave oven that makes it cheaper and faster to cook. Because of this shift we're snacking a lot more. This brave new world is especially hard on those of us with weak will power. We live a world now of endless food temptations.
And where you find more microwave ovens, you find higher obesity rates. Consider that 80 per cent of U.S. households have microwave ovens. In Italy, where obesity is lower, only 14 per cent of homes have them. Italians spend about 20 minutes more per day cooking than heavier American and British adults. But technology doesn't seem to explain why Mexicans and Chileans are so fat.
But now we know something else. We know how difficult it is to lose weight, and why it may be the toughest thing you'll ever do. Because of our hormones, or fat cells, once they've been filled-up as we get fatter, that's where they want to stay. Our hormones have long memories and are very patient. Even if we diet hard, our hormones are determined to get their way waiting for us to drop our guard. That's evolution at work. Our bodies are trained to put on weight, not lose it.
So how do governments get people to eat better and take care of their health? Short of banning microwave ovens, not much it appears. Taxes are a clumsily and generally useless way to get people to eat less junk food. The Danes are trying it with a tax on saturated fat, but I doubt it will work. People find ways around these things. How about more calorie information? Sure, but that doesn't hold out much promise. At Harvard, cafeterias abandoned the idea when students chose low calorie foods, and avoided foods that were more nutritious. These tricks are just toys to our genes.
Neil and I argue that you have to get individuals to somehow take control of their health. Top down one-size-fit-all policies are expensive and don't work. Our idea is to take a page from the educational voucher program. Let people choose their own programs to lose weight by providing them with cash vouchers for pre-approved programs. Will vouchers work? A better question is, what else is there? And you can forget about science finding a pill to tame our genes. The side effects boggle the mind.
There are more details of how such a voucher program would work -- what we call Healthy Living Vouchers or HLVs -- in our book.
In the meantime, I've got to get back to my nicely marbled Argentinian steak and Malbec wine.
]]>Were Italian Cruisers Killed by Nepotism?tag:www.huffingtonpost.com,2012:/theblog//3.12509062012-02-03T11:31:58-05:002012-04-04T05:12:01-04:00Patrick Lucianihttp://www.huffingtonpost.com/patrick-luciani/
To solve the mystery is to understand how the Italian economy works, or doesn't in this case. It's not one based principally on meritocracy. When looking for work, family connections and status are more important than competence, skill, and education. And from anecdotal evidence, this is true whether in the north or south of Italy even though Harvard political scientist Robert Putnam made the point in his book, Making Democracy Work: Civic Traditions in Modern Italy that social capital is stronger in northern Italy and hence has less corruption.
I'll wager Schettino rose quickly through the ranks not because he was a fine captain, but was privileged with family connections in the naval business. According to the Italian newspaper Corriere della Sera, Schettino was "trained" at the naval institute in Piano di Sorrento "passing" all his tests. (He must have missed the lesson about not abandoning passengers when the ship is sinking.)
It's not unusual for Italian students who come from well-connected families to get special treatment in schools with higher grades and easier degrees. Not that wealth doesn't have its privileges in other countries, but in Italy there is an expectation that institutions will bend over backwards to accommodate those with names from wealthly and powerful families. If your name is Montezemolo, De Michelis, or Agnelli, you float above the struggling masses with better services, status, and titles.
Aside from the demoralizing affect of nepotism, the entire country suffers economically. That's one reason Italy has struggled for years with little growth and poor productivity. It carries too much dead weight. There are instances where two people are hired for the same job; one for the well-connected, the other for someone to do the work. It's worse in the public sector where thousands of phantom workers collect salaries who never show up for work.
Did Schettino benefit from nepotism? Hard to say, but what's undeniable is that in Italian society meritocracy takes a back seat to family connections. After all, Schettino's first call when he made it to shore was to his mother.
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