Note to casual readers – if you aren’t reading the comments, you are missing the best of this blog – the commenters are superb. Now, in response to a brilliant observation on my last post from Debby, I found a worthy observation falling from my own fingertips:
“My mission statement, as a blogger, and I probably ought to post it somewhere, is “tell a truth; advance compassion.” I can do that, since I’m not a scientist — I just observe them. A scientist’s mission statement can only be “tell a truth; advance more research.” When they unwittingly adopt an agenda, such as “advance weight control for all,” then they betray their mission as scientists.”
Other people, say, public policy makers, rely on scientists to provide unbiased information so that they may make decisions about what to advance. Biased information, by definition, is incomplete, and that will compromise decisions.
I recently ran across an interesting scientific overview of ethics as they might apply to public policy and obesity. Forgive the grammatical eccentricities. I think it’s been translated from Dutch.
The scientists looked at various ethical frameworks that public policy makers might use to frame decision making with regard to obesity. As I was reading, however, I couldn’t help but notice that the overview itself has been affected by bias. I was stopped short at the background section, for example, where they give three sample ethical questions that public policy makers might ask when creating policy:
“Is a campaign that stresses the importance of a healthy weight acceptable when it stigmatizes overweight persons? At what point does encouraging physical activity in the workplace become too intrusive in the personal life sphere? Is policy to inform people about health risks of obesity ethically sound when it does not reach people from ethnic minorities?”
Each of these questions could merit a blog post, but I would like to highlight the third today, because it blatantly states the most dangerous false assumption that underlies much of current public policy: the “health risks of obesity.”
Let’s be clear: causation has never been proved. It would be fair to say “the health risks associated with obesity,” but public policy that assumes that obesity itself is the cause of compromised health is wrong, and may lead to bad decision-making, both by public policy makers and the people they serve. Moreover, it contributes to the stigmatizing of fat people, something they clearly recognize as a problem in sample question one.
It is fine for public policy makers to think in terms of health risks associated with obesity, because those health risks are also associated with other conditions we recognize as life threatening: heart disease, diabetes, etc. It is fine for policy to encourage healthy habits, but to state that obesity itself is a health risk does NOT encourage healthy habits. Quite the opposite. Average people try to rid themselves of their dreaded obesity through all kinds of unhealthy measures – fad dieting, disordered behavior, unnecessary surgeries, untested dietary supplements, reliance on amphetamines, etc. Actually, ethically, public policy should be debunking that phrase “health risks of obesity.” Public policy should counter the diet culture presented in silly women’s magazines, not justify it.
Obesity may be a symptom of disease (especially when it is located in the abdomen and it is engulfing organs), and its rise in our developed world may be a harbinger of something that should catch our attention. However, demonizing obesity and calling it a health risk in its own right is unproductive, even dangerous.
Now, since I have summarily determined that our public policy makers and many of our scientists are working from false assumptions, what, my friends, do WE think they should be asking, with regard to obesity and public policy? As you contemplate this, you may wish to work backward from an ethical framework. Let’s choose the Public Health Leadership Society, which governs the thinking of the American Public Health Association. I have copied it here from Table 4 of the study at hand. Ask yourself, what assumptions might lead to good policy under the following framework:
- Public health should address principally the fundamental causes of disease and requirements for health, aiming to prevent adverse health outcomes.
- Public health should achieve community health in a way that respects the rights of individuals in the community.
- Public health policies, programs and priorities should be developed and evaluated through processes that ensure an opportunity for input from community members.
- Public health should advocate and work for the empowerment of disenfranchised community members, aiming to ensure that that the basic resources and conditions necessary for health are accessible to all.
Number one begs the question: is obesity a disease? I, obviously, would argue it is not, and that should be one basic assumption that guides policy. The question that follows from that is whether controlling obesity itself is one of the “requirements for health, aiming to prevent adverse health outcomes?” Hmmmm.
Number three assumes (rightly or wrongly) that the community has good information to participate in the discussion. It makes me scratch my head: Is Michelle Obama’s “Let’s Move” campaign supplying good information?
There is much to think about here. I hardly know where to begin, so I throw it to you!