Should we legislate for healthy Lifestyles?
Barbados
Many people dislike the thought of governments intruding into their (our) personal lives. They think that governments are too intrusive and society over regulated with well intentioned programs. On the other hand, many governments are quick to point out that unhealthy lifestyles invariably end in one or more of the chronic non-communicable diseases. The Caricom Ministers responsible for Health at their special summit in Port-of-Spain, Trinidad on September 15th, 2007 acknowledged these chronic diseases end up costing governments a ‘pound and a crown’. This scenario is unlikely to change unless ‘something’ is done about it. Should that ‘something’ be legislation of healthy lifestyles?
Governments may have a responsibility to inform and educate their citizens about serious health risks. But informing and educating is not dictating, and passing laws can be seen as an attempt to dictate people’s behavior. At the moment, we do have laws that restrict some unhealthy lifestyles. We have laws that mandate seat-belt use, after there was overwhelming evidence that their non-use contributed to significant mortality following road traffic accidents.
We have laws that restrict alcohol use in drivers of motor-vehicles: the breathalyzer legalization attempts to do this. Unfortunately, there is no such restriction on any of the other occupants of the car, or anyone else at the fete/party/celebration. So physicians who have to deal with the ‘drunk and disorderly’ would not be heartened when faced with a variety of medical problems, some life-threatening emergencies. Some alcohol consumers present as uncooperative, confused and disoriented patients, who generally do not realize that the ancient Chinese proverb was right: First the man takes the drink, then the drink takes the man. The employers would not be happy with employees who miss work frequently, and even when at work don’t (or can’t) produce optimally. The physicians and nurses at the psychiatric hospital won’t be happy with an increasing workload caused by people who have no clue about their health deterioration caused by ‘having blood in their alcohol streams’. And importantly, the people who have to pay for this all, ultimately the Ministers of Finance, will wonder why we don’t have legislation to control all alcohol consumption, and reduce government spending.
The laws that apply to cigarette use are restricted to the labeling of the packages, and the restriction of public places in which smoking is allowed. As Dr. Anthony Gale, former head of the Barbados Cancer Society put it, cigarettes are ‘the only drug which, when used as directed, is guaranteed to make the user sick’. The list of medical problems that arise from cigarette use is long, although cardiovascular diseases and lung/throat cancers are best known by the general public. Ultimately, cigarette use causes government money to go up in smoke.
We have laws that (attempt to) restrict cocaine and marijuana use, and we devote special sections and resources of our law-enforcing agencies, to maintain these laws.
The Caricom Ministers responsible for Health declared, at the conclusion of their special summit in Port of Spain, that they “support the immediate enactment of legislation to limit or eliminate smoking in public places, ban the sale, advertising and promotion of tobacco products to children, insist on effective warning labels and introduce such fiscal measures as will reduce accessibility of tobacco”. This is a commendable declaration, but earlier this year (2011) the Jamaican Government indicated that Jamaica was about to increase its tobacco production. It is obvious that government priorities change over time.
So we already have some laws that attempt to limit the unhealthy acts that individuals can do on themselves and others: some suggest we should consider additional laws to help create the appropriate environment for appropriate health behaviors.
To date, apart for legislation, attempts have been made to ‘nudge’ individuals to adopt healthy lifestyle practices. “Eat your vegetables, they’re good for you”. “Everyone must take responsibility for his/her health”. “Be wise, Exercise”. The behavior scientists are divided on the ability of the ‘nudge’ – getting people to change their behavior without forcing them to do so - to lead to a sustained behavior change, but at least agree that it is one tool that can be used in attempts to stimulate behavior change.
Should ‘nudging’ be our public health policy? Or should government just legislate? Should governments attempt to take over more aspects of our lives? There is little evidence (although this has not been formally evaluated) that these slogans have led to significant or sustained behavior change in Caribbean people. Perhaps we need both nudging and laws, to complement each other. But then, this raises the question, should ‘nudge’ become dictate? Can we rely on our politicians to legislate appropriate lifestyle programs? Cynics would point out that history suggests that government programs, however well intentioned, often become fertile ground for corruption and waste. And finance generally comes before health on the list of priorities of 99.9% of politicians.
So it is clear that we need ‘something’ to push us towards healthy lifestyles, if only to stop the drain on the national purse? But should that ‘something’ be legislation?
Should we legislate for healthy lifestyles?
Dr. C.V. Alert MM BS, DM (Family Medicine).
Family Physician.
- Login or register to post comments
- Discuss this in the CCFP forums
Should we legislate for healthy lifestyles?
This should create a lively debate because there is so much controversy surrounding same.
The problem is that legislation also creates 'criminals' because if there is no law there can be no law breaker.
It is clear that intervention had to be made legally for tobacco control- because there was irrefutable evidence-based backing for same plus intransigence at the point of the supply with media control necessary to assist in that intervention.
The "Tobacco Control" model should in my opinion be the one to apply to each new situation.
For instance- in the matter of Alcohol- the question is - where does the risk apply? and it is clear that the risk differs from that of Tobacco where there is a direct link between use and pathology. There is no such direct link with alcohol- so different methods , in my opinion, need to be applied and please note that I am a teetotaller.
Adults in their right mind need to be aware of their personal risk and therefore have free choice how to proceed so, for instance, an inebriated individual travelling in a vehicle and not driving, to me does not need to be legally tramelled; however the driver of a vehicle would need to be constrained legally because of the special responsibility attached to that person.
My feeling is that if there has to be legal constraint, it should be applied to treatment of certain conditions- where if that person has been repeatedly admonished of the consequences of his/her actions- be it alcohol overuse , inappropriate use or abuse; calorie abuse or inappropriate use-- resulting in the state's coffers being repeatedly "raped" due to hospitalisation and other expensive treatments, then a tax - similar to VAT could be applied.
But if one examines what happens in most territories, this in fact already occurs indirectly- because the poor either die before they can be adequately treated, have to pay what many cannot afford in the private sector, or have to wait interminably for appropriate care - if they suffer from complications of diabetes, dyslipidemia or heart disease - all related in some measure to obesity, poor eating habits and /or abuse of alcohol.
My feeling is that these are some activities that we can promote :
Emphasis must continue to be placed on health/ therapeutic education; partnering with the media to produce appropriate messages, particularly those targeted to the youth and specially vulnerable;
Making sure that all our doctors and other health personnel -as well as our lay persons in the various health-related NGO's and faith-based organisations are on the same page and giving the same advice;
Being vocal in refuting every myth perpetuated by "bush doctors" and the like
Every doctor and health professional taking every opportunity to get these health information messages across to each patient and family member- thus working towards creating a revolution of change of thought and behaviour that has started with the "No Smoking Campaign";
Working towards a positive rather than a negative outcome- that of making "Healthy" cool.
My feeling is also that the legal emphasis should be more on the "source" - especially when there is cogent evidence to back up what is advised- for instance working with the fast food establishments to help them to serve healthier foods. We have to accept that "fast foods' will always be with us - now that our work force has so little time to prepare meals and to eat at home.
If the governments are so keen on legislation- why not think on these things:
1) Transport to and from home- why should persons going to and from work or school have to spend so much of their time on the road? There are only 24 hours in any one day
2) Why are schools being built with no play or sports spaces?
3) Why is the school curriculum so packed that children have no time to really keep fit- and neither are they encouraged to do so unless he/she is considered a potential elite athlete?
4) Why are children not encouraged to learn more about use of local foods in fashioning a healthy diet and why aren't there more accessible farmer's markets and incentives to sell local foods more cheaply everywhere?
5) Why are there not more partnerships between commerce and the dietitian and home economics associations to help to educate our people in a practical way; why aren't there demonstration kitchens and local reality shows to help people to manage their weight and their dietary choices better?
6) Why are the fast food outlets allowed to have their way with high fat and high cholesterol and empty calories with no attempt at letting the public know the nutritional content of the meals they serve so that intelligent choices can be made.? Why are they not encouraged to use more local content?
7) Why are the meals served in the school canteens and the cafetarias that operate in schools allowed to serve offerings that are less than healthy or nutritionally balanced?
8) Why are there so few safe places to play and exercise - in our residential neighbourhoods?.
We could go on and on.
To me there are many incentives and many activities that governments can assist with or initiate, short of passing laws. and creating unreasonable obstacles to getting there- like legalizing margarine but outlawing butter as they are now doing in Denmark.