Global Nutrition and Obesity How Much Government Help is Helpful?

1. Global Nutrition and ObesityHow Much Government Help is Helpful? Friday, February 20, 2009 12:30 – 5:30 PM MCCORMICK TRIBUNE CENTER NORTHWESTERN UNIVERSITY www.globalnutritionandobesity.org

2. Mind the Gap Conferences: Introduction • Why three circles? • Educational conferences & websites • Generate discussion amongst students, government professionals, academics, NGO personnel, businesspersons • Fellowships

3. 2006 Human Trafficking Conference Our first conference, in 2006, was devoted to human trafficking. Human trafficking initiatives – Spearheaded by odd combinations of advocates: • Andrea Dworkin and Catherine McKinnon (“radical feminists”) and the Christian right vs. more centrist, pragmatic people • For example, U.S. legislation authored by Senators Sam Brownback, Chris Smith, and Paul Wellstone

4. “Working Both Ends Towards the Middle” • We decided that these conferences would be devoted to the Wellstone/Brownback/Smith way, rather than the vigorous (to be polite), confrontational approaches that not only define the NGO world of anti-trafficking, but have in recent years defined so much of American political life. • I know that many of us hope we have begun to turn a corner on these confrontational politics, noting that President Obama’s Inaugural Address proclaimed “an end to the…recriminations and worn-out dogmas that for far too long have strangled our politics.”

5. 2007 HIV/AIDS Microbicides Conference We selected HIV/AIDS and microbicides as the subject matter of last year's conference both because we wanted to increase awareness of microbicides and because of the philosophical and political issues that exist about the appropriateness of government financing and promoting medical technology that might encourage out-of-wedlock sex and provide additional contraception options.

6. 2007 HIV/AIDS Microbicides Conference Cont. Political/philosophical issues comparable to those regarding the distribution of condoms--with one big difference--that microbicides are being developed in noncontraceptive as well as contraceptive forms. So that those who passionately oppose condom distribution, and are likewise opposing the development and distribution of microbicides, arguably only have the "we don't want to encourage out-of-wedlock sex" argument, and not the religious arguments that contraception raises for many people.

7. 2007 HIV/AIDS Microbicides Conference Cont. And we thought, if we are just talking about some quantity of additional out-of-wedlock sex that microbicides might "encourage" by lessening fears of terrible illness, does the "punishment" of dying a horrible death fit the "crime" of whatever marginally increased sexually activity some people might engage in if microbicides existed and were readily available? (See http://cgeweb.wordpress.com/conference-on-microbicides-and-hivaids/)

8. 2008 Global Nutrition and Obesity Conference We picked this year’s topic, global nutrition and obesity, for a couple of reasons: it is a rapidly emerging major policy issue, not only in the United States but globally. But also, we noted lots of talk from the Presidential candidates about health care reform, but very little discussion about what many regard as a necessary component of any relatively universal, relatively high-quality health care reform - the need to get people to better participate in their good health.

9. Health Care Reform and the U.S. Presidential Election • Not only was there very little discussion about this necessary component of providing relatively universal, relatively high quality health care to Americans: that is, motivating people to participate more actively in their good health... • But there has been even less discussion of a major political and philosophical issue around government and business motivating people to participate more actively in their good health; that is, the liberty issue. • So the subtitle of this year’s conference is “How Much Government Help is Helpful?” • And, as in previous years, we will focus in “working both ends towards the middle.”

10. Global Nutrition: A Spectrum While this conference will primarily focus on strategies to minimize waistlines around the world, it is important to note that having people participate in their own good health includes individuals who are at the opposite end of the spectrum. In the study and discussion of eating behaviors, eating disorders should be included.

11. Global Solutions to Obesity • “Push”, “Pull”, and “Nudge” Solutions • United Kingdom – “Pull” Strategies • South Africa – “Pull” Strategies • Singapore – Undecided (traditionally oriented to “pushing,” but thinking about “pulling”) • Japan – “Push” Strategies • United States – “Nudge” Strategies?

12. Creative Strategies Being Used in Other Countries – “Pull” Strategies • Some foreign governments are doing creative things that the U.S. government is not doing in any material way • In places like the U.K. and South Africa, the health insurance companies are giving people financial incentives to stop smoking and go to the gym • See www.whypayforthegym.com • London newspapers dated January 24, 2008 after U.K. government announced anti-obesity plan: • Daily Telegraph declared "Obesity Crisis: get paid to lose weight" • Daily Mail's headline proclaimed, "We'll Pay You To Lose Weight" with a smaller subheadline reading "Cash Prizes and vouchers for healthy food in Labour's anti-obesity plan.” (See resource table)

13. Creative Strategies Being Used in Other Countries – “Push” Strategies • Some countries take a different “push people” approach, for example, withholding a material portion of your social security payment if you are obese at age sixty, still smoke, etc. • Japan has undertaken one of the most ambitious campaigns ever by a nation to slim down its citizenry. • Under a national law that came into effect in early 2008, companies and local governments must now measure the waistlines of Japanese people between the ages of 40 and 74 as part of their annual checkups. That represents more than 56 million waistlines, or about 44 percent of the entire population. Those exceeding government limits (33.5 inches for men and 35.4 inches for women) and having a weight-related ailment will be given dieting guidance if they do not lose weight after three months. • If necessary, those people will be steered toward further “re-education” after six more months. • To reach its goals of shrinking the overweight population by 10 percent over the next four years and 25 percent over the next seven years, the government will impose financial penalties on companies and local governments that fail to meet specific targets.

14. Creative Strategies Being Used in Other Countries – “Push” Strategies • Carbonated soft drinks banned from schools and libraries in Seoul, South Korea • Great Britain has banned commercials for junk food during TV programs aimed at children under the age of 16 • Also considering proposals to ban the use of celebrities and cartoon characters to advertise unhealthy foods Source: http://www.timesonline.co.uk/tol/news/uk/health/article1013579.ece, http://news.bbc.co.uk/2/hi/uk_news/magazine/4304118.stm

15. “Nudge” Strategies • See Nudge: Improving Decisions about Health, Wealth and Happiness by Richard N. Thaler and Cass R. Sunstein, two University of Chicago professors • “Choice architecture” • The cafeteria • The 401(k) election • Organ donation • Libertarian paternalism • Make it easy for people to go their own way • While setting default options to influence choices in a way that will make users better off, as judged by themselves

16. U.S. Responses • Most creative U.S. responses to obesity have come from private employers, health care companies, and non-profit organizations • Fewer proposals from state and local government officials • Limited response from federal government (but U.S. $590 million in 2007) • Our speakers will describe some of these and other strategies in their presentations, and their efficacy

17. Beware: The Cost Argument • Some argue that obesity, like smoking, is good for society, because people die sooner and consume fewer health resources overall compared to healthy people who live much longer • Smoking even better, because of high cigarette taxes and people dying younger. • But the premise of this argument is more than questionable. • First, the purpose of our government is to secure for people “life, liberty and the pursuit of happiness” • Second, if it is better that people die earlier because it saves costs, it would be better yet if they died even earlier, or better that they had never been born.

18. Conference Goals • We hope the conference will both educate the attendees about global nutrition and obesity issues generally and make them think about the liberty issues inherent in the alternative government policies that the Obama Administration might choose from if it is meaningfully committed to health care reform. • The online version of this powerpoint will include additional information that you might find of interest, including the speakers’ presentations, lessons to be learned on the liberty issue from President Clinton’s failed Health Security Plan, and some of the U.S. responses and programs being implemented to date. There is also a list outside you can add your name and e-mail address to if you would like us to send you a copy of the detailed powerpoint. • What can we as a society do? • What can you do?