The Exercise of Well-Intentioned Control

Childhood Obesity News has been looking at the various means used to reduce consumption of alcohol and tobacco in America, in order to think about how those measures might be adaptable to the seemingly unstoppable epidemic of food overconsumption.

It would be lovely to say this post is a collection of the answers discovered in each mini-exploration, but every attempt to scrutinize some corner of this enormous issue seems to generate more questions, and to reduce the number of what might have previously been identified as answers. One thing to hold in overall awareness is that there are no exact parallels.

Alcohol addiction is acknowledged to be a real thing, yet there are drinkers who can put their addiction on “pause” for months or years, and still end up dying of it. Tobacco addiction seems to be as much psychological as physical. A doctor can spend 12 hours performing surgery without once thinking about a cigarette, and then literally run to the smoking area. People must eat, maybe not every day, and often not the food they would prefer, but they have to do it.

Slippery comparisons

A responsible medical team will hook up an unconscious patient to intravenous nutrients. Since quitting alcohol “cold turkey” can result in seizures and death, a conscientious physician could understandably administer decreasing amounts of alcohol, as the patient gradually detoxes. There is probably no circumstance where a doctor would introduce nicotine into a patient’s system.

Or…. is there? Nicotine has been used medicinally in the past. Apparently, there is evidence that the drug itself is the least harmful ingredient from which cigarettes are constructed. Few quit-smoking methods advise tapering off. They are more likely to say, “Pick a day and quit.” A person who is obese because of an unhealthy relationship with food and eating, cannot pick a day and quit.

Broadly speaking, discussions about the abolition of liquor, tobacco, and dangerous overeating are replete with comparisons that never quite align. There are many differences between dependency on nicotine or alcohol, and compulsive overeating. That inescapable fact leads to a multitude of questions about how the methods of dealing with any one of those problems could be applied to the others.

All three categories of substances are amenable to taxation schemes, which can be sold to a certain percentage of the public as desirable, especially if there is a promise to use the collected tax to fight the ravages of smoking or obesity. According to the Tobacco Control Legal Consortium,

Proposed taxes on sugar-sweetened beverages raise many of the same policy and legal issues as tobacco taxes. The food industry’s arguments against them are also similar to those of the tobacco industry. Tax increases, as well as any laws limiting industry discounting practices […] are legally defensible as reasonable measures to reduce consumption.

Apparently, alcoholic beverages can be taxed by any jurisdiction they happen to land in, and taxed by multiple layers of government. But although the cost to society of excessive drinking is many times the amount that alcohol taxes bring in, those revenues do not seem to be vigorously applied to the problem. One source, for instance, gives the laconic answer, “Some states have been able to earmark revenues from alcohol taxes for public health programs.”

What follows will be a guide to and summation of the main takeaway, or in many cases the still unresolved questions, from each post on this complicated topic.

Your responses and feedback are welcome!

Source: “All about Nicotine (and Addiction),” TobaccoHarmReduction.org
Source: “Applying Tobacco Control Lessons to Obesity: Taxes and Other Pricing Strategies to Reduce Consumption,” PublicHealthLawCenter.org, March 2010
Source: “Alcohol Tax Revenues, Social and Health Costs, & Government Expenditures,” ChangeLabSolutions.org
Photo on Visualhunt

More Soft Control

Can any anti-smoking measures be adapted to anti-obesity efforts? What has succeeded in mitigating other unfortunate social maladies like nicotine addiction? It seems that public relations campaigns based on stigmatization may not be the right fit.

In 2009, the Food and Drug Administration was authorized to regulate the tobacco industry. Restrictions on the industry began to tighten, and attitudes solidified. As always, the Law of Unintended Consequences was at work, guaranteeing that “hard-hitting anti-tobacco ads could exacerbate health disparities and discourage access to high-quality health care.”

The American Medical Association’s Journal of Ethics said,

Given the current demographics of tobacco use, these campaigns might further stigmatize low-income and other vulnerable populations of smokers, who currently represent the majority of tobacco users. And people who already feel disempowered tend to feel even more resentful, defensive, and demoralized after exposure to anti-tobacco campaigns.

What happens when authorities take measures? Sometimes, events they did not foresee; or outcomes they could have predicted, but brushed aside, for better or worse. For instance, in some schools, any effort to remove vending machines entirely, or to offer the less junky kinds of junk food, seems to invite defiance. A black market starts up, giving both buyer and seller the thrill of breaking the rules. In other words, any ban can produce antisocial and even criminal behavior.

On the political side

In 2012 the Centers for Disease Control tried something new, a national ad campaign that featured real people with illnesses cause by their own smoking or by secondhand smoke. “Tips from Former Smokers” is said to have inspired more than a million and a half Americans to quit smoking. Supposedly, 100,000 succeeded, although there is no way to know how many later relapsed, or even how many reported honestly.

The campaign cost $54 million, which was less than 1 percent of what the tobacco industry spends on a year of advertising. It also proved why people are suspicious of the government. Together, the states rake in $26 billion a year from the Master Settlement Agreement and from taxes. How many politicians promised that cigarette tax money would be used to fight smoking? Yet the states spent less than 2 percent of those revenues on trying to prevent smoking.

Some Americans see the whole sin tax concept as government overreach, pure and simple. In that camp, “nanny state” and “social engineering” are two hot-button phrases.

Public opinion does alter, and legislation can change behavior to a certain extent. But then, especially in the U.S.A., there comes a point where people have enough of government regulation, and kick up a fuss about their rights, real or imagined. Before trying big outreach psychology on people, well-intentioned activists need to look at all the angles.

Anyone can make mistakes, and they can cost millions. In some battles, the better part of valor is to “keep your powder dry.” A misconceived attempt could sway opinion away from accepting government intervention, and skew the public mindset for years.

Your responses and feedback are welcome!

Source: “Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care,” AMA-Assn.org, May 2017
Source: “CDC’s Anti-Smoking Ad Campaign Spurred Over 100,000 Smokers to Quit,” TobaccoFreeKids.org, 09/09/13
Source: “Sin Tax,” Investopedia.com, 05/03/18
Image by Aine via Flickr

Soft Control

In 2008, Christopher Gildemeister wrote in his article for the Parents Television Council,

Today, smoking is much rarer on television, and with a very few exceptions is done only by unsympathetic or disreputable characters. So stigmatized has cigarette smoking become that it is the butt of humor and satire. The Simpsons consistently mocks cigarette smoking and advertising.

At a certain point in the American cultural continuum, smokers were hit with the old one-two punch of vilification and ridicule. Compassionate people operate on an old-fashioned standard that used to be called “Hate the sin but love the sinner.”

In contrast, the current culture seems to have no tolerance for nuance, and goes straight to demonization. Some smokers are quite emotionally invested in not being demonized. They become paranoid, defensive, and balky.

The Food and Drug Administration was empowered to regulate the tobacco industry, via the Family Smoking Prevention and Tobacco Control Act of 2009. It is just the sort of pesky governmental interference that many people resent. Large numbers of Americans resist being ruled, whether by nature (their personality) or by nurture (the political beliefs they have absorbed).

Public relations — it’s complicated

To borrow a slogan, “When smoking is villainized, only villains will smoke.” Negative campaigning can backfire, because people admire and identify with villains. Moviegoers cheer for a bad guy with redeeming qualities, or a cop who breaks all the rules.

Any effort at persuasion through public relations can fail if it is perceived as shaming. Smokers are made to understand that they are pariahs, shunned and disparaged, herded into separate areas of space, ostentatiously coughed at, unremittingly admonished by signage, and so on. Discriminating against people by treating them as socially unacceptable is a form of bullying, and we are all supposed to be against bullying. So, now what?

Public health campaigns presided over by celebrities can be particularly grotesque. Those “kids today” know enough about everybody’s private lives and public mistakes to ration out their credence sparingly. Now, as in Shakespeare’s day, the young hate bogosity. They may suspect that any famous person who delivers anti-smoking or anti-drinking propaganda was probably ordered to by a judge, to atone for some impulsive escapade.

Public health campaigns that rely on stigmatization can backfire, in two different ways. People might react angrily, “Get out of my life.” Or they might experience the “Maybe I’ll just get out of my own life” reaction. Stigmatization makes them feel so bad they give up and don’t even bother trying to quit. Word gets around that shaming might not be the ideal approach.

On an individual level, a child might overeat because she or he knows how much it upsets a parent, and by the child’s reckoning, that parent has done something bad enough to deserve retaliation. Such a misguided emotional response is apt to scale up. When the government gets involved with a seemingly private matter like body weight, it provokes the deep-seated outlaw impulses that drive some personalities.

(To be continued…)

Your responses and feedback are welcome!

Source: “TV Stubs Out Smoking,” ParentsTV.org, 2008
Photo on Visualhunt

Fortunes Up for Grabs

Is anyone worried about bankrupting the health care system, or shutting down the military because all the recruits are too heavy to qualify? Is anyone concerned about the environment replete with easily available comfort food, or the kids who give every appearance of being addicted to overeating in a way that devastates their lives? Dr. Pretlow says,

These kids are in real pain. They desperately need for the health profession, parents, schools, the food industry, and policy makers to do something about this deplorable problem. If one third of our kids were suffering from asthma due to air pollution, we’d take draconian measures. Why is childhood obesity different?

Sadly, what we are willing to do, and what works, are often two very different phenomena. Childhood Obesity News has been describing the reasons why various jurisdictions have either enacted, or discussed enacting, excise taxes on substances and practices that are, or are reputed to be, harmful to people.

Punitive taxation is credited with reducing the relative (but not the absolute) number of smokers in America. Nevertheless, it appears that in order to make a significant difference, the tax would need to be much higher. Many nicotine veterans and all “replacement smokers” have shown themselves willing to endure punitive taxation. Even an astronomical “sin tax,” experts say, would be unlikely to eliminate the behavior.

Also, the effort to reduce tobacco use has been so multifactorial that cause and effect cannot reliably be assigned. The proponents of each factor want to claim its supremacy as a deterrent. Who knows? Maybe, what really keeps at-risk kids away are the scary warnings on the packaging.

Business journalist Amelia Josephson writes,

Over 30 states impose some kind of special tax on sodas and other sugary drinks. So far, it’s been hard to see a relationship between these taxes and any substantial decrease in the consumption of the taxed beverages. In many cases, the amount by which a sin tax raises the price of an item is not enough to discourage consumption.

This type of excise tax gains acceptance by convincing people that the money will go to prevention of the sin, or healing of the people who have damaged themselves. Even if the revenues from tobacco sales were unerringly transferred to their intended destinations, presumably hospitals and research institutions, they would not completely pay for the societal costs of the addiction.

But, as we have seen, promises made during campaigns are seldom kept, and the states are far from diligent about using tax windfall money to discourage drinking or smoking. Before advocating any such legislation, history should be consulted, and ironclad guarantees put in place.

Of course, in the sugar-sweetened beverage business, there is plenty of room for jiggery-pokery — a fine old term that signifies underhandedness, dishonesty, manipulation, deceit, “creative accounting,” and a host of other commercial tricks. Manufacturers will obey the laws of corporate nature and find a way to extract even more profit from the commodity, like the Coca-Cola Company, that put on a show of cooperating with obesity prevention by selling soda in smaller containers.

Meanwhile, the markup on the contents of the smaller bottles is proportionately higher. Also, they depend on human nature, which dictates, “Hmmm, that little bottle does not look very thirst-quenching. Better go ahead and buy two, just in case.”

Your responses and feedback are welcome!

Source: “What Is a Sin Tax?,” SmartAsset.com, 07/05/19
Photo credit: Internet Archive Book Images on Visualhunt/No known copyright restrictions

Taxing the Devil

“Sin tax” is a strange artifact of capitalism that decrees the consumer must pay an extra fee when purchasing certain selected goods that are deemed harmful to society, or at least that society very much wants to discourage. Examples are alcohol, tobacco products, gambling, pornography, firearms, and cannabis.

Excise taxes are pre-figured into the unit price, and paid at the point of sale. An example is the tax on gasoline, which one might think is intended to discourage unnecessary driving, since the wars conducted to assure an unfailing supply of oil cost American lives. The aim is not so lofty, however. It’s just to pay for roads.

Indoor tanning treatments also come with an excise tax, the reason being anybody’s guess. A sin tax can be imposed by both federal and state governments, and in exceptional cases might actually benefit the local community. For instance, Nevada makes so much from taxing gamblers, there is no state income tax.

An excise tax is a regressive tax, meaning that if a millionaire and a homeless person both buy identical packs of cigarettes, they pay an identical tax. In other words, the poor are disproportionately penalized, which some people see as a flaw. Others see it as a perfectly logical feature, because the pauper’s medical costs will be borne by public funds, whereas if the rich person gets cancer, he or she can pay for treatment. What they fail to grasp is that even when people with harmful habits are insured, their costs make the rates go up for all the other insured people.

Not my problem

In America, we have gotten used to the idea of sin taxes, which most people seem to be okay with, because they either don’t self-identify as sinners, or because (as in the case of the tanning beds) they may not even know about the built-in tax. According to Investopedia:

Society accepts sin taxes because they affect only those who use sin-taxed products or engage in sin-taxed behaviors. When individual states run a deficit, a sin tax is generally one of the first taxes recommended by lawmakers to help fill the budget gap.

Authorities justify sin taxes by claiming that the use of unhealthful products is reduced. That may or may not be an accurate perception, but either way, acceptance is sad for America, which was, after all, founded on tax resistance. In states where cannabis products have been decriminalized, many people are so grateful and relieved to be legal consumers that they gladly accept an unprecedented level of taxation.

On the tobacco front, the Master Settlement Agreement (MSA) was seen as a great accomplishment, but while the funds collected by the states have actually done very little for Americans, the provisions actively harm people in other countries by incentivizing manufacturers to sell more and more nicotine overseas. According to one research paper on MSA:

By applying only to U.S. sales, and by excluding coverage of production for export sales, thus lowering the cost to the companies of exported cigarettes relative to cigarettes produced for domestic consumption, the MSA may have provided an incentive for participating firms to increase their exports…

Many drinkers and smokers consciously or unconsciously believe that they should not. There is plenty of room for self-deception, because people think, “Well, I don’t really drink that much, so what do I care?” Those who acknowledge that they drink a lot may be okay with kicking in a little extra, because it’s only right that they should help pay for the Jaws of Life to extricate victims from accidents caused by drunk driving. It is difficult to arouse similar guilt in someone who just wants a bottle of soda pop.

Your responses and feedback are welcome!

Source: “Sin Tax,” Investopedia.com, 05/03/18
Source: “Impacts of the Master Settlement Agreement on the tobacco industry,” BMJ.com, 2004
Photo credits: Pedro Ribeiro Simoes on Visualhunt/CC BY; Visualhunt.com

Suing the Devil

As we have seen, tobacco holds a very strange position in society. The producers are rewarded for producing it, while the consumers are punished for consuming it. The government both encourages and chastises its existence, sale, and use.

The same goes for alcohol. Entire government departments are devoted to preventing the use of these substances; discouraging the young from ever starting to use them; controlling their availability especially in relation to the young; dealing with the catastrophic and expensive results of their overuse; and punishing the manufacturers for inappropriate self-promotion.

Meanwhile, the government does everything it can to make the lives of these and other corporations a dream landscape of permissiveness. In return, Uncle Sam takes his cut. Liquor and tobacco are lavishly taxed. Why? Because they are bad for people. Religion and government are supposed to be separated, so we cannot forthrightly call these sin taxes, but that is basically the gist of the situation.

The taxation of tobacco products is credited with decreasing tobacco use by making it less affordable. But the corporations are not hurt, according to this analysis:

Conceptually, such a tax is shifted to consumers of the product, and […] there may be an overshifting of the tax. Imposition of an excise tax-like payment may facilitate collusion in price among competing companies. Thus, profitability may increase after the tax is imposed.

In the 1998 Master Settlement Agreement (MSA), the industry agreed to pay the states in perpetuity for the present and past damages caused by their products. However, “neither the federal government nor persons with tobacco related diseases were compensated by the MSA… Recipients of MSA funds were not required to spend the money in particular ways.”

Although not exactly a tax, it had the same effect of encouraging the manufacturers to extract more from the customers, and in the month following the passage of the MSA, retail tobacco prices rose by close to 20 percent. The Public Health Law Center elaborates:

Many states use a small portion of the funds for tobacco control and cessation programs, but most of the money is typically used for other purposes, such as security for loans or simply for a state’s general fund. No states provide for direct MSA payments to individuals to pay for medical costs resulting from tobacco use.

Concerning prevention and cessation programs, the Tobacco Free Kids organization puts a finer point on it:

While overall funding did increase for such programs, especially in the first few years after the MSA, many states subsequently cut funding and almost every state broke its promise… Most states have consistently fallen far short of funding these programs at amounts recommended by the U.S. Centers for Disease Control and Prevention.

Over all the years, for instance, Connecticut, Missouri, and West Virginia have spent $0 on tobacco prevention programs, while others have spent for that purpose only a tiny fraction of what they receive. The MSA money is basically a bribe the industry pays as the cost of doing business, while the revenues are dispersed at the whim of each state’s political bosses in ways that don’t prevent smoking, help smokers quit, or cure tobacco-related illness.

Your responses and feedback are welcome!

Source: “Impacts of the Master Settlement Agreement on the tobacco industry,” BMJ.com, 2004
Source: “The Misleading Ad about Individual Payments from the Master Settlement Agreement,” PublicHealthLawCenter.org, June 2017
Source: “Finish the Fight Against Tobacco,” TobaccoFreeKids.org, 11/26/18
Photo credit: Paul Sableman on Visualhunt/CC BY