Being reductionistic is the source of all of medicine's success in the past 100 years, and I don't see that changing - ever - without evidence that another approach is superior. Which non-reductionistic approach do you see as supplanting reductionism?
Behavior isn't really a medical problem so much as it is a series of choices between different 'goods' - both medical and nonmedical. I see it as a public health problem. Want people to eat less McDonald's? We know that counsel from your doctor is very modestly effective. We also know that price changes are very effective. So tax McDonald's food at 100% and subsidize produce with that extra money. People can still choose McD's, but you just made it a whole helluva lot easier to eat well. Large-scale systemic interventions are the only things that will be able to change behavior, and this is neither surprising nor particularly problematic.
Sorry, but for what reason should the state intervene here? I could see the point in a system where everybody has state-run health care, but even then a junk food tax would probably attack the problem at the wrong end.
Never mind that the criteria for additional taxes would be pretty hard to specify and justify...
The state's interest here is about as obvious as it gets. The state already intervenes. It pays (entirely) for the training of all physicians during their residencies. It determines physicians' reimbursements. It runs Medicare. It runs Medicaid. In other words, if the state could reduce the usage of Medicare by improving the health of its citizens with targeted taxation, it could save itself money.
Oh, and let's not forget that the state intervenes on the other side of the argument, too: it subsidizes high fructose corn syrup, etc. The state is already intervening every step of the way. I'm just showing you the way it could do so to the benefit of people, instead of to their detriment.
My major point in that post was that behavior is not a medical problem. I'm not actually saying that I think the state should do this (in fact, if it just stopped subsidizing the bad stuff, we'd be much better off already). I was just giving an example of what one could do to effect large-scale behavioral change, which is not a medical problem but instead a political one. If one opposes statist interventions, as you seem to, then one would not like this solution. Large-scale private solutions to effect behavioral change could be just as effective. To reiterate, my point is that behavioral change is not a medical problem.
Oh, as an aside -- taxing these products would be no harder than subsidizing them: a problem that has already been solved, unfortunately.
I'm not entirely against statist intervention -- especially if it would be prefixed by a more universal health care system to justify it. But speaking of justification, I am not sure whether we really reached a point where we could equate sugar with alcohol and tobacco, i.e. as a substance where any amount is hurtful, and so taxation can begin with the first milligram. Is there a substance where we impose fines for "too much" of it? Unless science is very, very clear here, I would fear to tread on that slippery slope.
But I don't see this as a truly solved problem on any side. I assume that "taxing McDonalds" is basically a simplication. Still, what would you tax? Products containing refined sugar? Anything above a certain cal/lbs ratio? (Of course, the problem doesn't arise as much if you really agree with the sugar/substance X = 100% badwrong assumption)
Of course, private efforts don't need to be held to the same standards as those of the government, but on the other hand are quite a bit less effective. I would be interested in how a group of "concerned citizens" would try to tackle this.
I agree that it would be really interesting to see a "concerned citizens" effort. One might pilot different ideas. Let's say that the Gates foundation all of a sudden became interested in this. Perhaps they could target one particularly obese place that's not too big (maybe a few tens of thousands of people). They could then subsidize produce, etc, by paying the local grocers X% of the total price for each of a predetermined selection of items. Broad health measures could be tracked over the years.
The problem is that my idea isn't very inventive; it's just replacing "government" with "some rich group." There must be something more creative that people can do.
I don't know where the general trend is heading. It seems like there's more awareness, but a lot of that is actually pretty trend-ish and a lot of the literature is akin to self-help books. It could mean that people are going to pay more attention to nutrition in the future, but it could also go the way of the hula-hoop and the Atkins diet... Apart from that, I would guess that there's a big divide between urban and rural areas, as well as between economic classes.
Public and private campaigns against alcohol or tobacco won't serve as an inspiration, as they're mostly of a prohibitive nature, whereas obesity requires a more pro-active approach.
Ireland has a Tidy Towns campaign, and I remember something similar in Germany and Austria. Maybe something like that would work for health, too... Something that combines health with economic advantages probably has the biggest chance of success in the end.
> I would guess that there's a big divide between urban and rural area
Bingo! 100% correct. Look at West Africa. Rural areas have a very low incidence of obesity/diabetes/HTN (though I think their rate of hyperlipidemia is about normal, which makes mechanistic sense). Urban areas have rapidly increasing rates of those diseases.
I agree that public health campaigns, though helpful for raising awareness, are unlikely to succeed (at least, to a degree that you and I would consider successful).
It's all about the money (economic advantages), which is why the tobacco tax appears to have worked so well. (Or, who knows, maybe it just takes 20 years of public health campaigns; I guess I can't honestly say for sure.)
Behavior isn't really a medical problem so much as it is a series of choices between different 'goods' - both medical and nonmedical. I see it as a public health problem. Want people to eat less McDonald's? We know that counsel from your doctor is very modestly effective. We also know that price changes are very effective. So tax McDonald's food at 100% and subsidize produce with that extra money. People can still choose McD's, but you just made it a whole helluva lot easier to eat well. Large-scale systemic interventions are the only things that will be able to change behavior, and this is neither surprising nor particularly problematic.