Designing Public Health Policy: After Tobacco, What Is Next?

By Bilis Manuel
“Coke and Sprite aren’t the only reasons that more than half of New Yorkers are overweight or obese”
There is an interesting discussion around initiatives to protect and improve the health of residents of New York City that is instructive for us in Nigeria. Indeed, the entire three-term tenure of Mayor Michael Bloomberg has been dotted with his desire to use restrictive policies to address health concerns – sometimes earning him the ire of many who say they do not want to live in a ‘nanny state’. Asides from introducing tobacco policies, another one he focused on was to try to cap the size of soft drink offers in order to protect overweight New Yorkers and those arguably in danger of becoming overweight. Bloomberg wants to ensure that the 32-ounce size helping becomes illegal and peg offerings at 16 ounces but so far a judge has ruled that the City’s Board of Health is not empowered to limit or ban otherwise legal items in order to control chronic diseases.
In a country like Nigeria struggling to deal with a crippled health care system and trying to make the necessary investments to improve health care delivery, it is anyone’s guess how long it will be before health care policy advisers decide to turn to the alleged ‘source’ of illnesses the way certain other countries are doing. Are manufacturers of soft drinks, fast food, and alcohol about to feel increased pressure from regulation similar to the way tobacco does? Sugar for instance has been called the next tobacco and there is an ongoing global campaign against the sugar industry. Denmark had a health policy tax on saturated fat introduced in October 2011, but this was thrown out soon after when at least 10% of tax revenues were swallowed up in administrative costs and it was estimated to have cost 1,300 Danish jobs. However, the question then is in Nigeria what is next after Tobacco; will we come to a point in time when almost every product faces these types of regulation such as tobacco is currently doing.
There are many reasons why international and local manufacturers of alcoholic beverages such as Guinness and Nigerian Breweries, and soft drink manufacturers such as the Nigerian Bottling Company should be nervous. Our Mr. Biggs, Tantalizers et al must not feel too safe either as McDonalds – the subject of many documentaries has also been the target of lawsuits by dedicated consumers. There are many ramifications to the development of regulation and legal jurisprudence around consumer goods which at this stage can only be said to ‘contribute’ to health. The trend around the world makes it important for policy experts in Nigeria and the corporations to start analyzing the implications carefully. For instance, just as the New York court raised in striking out the plans of Mayor Bloomberg to ban super-size soft drink offerings in New York City – is this type of policy regulation the role of the Executive or the Legislator? Which government arm should be responsible for this type of regulation? The same question would apply in Nigeria and the outcome would depend on the independence of the judiciary and the arguments made on each side. Laws can emanate from the Executive but it must be considered and passed into law by the Legislature. It is not an accident that if you visit most of the premier universities in the United States, you will find it near impossible to find a Burger King, McDonald or Kentucky Fried Chicken. The schools probably do not have anything in writing but just have enough hold on the real estate within and around the school to prevent such franchises from setting up shop.
Next is the issue of liberty and personal responsibility. The arguments in the case of the ban of the super size cups are fierce on the issue of freedom of choice. One side claims that individuals have the right to make their own decisions and the state should not be allowed to tell them what to do. If a person wants to eat fast food everyday and subsequently becomes obese and vulnerable to heart disease and other related diseases, then it is that person’s choice. Others argue that consumers are being subliminally manipulated into buying and eating things which are not good for them and that they do not have the right information.
Then comes the issue of investments, profit and revenue. Corporations are in business to make returns on their investments and make money for shareholders and governments need to raise revenue to provide services. Where lies the balance between making policy which directly impacts on the profitability of a company’s operations and supporting businesses so that they can continue to pay taxes and create employment? It must be tricky and delicate to maintain and it is most unlikely that it happens when one side of the equation acts unilaterally.
In the final analysis the jury is still out on whether Mayor Bloomberg’s policies will actually make a difference to the eating habits of New Yorkers and ultimately to reducing the incidence of obesity. This, along with the other reasons above is instructive for those in Nigeria who make policy and who find themselves at the receiving end of policy – sometimes the means never delivers the desired ‘end’, hence, l agree with all the advocates for balance in the tobacco legislation – balance in formulating legislation is key.
Bilis Manuel is a public policy analyst based in Abuja