October 14th, 2015

Two articles about health policy

Gizmodo recently reposted this, from Mosaic, a site I was previously unfamiliar with:


In it, the mayor of Oklahoma City's effort to improve his city by addressing the obesogenic environment is described in some detail. He started with a diet for himself and the citizens of the city (lose a million pounds collectively), and then proceeded on through undoing the one way system through the center of the city, improving sidewalks, adding bike lanes and providing a variety of educational/informational and other supports to people in the city who did not necessarily have the best nutritional information.

The initiative was a classic midwestern Republican good governance/reform movement. It started with a personal responsibility approach (I'll go on a diet and get everyone else, to, too) then incrementaled into massive changes to the environment in a classically American public-private hybrid effort, in which schools, churches, restaurants and other organizations all found ways they could participate. Stone Soup, at its finest. It is an inspiring story.

By contrast, the NYT recent published this article:


Jen Miller has a book coming out in March about running. She is a self-described feminist, marathon runner who gained weight while running, and then decided to change the way she ate. Her new eating pattern is a classic of the current age: forgo carbs in favor of full-fat foods and bacon. She agonized over her goal of weight loss:

"My first impulse was to tell myself, “I do not want to be at this spot on the scale,” and guilt hit me almost immediately. I felt like I was trampling on every single thing I believed about women not needing to be as thin as fire poles in order to be attractive. What kind of feminist was I, anyway? I told my female friends of all shapes and sizes they were perfectly fine at those shapes and sizes — and I believed it. What did it say about me that I couldn’t apply the same words to myself?"

and ultimately justified it because it helped her improve her running times. But the reward described at the beginning of the article and at the end is male attention from a cute trainer at the gym:

"So the trainer at my gym had stellar timing in giving me that compliment. I finished my workout with gusto, dead lifts and all. On my way out, I stopped him again and said, “I hate to say this, but you really just made my day.”

“Oh, of course,” he said. “Some people come in here and never change. You did. And I wanted to congratulate you on it.”"

There are real health consequences to how we move and how we eat. Those consequences are NOT political. However, we have made huge strides against smoking, reducing annual deaths related to smoking sharply. We have made huge strides in automotive safety, reducing annual deaths related to cars sharply. It is difficult to characterize the mortality and morbidity directly attributable to poor exercise and/or food patterns -- certainly much harder than saying, that bullet killed that person. But it is probably the case that exercise and food patterns are probably killing more people before their time than bullets, and if I'm right, and policy works by body count, an effective way to improve exercise and food patterns could help more people live longer, better, less-health-care-consuming lives.

And right now, at the grass roots level, the Midwestern Republic choice looks way better than the coastal Democratic choice. Good policy makes good politics. Democrats should try to do better.

ETA: Previous high-profile coastal Democratic efforts have failed to survive judicial review.