- High-cigarette taxes have driven sales underground in New York, ethicist says
- Persuading people of public health measures' worth may be a better way to go, she says
- Ethicist: Medical care costs for obese need to be compared with costs for underweight
I was walking down 125th Street in Harlem last week when my iPhone beeped to alert me that New York Mayor Michael Bloomberg had proposed saving obesity-prone urbanites from themselves by banning restaurant sales of large sugary sodas and teas.
Nor was he taking any chances on a thumbs-down from New Yorkers. Instead of putting the measure to referendum, he is bypassing the vote to seek approval from the 11 members of the Board of Health, who are all his handpicked appointees.
Knowing what I do about Bloomberg's relationship with sugary drinks, I stopped, stunned.
Isn't this the same man who made Snapple the official drink of New York, giving its sucrose-laden potions a monopoly in high school vending machines over the objections of the health-conscious?
But this whiff of hypocrisy is just one of the many problems with this proposition.
Imposed bans and "sin taxes" often have unintended consequences.
For example, the high cigarette taxes that New York has imposed to discourage smoking while filling government coffers have instead driven cigarette sales underground -- as entrepreneurs buy untaxed cartons from Native American shops and other outlets, then sell them cheaply on the street. The tax-evading tobacco addicts are still smokers, but now they are criminals, too, as the state rakes in extra revenue, but citizen smokers realize no health benefits.
This result may have been unintended, but it could hardly have been unforeseen: When Canada imposed even higher taxes on cigarettes, tobacco smuggling became an industry worth $1.5 billion (in Canadian dollars) as the enterprising stocked up in the U.S.
Plying the waters of Lake Ontario after dark in boats laden with contraband cigarettes, freelance tobacco merchants became indistinguishable from the cocaine and marijuana smugglers with whom they shared the night.
The moral? Autocratically imposing public health measures rather than persuading people of their worth can easily backfire.
Reducing the high intake of sugary drinks is a laudable goal, but should it be a priority, and if so, is this the best way to pursue it? No, and no.
Imposing an outright ban is less ethical than public health leadership that induces behavior change.
Some public health experts have achieved such positive health behavior transformations very successfully indeed. As a visiting fellow at the Harvard School of Public Health's Center For Health Communication in the early 1990s, I observed its masterful spearheading of the U.S. "designated driver" campaign.