FACULTY OF BEHAVIORAL SCIENCES
Department
ofP
oliticalS
cienceA normative framework for public policy analysis:
The case of government intervention in the food industry to reduce
obesity
Student: Jessica Endert 6366120 Supervisor: Dhr. Dr. M.J.M. Maussen
20/08/2015
MASTER THESIS,
POLITICAL SCIENCE, track POLITICAL THEORY AND POLITICAL BEHAVIOR
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Index
Acknowledgments ______________________________________________________________________________ 4
Chapter 1. Introduction ________________________________________________________________________ 5 1.1 Pelman vs. McDonald’s Corporation, suing for obesity ________________________________ 5 1.2 Advocating government intervention in the food industry ___________________________ 6 1.3 Evaluating public policy _________________________________________________________________ 7 1.4 A roadmap for this thesis ________________________________________________________________ 8
Chapter 2. Obesity in relation to the food industry _________________________________________10 2.1 Introduction _____________________________________________________________________________10 2.2 Spilling the beans on obesity ___________________________________________________________10 2.3 The food industry in relation to neo-liberalism, state neutrality and
anti-paternalism __________________________________________________________________________________13 2.4 How the food industry is buttering everyone up _____________________________________17 2.5 Conclusion _______________________________________________________________________________21
Chapter 3. Reasons for government intervention in the food industry ____________________23 3.1 Introduction _____________________________________________________________________________23 3.2 The power of the ‘‘obesity epidemic’’ discourse ______________________________________24 3.3 Defining obesity as a public health problem due to its scale_________________________25 3.4 The social construction of obesity and its real world effects ________________________28 3.5 Fighting obesity to reduce social inequality and create equal opportunities ______31 3.6 The preference for obesity and the basic human right to health ____________________34 3.7 Conclusion _______________________________________________________________________________37
Chapter 4. Guiding principles for government intervention in the food industry ________39 4.1 Introduction _____________________________________________________________________________39 4.2 Liberal paternalism the best thing since sliced bread ________________________________40 4.3 Liberal Paternalism in relation to specific and nonspecific freedom _______________45
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4.4 Consumer irrationality, regulatory bias and ‘‘the better’’ conception of the good _49 4.5 A democratic critique on constructing interests and preferences __________________53 4.6 The moral costs of intervention in the food industry ________________________________56 4.7 Conclusion _______________________________________________________________________________60
Chapter 5. Conclusion _________________________________________________________________________61 5.1 Summary of main arguments ___________________________________________________________61 5.2 Challenges for liberal paternalism _____________________________________________________62 5.3 The other three levels of policy deliberation__________________________________________63
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Acknowledgments
Writing this master thesis has been a time consuming and challenging undertaking. I am proud of the final result. There are a couple of people who have made a significant con-tribution to the final product. It is here in the acknowledgement section that I would like to pay a special tribute to these people.
First and foremost, I would like to thank my thesis supervisor, Marcel Maussen. Without his extensive knowledge on political theory, critical suggestions and excellent guidance this thesis would have never been able to reach the same level. A special thank you also goes out to Luara Ferracioli, who played an important role in the preliminary phase of writing this thesis.
Further acknowledgements go out to those, who during and after writing my thesis, provided my research with critical commentary. Here too it goes that the end result would not have been the same without them. Thank you, Simone Endert and Howard Caulfield.
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Chapter 1. Introduction
1.1 Pelman vs. McDonald’s Corporation, suing for obesity
In 2003 a group of overweight children litigated against the McDonald’s Corporation, seeking compensation for obesity-related health problems. Many considered the lawsuit frivolous and representing the worst aspect of the tort liability system. Others predicted that a proliferation of obesity lawsuits would soon follow. The cover of the February issue of Fortune magazine read ‘‘Is fat the new tobacco?’’ (Wilensky and O’Dell, 2013). Several newspapers wrote how this was just another way for the plaintiffs to discard personal responsibility in an attempt to capitalize on an opportune legal theory concoct-ed by their counsel.
The original claimants in the Pelman vs. McDonald’s Corporation lawsuit saw the matter in a different light. Their claim rested on five counts: 1) McDonald’s committed affirmatively deceptive acts and deceptive acts of omission, by marketing their food as nutritious and enticing plaintiffs to eat larger portions, 2) McDonald’s directed its mar-keting towards children and failed to disclose the food’s adverse health effects, 3) McDonald’s negligently and intentionally distributed food high in fat, sugar and salt which could cause adverse health effects, 4) McDonald’s failed to provide consumers with a warning of its products ingredients and the negative health consequences of con-sumption and 5) McDonald’s recklessly, carelessly and intentionally sold products to consumers that were physically or psychologically addictive and that caused severe health problems (Benloulou, 2005: 8-13).
McDonald’s characterized a large portion of the representations as non actiona-ble puffery. They claimed their ads were not objectively misleading or deceptive. The court agreed and ruled in favor of McDonald’s. The rhetoric used was primarily one of ‘‘common knowledge’’. McDonald’s could not be held liable for causing obesity, because it could reasonably be expected of people to know that frequently eating fast food over an extended period of time could cause adverse health effects.
Campaign slogans such as ‘’McChicken Everyday!’’, ‘’Big N’Tasty Everyday!’’ and a statement on the website of McDonald’s that read ‘‘McDonald’s can be part of any bal-anced diet and lifestyle’’ were within the range of acceptable marketing behavior.
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thermore, the court placed the burden of proof on the plaintiffs. They had to show that it was in fact McDonald’s’ fast food that had made them fat and not other types of fast food, personal circumstances or environmental factors (Benloulou, 2005: 14-32).
1.2 Advocating government intervention in the food industry
The Pelman vs. McDonald’s Corporation lawsuit shows us the different discourses that accompany fast food, the entire food industry and one of the most pressing health and policy problems of our time, obesity.
McDonald’s, as one of the most well known fast food chains in the world, exempli-fies not just other fast food franchise but an industry at large. There has been ongoing political and academic debate about whether or not the government should intervene and start regulating the food industry more stringently in order to fight the obesity epi-demic (Brownell, et al., 2010; Hill, et al., 2003; Kersch and Morone, 2002).
Regulatory approaches are frequent and controversial topic of discussion, both in society at large and academia. These include nutrition labeling, restricting fast food ad-vertising, zoning laws for fast food restaurants, educational programs, reformulation of products, high caloric food and drink availability, reduction of portion sizes and a tax on fat (Balasubramanian and Cole, 2002; Dharr and Bayliss, 2011; Leicester and Windmeijer, 2004; McKinssey Global Institute, 2004; Sturm and Cohen, 2009). This list is by not exhaustive and many alternatives exist. Despite policy programs being abun-dantly available implementation is usually considered problematic or undesirable.
This thesis is about the discrepancy between the ability and the legitimization of the government to regulate the food industry in order to reduce obesity. There are ma-jor ethical and normative implications if the government engages in any kind of the above mentioned types of regulatory behavior. I will discuss two things: 1) that govern-ment intervention is legitimate and 2) which basic moral principles should guide public policy. This examination will result in a normative framework that can be used for eval-uation and analysis of public policy programs that aim to reduce obesity. The research question that is central to this thesis and that will require answering is:
Is the state permitted to regulate the food industry in order to fight the obesity epidemic and what are the most basic normative principles that should guide public policy?
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1.3 Evaluating public policy
Classic policy analysis and evaluation relies primarily on technocratic principles and positivist claims (Hoppe, 1996: 72). I pose that it should also include an evaluation of the moral principles and value judgments that precede it. The choice to refrain from, or in-tervene in, the food industry is inherently moral. Therefore the legitimization to engage in regulatory behavior should (partly) be motivated as such. This thesis will focus on the matter of desirability. It will provide a philosophical perspective on the type of condi-tions and premises that are required to legitimize more stringent regulacondi-tions in the food industry.
The arguments put forth in this thesis can be used as a framework that allows for public policy evaluation by legislators, politicians, food companies, citizens and all who are interested in confronting obesity as one of the major policy and health problems of our time.
Fischer in his book on Evaluating Public Policy (1995) advocates broadening the scope of significant evaluative criteria by constructing a four-level deliberative and eval-uative model. The first level addresses the technical aspects of certain policies and the ability to empirically establish whether a policy can fulfill its stated objectives. The se-cond level is about situational validation and makes use of a contextual discourse that focuses on the relevance of policy’s objectives. The third level deals with the struggle over problem definition and policy objectives through social vindication. Here evalua-tion is tasked with deciding whether or not policies are compatible with existing social structures in society. The fourth level of policy evaluation is about dealing with ques-tions of moral and ethical nature. It is deals with how conflicting ethical world views frame and value the judgments and implications of particular policy programs.
By constructing a normative framework for public policy analysis I contribute to the fourth level of Fischer’s model of policy deliberation and evaluation. The fourth normative level of evaluation is important because of the moral nature of some of the major policy problems of our time, such as the energy crisis, global warming, pollution and to this thesis most relevantly, obesity. These problems are characterized by having consequences that extend well beyond the boundaries of any given nation state. The complexity of the problems is matched by the difficulty in finding a solution. Obesity fits into this category of problems. Often the underlying controversies in debates about
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ing these kinds of problems are about the clash of different ideals and world views. As-sessing the internal logic of these views and ideals, their consistency and moral value, becomes a task that needs to be taken up with due consideration. It requires a more in-tegrated multi-methodological approach, which offers more room for normative value judgments (Hoppe, 1996: 74).
1.4 A roadmap for this thesis
Western liberal democratic states are currently coping with some of the highest num-bers of overweight and obese people, while simultaneously controlling the largest part of the food industry (Paarlberg, 2010: 80-82). To define my evaluative framework, I will rely on the concept of the liberal democratic state. This type of state is characterized by functioning democratic institutions, a free civil society and a free market economy. The-se are all minimal requirements for engaging in a fruitful debate on regulating the food industry.
Next I will go on to argue that liberal paternalism should be the guiding principle when contemplating and constructing public policy to tackle the obesity problem. The following three premises will provide the foundation for my suggested solution:
1) The state can intervene when well-being is objectively being threatened and it should always improve well-being without restricting liberties if this is possible, 2) the bias of state officials that engage in regulatory behavior in the food industry should be minimized as much as possible despite the state being permitted to favor one concep-tion of the good over another and 3) society has to weigh and accept the moral costs that come with a specific policy relative to the benefits this policy delivers.
Chapter two will give a clear demarcation of the concept of obesity and some of my assumptions on its primary causes. I will argue that neo-liberal governmentality has been conducive to the development of a food industry that is primarily responsible for obesity. Notions on state neutrality in combination with anti-paternalistic sentiments have long problematized and delegitimized government intervention in this industry. In chapter three I will provide several arguments why government intervention in the food industry is legitimate. In chapter four I advocate that public policy based on the princi-ples of liberal paternalism is most desirable from a normative standpoint. I will also dis-cuss several neo-liberal, paternalistic and democratic critiques on liberal paternalism.
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Chapter five will contain the conclusion of this thesis and a summary of the main argu-ments. I will discuss how this framework contributes to the possibility to analyze and evaluate policy interventions in the food industry. Emphasizing that it is only a part of a more integrated and multi-methodological approach to public policy analysis, an area that requires further research.
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Chapter 2. Obesity in relation to the food industry
2.1 Introduction
In this chapter I will argue that the food industry is primarily responsible for the onset and progression of the obesity epidemic. Therefore the solution to the problem resides in restructuring the food industry through government intervention. Establishing the relationship between obesity and the current food industry is the foundation for this argument. This chapter will provide the framework within which the rest of my argu-ments are to be regarded.
In paragraph 2.2, I will give a clear definition of obesity. I will position myself in a still ongoing debate on the causes of obesity and clarify some of the basic assumptions of my arguments. In paragraph 2.3, I will discuss the context in which the food industry is set. This context is characterized by neo-liberal governmentality that appeals to eco-nomic freedom, minimal state interference, state neutrality and anti-paternalism to del-egitimize government intervention. This gives rise to a situation where society holds the current functioning of the food industry to be acceptable and justifiable, at least to a cer-tain extent.
In paragraph 2.4 I argue that the food industry is one of the most important driv-ing forces behind the onset and progression of the obesity epidemic. I show how the food industry is responsible for defining and using the discourse on food, to support its own profit maximizing interests.
2.2 Spilling the beans on obesity
2.2.1 A working definition on obesity
Obesity refers to having too much body fat relative to height and weight. The most commonly used measure of weight status today is the body mass index (BMI). BMI is calculated on the basis of a person's height and weight and provides a good estimate whether or not someone is obese.
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For adults a healthy BMI lies between 18.5 and 24.9. Being overweight means having a BMI between 25 and 29.9 and one can speak of obesity when a person has a BMI that is over 30 (Harvard School of Public Health, 2014). BMI does not take the mus-cle to fat ratio into account, therefore sometimes unjustifiably qualifying someone as being overweight. Furthermore it does not take fat distribution into account when as-sessing someone’s health. People who have a high waist-to-hip ratio stand a greater risk of health hazards (Wingard, 1990). Despite some of the shortcomings of the BMI it is widely used as a measure to determine obesity. The reason for this is that an easily ac-cessible, acceptable and commonly used alternative is not available.
2.2.2 Basic assumptions on the energy imbalance principle
This thesis does not aspire to contribute to a still ongoing academic debate on the medi-cal causes of obesity. But to what follows it is important to take position in this debate and clarify three of my basic assumptions.
The first assumption is that obesity is predominantly caused by a heightened ca-loric intake and a lack of physical activity to compensate for this intake (Jequier, 2002; O’Hill and Peters, 1998; Rosenheck, 2008). The increase and prevalence of obesity world-wide indicates that it is caused by behavioral and environmental changes, rather than genetic modifications. Many factors, such as gene composition, hormone levels and hereditary factors have been identified as possibly causes to the development of obesity. However the basic energy imbalance principle, where one consumes too much energy and expands too little, has gone relatively uncontested. Both in medical and other aca-demic disciplines it is commonly held to be one of the most important driving explanato-ry factors behind obesity.
The second assumption is that the solution to the obesity epidemic resides in eliminating this energy imbalance. Examples of possible effective policy programs are installing a tax on fat, reducing portion sizes, promoting active transport and regulating the nutritional value of products. What the energy imbalance principle essentially does is structure the debate on possible policy solutions to the obesity epidemic. It does this by acknowledging that an individual has opportunities to influence his own behavior, thus holding him accountable for his own food choices. While simultaneously acknowl-edging that his behavior and the choices he makes are influenced by external factors.
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The food industry is arguably the most important external factor for two reasons: 1) it defines and constitutes a large part of the context in which food choices are made and 2) it actively tries to influence consumer choices and the environment in which these choices are made.
The third assumption is also related to the energy imbalance principle. I assume that our current society fosters, furthers and magnifies this potential imbalance. We have all grown accustom to a more sedentary lifestyle. This is largely due to inventions like the car, less physical labor, more desk jobs and more time spent behind a monitor. We live in a culture characterized by convenience. Food has become more widely and easily accessible. In addition to taste and price, convenience has become one of the most important selection criteria for food. This is reflected in the number of processed and pre-cooked meals that are being consumed. As well as in the fact that, now more than ever, people consume the majority of their calories outside the house. This leaves less room for a wholesome home cooked meal (Paarlberg, 2010:90-96).
2.2.3 Evolutionarily disadvantaged
The problem of our less active and convenience oriented lifestyle is magnified by our inability to adjust to our continuously and rapidly changing environment. Recent life-style and dietary changes in society have been radical and they have taken place in a very short time span. Evolutionarily speaking we are simply lagging behind.
Not too long ago it was relatively uncertain when your next meal was going to be. Food scarcity was a common problem that could be brought about by disappointing crops, political instability and war. In response to this the body developed the ability to use and store energy as efficient as possible, in case of being deprived of food for a long-er plong-eriod of time. The most effective way the body does this is through storing enlong-ergy in fat cells, and by always having the cognitive drive to want to store more energy in case of unfortunate events (Spiegelman and Flier, 2001: 531). For a large part of the world population the harsh living conditions of worrying about the next meal no longer ap-plies. This means they are now falling victim to their body’s ability to efficiently store energy.
This potential problem is further magnified by the way our will and our drives are constructed. Our will is supposed to be what keeps us in check and stops us from overeating. Our drives however make the body enact in such a way that it wants to meet
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its needs. Our needs in this case are strongly related to our biological desire to store as much energy in our bodies as possible in case of an uncertain future or unfortunate event. Eating in this case can be seen as an act of compulsion and something that indi-viduals in some instances have only limited control over (Vogel, 2014: 3-7). This knowledge has not gone unnoticed by the food industry, they engage in all sorts of be-havior to capitalize on it.
2.3 The food industry in relation to neo-liberalism, state
neutral-ity and anti-paternalism
2.3.1 Neo-liberalism and the market for food
Today’s economy is characterized by highly dispersed global production processes. The food industry is no exception. Production and consumption of goods often takes place in different hemispheres, where cheap products are made with even cheaper labor. It is in this time of post-Fordism, defined by globalization and a changing social, economic and cultural context, that neo-liberalism as a political doctrine emerges.
It stands in sharp contrast to classical liberalism in the sense that it considers the market to be the most important sphere in which human activity takes place (Bonanno, 1998: 229-233). While classic liberals attribute great importance to economic liberties they do not equate them the same status as basic liberties. This means that even though classic liberals reject restrictions on basic liberties, they generally do allow for re-strictions and regulations on economic liberties in instances where the community has deemed this appropriate (Freeman, 2011: 20-22).
Friedman as one of the most influential neo-liberalist thinkers subordinates polit-ical freedom to economic freedom. He holds that economic liberties are the most basic condition for a free and democratic society. This kind of freedom means the superiority of laissez-faire arrangements, where the market is left to its own devices, relative to ones where the state intervenes (Bonanno, 1998:233-234). The standard approach to con-sumer policy in the food industry has also been based on the principle of laissez-faire, with all its consequences. This type of policy grants individuals the autonomy to eat what they want, when they want and as much as they want. Consumer sovereignty is one of the conceptions of modern economic theory that sanctifies purely private and
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personal interests and translates them into the driving force behind capitalism (Albritton, 2009: 166).
Adhering to economic liberties and consumer sovereignty as values with the highest moral status does not mean that under neo-liberal governmentality the market is not regulated at all. Interventions in the market for food are already common practice: we regulate food standards to ensure our food is safe, what additives can and cannot be used, under what circumstances food can be produced, packaged and sold and how long it can stay on the shelves. Government intervention is often not considered to be very problematic, and even desirable, when it is about regulating food safety standards (Chambers and Pick, 1994; Kramer, 1990; Martinez, et al., 2007). It is when regulations are based on the government’s adherence to a specific conception of the good that inter-vention becomes controversial.
2.3.2 State neutrality and anti-paternalism
Within neo-liberalism it is believed that consumer sovereignty is a way to ensure the maximization of each person’s conception of the good (Albritton, 2009: 183-184). In order to facilitate this the state ought to be neutral and not impose its own conception of the good on its citizens, thus allowing them to pursue their own good in their own way. A neutral state is considered to be a state that deals impartially with its citizens and that remains neutral with regards to how its citizens choose to live their lives. Neutrality in this sense is not merely a desirable feature of the liberal democratic state rather it is one of the defining features (Madeley, 2010: 4-5).
It is possible to distinguish between three different types of state neutrality that all have a distinct focus: 1) neutrality of effect, 2) neutrality of outcome and 3) neutrality of intent.
The first type, neutrality of effect, which as the name implies, relies on the results of governmental policy. This kind of neutrality would be threatened if the state privi-leged one way of life over another. An example would be if the state was to put a tax on fast food, therefore making life for those who prefer to consume fast food more difficult (Murray, 2011: 474-476).
Neutrality of outcome is the second viewpoint and it refers to when a state should act in such a way where each conception of the good is made equally easy or difficult to attain. This would mean that the state would have to accommodate all preferences
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equally. They would have to compensate those who have an expensive taste and enjoy eating caviar, to guarantee that they too have an equal opportunity to achieve the things that fall within their conception of the good (Idem).
The final type of state neutrality relies on the neutrality of intent. This type of neutrality accepts that the state through action will undoubtedly advance some tion of the good. However the intention of the state should be not to favor one concep-tion more over others. This leads to a situaconcep-tion where the justificaconcep-tion for social policies ought to be neutral with regards to a imposing a conception of the good (Murray, 2011: 474-476).
In this thesis, I will adhere to state neutrality as the neutrality of intent. By many political philosophers this is considered the most viable way of conceptualizing the idea of state neutrality. Although it seems apparent in the food industry that all forms of state action and inaction are inherently moral. Even by not intervening in the food industry the state inevitably passes a moral judgment. This judgment is that laissez-faire ar-rangements, in accordance with the principles of neo-liberalism, are superior to more stringent government regulations. This leaves us with a situation where the intent of the state to be neutral can never be more than intent. Because both intervening and not in-tervening in the market for food automatically means adhering to a specific conception of the good.
Neo-liberal governmentality does not allow for the state to give up its neutrality, even if it is the already value laden form of the neutrality of intent. This has to do with the potential problems that this holds for the structuring of society. Minimal state action can interfere with the will of the community. It potentially prevents some citizens to pursue their own conception of the good. Government intervention has inherently pa-ternalistic tendencies for it taints the relationship with the community in such a way where the former is allowed to suppress the latter. A return to unrestricted laissez-faire capitalism is the only thing that can reestablish the balance of power and guarantee a prosperous community (Bonanno, 1998: 227-228).
Neoliberals, and liberals alike, often seek to connect the idea of state neutrality with personal autonomy. By linking state neutrality with respect for a person’s autono-my neoliberals are quick to point the paternalistic finger towards the state. A situation can be considered paternalistic when the state uses its power to coerce or motivate its citizens to do something, that without that intervention being present they might not
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have done (Arneson, 1980: 481). The requirement of state neutrality is therefore closely related to anti-paternalistic tendencies. In this thesis I will adhere to paternalism as de-fined by Dworkin. According to Dworkin paternalism is ‘‘the interference with a person’s liberty of action justified by reasons referring exclusively to the welfare, good, happi-ness, needs, interests or values of the person being coerced’’(Dworkin, 1972: 65). The exercise of a person’s autonomy may lead to the acceptance of a variety of conceptions of the good.
2.3.3 Delegitimizing government intervention in the food industry
I have argued that neo-liberalism, state neutrality and anti-paternalism define the con-text in which the debate on regulating the food industry takes place. These concepts make up the theoretical framework in which the rest of my arguments are to be regard-ed.
With the food industry operating under neo-liberal governmentality, state inter-vention is delegitimized based on notions of economic freedom and a preference for
lais-sez-faire arrangements. The economic liberty of individuals should be respected and the
state should refrain from intervening in the private matter of consumer choice. The ideal of minimal government interference is also reflected in the notion of the liberal demo-cratic state as a neutral state.
When the government engages in regulatory behavior they should do so with the intent of this behavior being neutral. This means that the state does not impose its own conception of the good on its citizens. This makes government intervention in the food industry with the objective of reducing obesity very problematic, because such interven-tions inevitably require the state to favor one conception of the good over another. Therefore the state can easily be accused of paternalism, seeing how it is trying to inter-fere with a person’s liberty of action through intervening in consumer choices. Ultimate-ly this has given rise to a food industry that fosters and contributes to obesity. While simultaneously government intervention in this industry is condemned and constrained.
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2.4 How the food industry is buttering everyone up
2.4.1 The use of marketing strategies
The food industry competes fiercely over every dollar spent on food. Food companies try to convince people to eat more of their products. After all increasing consumption equals increasing revenue. The most obvious way they do this is through marketing and public relations. In societies where food is overabundant food choices are no longer made sole-ly on the basis of biological needs. It is consumer preference that is the driving force be-hind the market (Nestle, 2013: 1-2).
Food is the most advertised product in the United States; companies spend a total of $36 billion a year on marketing and advertising (Albritton, 2009: 172). For the most part it is processed food, pre-cooked meals, candy, desserts, alcohol and soft drinks that are being promoted (Nestle, 2013: 21-23). Advertising is a very effective way of increas-ing consumption. An example is the prevalence of soft drink consumption under chil-dren aged 6 to 17 which increased with 47% between 1977 and 1997. The mean intake of carbonated beverages rose from 150ml to 350ml per day (French, et al., 2003: 1326). In order to play in on consumer preferences marketing imperatives to increase con-sumption include taste, cost and convenience (Nestle, 2013:15-17).
Dietary choices are strongly influenced by taste and texture. Fat, sugar and salt contribute to many of the sensory properties of food and they increase eating pleasure. Preferences for foods that are high in these nutritional properties seem to be universal (Moss, 2013: 3-7). Furthermore fat consumption is determined by the amount of fat available in the food supply, there is no effective physiological mechanism that regulates the intake (Drewnowski, 1997: 58). This means that at a national level, as income in-creases, so does the amount of food that is being consumed that is high in fat, sugar and salt. Consumer preferences are a very important part of food purchasing. Food compa-nies feed in on these preferences by focusing most of their marketing strategies and public relations on food that is high in fat, sugar and salt.
In addition to taste, keeping the costs low through processing and adding value to products is also common practice. Raw foods are not nearly as economically attractive to sell as processed foods. The ingredients used for processing that add flavor, size or tex-ture, are often a lot cheaper than the actual raw food itself. There is a much larger profit margin on food that has been processed (Nestle, 2013: 17-19). Generally speaking
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cessed foods are also cheaper than non-processed foods, which means that with income remaining stable more can be bought (Rao, et al., 2013: 4).
A final marketing imperative is the sale of convenience food. Over the past three decades household consumption of unprocessed and minimally processed foods has shifted towards high-processed and ready to eat products. These products have a high energy density and have been associated with obesity (Monteiro, et al., 2011: 5-6). Con-venience has become a more important choice criteria due to changes in the demograph-ic. As people began traveling more, started working longer hours and more women joined the workforce, fewer and fewer meals were home-cooked and being consumed at home (Paarlberg, 2010: 94-96). Processed ready to eat foods ingeniously played in on these changes and became an indispensable part of the consumption oriented society.
Commercialism peaked further when companies began to direct their marketing attentions towards children. The commercialization of childhood has become a common phenomenon, as now more than ever children are being exposed to advertisements in the hope to create from ‘‘cradle-to-grave’’ consumer loyalty (Albritton, 2008: 173). In the United States this was made possible when advertising on children’s television was deregulated and cutbacks in funding for schools were being realized. Schools responded to this by selling pouring rights to companies like Coke or Pepsi, which in return were grated the exclusive right to sell soft drinks at the school. Soft drink vending machines were soon found in 94% of all American high schools (Schor, 2004).
It is no wonder that the food industry tapped into the children consumer market. Recent estimates indicate that children under the age of 14 influence up to 47% of the US household income spent on food. Children essentially became conduits between ad-vertisements and the family purse, thus turning them into profit generators for the food industry (Albritton, 2009: 172). In many instances the increased exposure of children to food advertisements has been connected with the development of obesity (Halford, et al., 2004; Veerman, et al., 2009; Andreyeva, et al, 2011). The food industry is thereby targeting and actively contributing to the detrimental health effects of an already vul-nerable part of the population.
2.4.2 How the industry is lobbying governments
The food industry also actively engages in lobbying. Traditionally lobbying is seen as promoting the views of special interest groups, attempting to influence political
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cesses that might affect these groups and communicating with government officials (Browne, 1985: 450-452). Food lobbyists seek to manipulate the political context in such a way that it better meets their interests, regardless of whether or not this benefits society or anybody else. The act of lobbying is something that is done mostly out of sight of public scrutiny and therefore it goes largely unnoticed. Since lobbyists are not public officials but are paid to represent private interest, the act of lobbying raises questions on the potential misuse of power (Nestle, 2007:95-96).
Lobbyists use three distinct strategies to ensure that their clients’ interests are being looked after: 1) they buy access, 2) they designate their own nutrition experts and 3) they disarm critics.
The first lobbyist strategy focuses on buying access. In the United States it is common practice that lobbyists engage in financial transactions with government offi-cials. They donate money to candidates that they can use for their campaigns, if they stand for reelection, or they give them gifts. When these candidates take office the finan-cial contributions have bought the lobbyists access to government offifinan-cials. The bought loyalty can then be translated into policies that are in the interest of the lobbyist’s clients (Idem: 102-110). Through this process a situation might be created where the govern-ment official no longer looks after the interests of the citizens whom he is supposed to represent.
A second strategy used by lobbyist, is influencing public opinion about their cli-ents’ products by designating nutrition experts. This is done in order to create a link be-tween academic knowledge and the food industry. Many of the world’s leading experts on food, and nutrition organizations, are hired as advisors or consultants, or are given research grants by industry (Owen and Braeutigam, 1978: 7). According to some nutri-tion experts’ cooperanutri-tion with the food industry is essential for reducing the number of overweight people and for the production of healthier food. Experts for a large part have become financially reliant on industry partners (Nestle, 2007: 112). Corporate sponsor-ship does not necessarily have to lead to an academic bias. In order for this symbiotic relationship not to run askew intense public debate to guarantee transparency is re-quired. Right now such debate is often lacking.
A final way for lobbyists to ensure that their clients’ interest are being best looked after is by disarming the critics. This is usually done through public relations, where a narrative is created that the products that are being sold promote health or at
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the very least are not harmful. If these softer methods of public relations fail it is also possible for companies to sue their critics in order to protect the image of a product. Where lobbying strategies are usually focused on winning over and influencing govern-ment officials, disarming critics and litigating can also be directed towards private citi-zens (Idem: 159-171). Overall lobbying can be a very effective instrument for food com-panies to maintain or create a favorable sales environment for their products. This is another way in which the food industry contributes to an obesogenic environment
2.4.3 The food industry actively contributes to confusion on dietary advice
The engagement of the food industry in lobbying practices and public relations is only part of the problem. The food industry also capitalizes on creating confusion on what constitutes a healthy diet. The government simply lacks the funds to compete with in-dustry’s advertising budgets in order to promote dietary recommendations. These rec-ommendations do exist but they run counter to the interests of the food industry.
As people became wealthier they started spending more on food and developed a taste for foods higher in calories. Shifting away from a largely plant based diet to a diet consisting out of animal products such as dairy, meat and eggs. Simultaneously food be-came progressively cheaper relative to income; this had to do with productivity growth and optimizing efficiency in the production chain (Paarlberg, 2010:85-87). With an in-crease in the average income spent on food and a dein-crease in the prices of food, people started consuming more. This development led to a situation where in the midst of the 20th century the government actively started to promote an ‘‘Eat less’’ message.
This message to consume less was formulated as a direct response to the growing number of overweight and obese people (Nestle, 2013: 39). This message ran counter to the interests of food companies because they ultimately want to sell more of their prod-ucts. In response the food industry began to lobby and pressure government officials and agencies in order to ensure that their products were not labeled as unhealthy by the government. They did not want to be excluded from the group of products that the gov-ernment promoted as constituting part of a healthy diet (Ibidem: 5-21).
Food companies also started funding and promoting single-nutrient research. This was done in an effort to claim that their product, containing that beneficial nutrient, was actually health promoting (Idem). All this was done while simultaneously broad-casting the food industries’ own message on food ‘‘Eat more’’. A message that resonates
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with the general public, as shown by the fact that average caloric consumption has steadily increased over the past few decades (Bleich, et al., 2007).
2.4.4 Creating mouthwatering and fortified foods through technological innova-tion
Through technological innovation the food industry develops food that has been altered or fortified, to either make it ‘‘healthier’’ or better tasting. Food that is believed, to create health benefits increases sales (Nestle, 2013: 295). The food industry has responded to this by developing products that confer health benefits beyond the nutritive value of the product itself. They do this by adding vitamins, minerals, protein, fiber, amino-acids and fatty-acids. Furthermore they invest in developing foods that, even though they are commonly known to be unhealthy, contain less calories, salt, fat, sugar and caffeine, thereby making them ‘‘less evil’’. (Nestle, 2013: 295-304). Ultimately food companies develop these kinds of technologically enhanced foods to increase consumption of their products.
Labeling food as ‘‘organic’’, ‘‘low in fat’’ or ‘‘with added fibers’’, says nothing about the caloric content or nutrition composition of a product. People however make the as-sumption that these products are healthier and can therefore be eaten more frequently and in larger quantities. Thus leading to a situation where the perceived appropriate serving size increases and consumer guilt decreases. This ultimately results in individu-als consuming more of these products than of their less healthy equivalents. Ironically, people who are already overweight overeat on snack foods because of this principle (Wansink and Chandon, 2006; Schuldt and Schwarz, 2010).
2.5 Conclusion
The food industry has given rise to the onset and progression of the obesity epidemic. The food industry actively advocates an ‘‘Eat more’’ message through marketing strate-gies, lobbying governments, creating confusion and technological innovation. The suc-cessful promotion of this message is facilitated by neo-liberal governmentality. Govern-ment intervention is delegitizmed on the basis of state neutrality and anti-paternalism. I am fully aware that the problem of obesity does not solely reside in the way the food industry is structured but that it also connected to other political, personal and societal
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factors. I acknowledge that individuals, at least to some degree, are accountable for their own choices through personal autonomy. Despite this, I argue that I have provided suffi-cient justification to frame the obesity problem primarily in terms of failure of the food industry. Obesity as a disease is related to an industry that in itself is showing symptoms of illness.
Therefore in the remainder of this thesis I will assume that in order to effectively fight the obesity epidemic, a solution must be sought in more stringent regulations of the food industry. Just because the problem of obesity resides in the food industry does not necessarily justify government intervention in this industry. What then is required to legitimize government intervention in the food industry to fight the obesity epidemic? In the second section of this thesis I will put forth several arguments on which basis state intervention in the food industry can be legitimized.
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Chapter 3. Reasons for government intervention in
the food industry
3.1 Introduction
This chapter sets out to establish under what circumstances the government can right-fully intervene. Legitimizing government intervention in the food industry is an integral part of the evaluative framework that I construct. It is a condition that needs to be met prior to the normative principles that should guide these regulations.
I advocate that the state has an obligation to intervene when at least the following four criteria are met: 1) the state should intervene in instances where certain behavior can rightfully be defined as a public health problem due to the social, environmental and economical costs that accompany it, 2) there has to be sufficient and relatively uncon-tested scientific knowledge relating specific behavior to an otherwise preventable dis-ease, 3) the behavior has to be displayed on a scale big enough, and has to be able to be manipulated in such a way, where it can reasonably be expected that government inter-vention is effective and 4) a state has an obligation to intervene if a disease or harmful behavior creates or contributes to social inequality in society.
If these four criteria are met, this should prevent the government from interven-ing on a bias of what they hold to be the ‘‘better’’ conception of the good. This minimizes the chance of the state engaging in unnecessary paternalistic regulatory behavior. The construction of these premises excludes the possibility for the government to start regu-lating all sorts of risky behavior that might result in disease. Snowboarding might be considered a risk because it increases the chance of breaking a bone. Having a promis-cuous sex life increases the risk of sexually transmitted diseases. Not brushing your teeth might lead to infectious mouth diseases and serious tooth decay. It also excludes regulating for things that are beyond a person’s control, like hereditary blindness or au-tism.
I argue that obesity is an example of a case that meets these four requirements. This means that the state does not only have sufficient legitimization to intervene, but that it also has an obligation to do so. Diseases or afflictions that stem from preventable behavior should be subject to more stringent regulations. Instances where this has been
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done successfully are smoking, and drinking. If it is possible to contrive of other types of behavior that meet these requirements, I hold that, they too should fall part to regulato-ry scrutiny. Assessing whether or not this is the case lies outside of the scope of this the-sis and it will therefore not be discussed at greater length.
3.2 The power of the ‘‘obesity epidemic’’ discourse
3.2.1 The medicalization of obesity
The discourse on food, for a large part, has been defined and constructed by the food industry. An alternative discourse on obesity might help provide legitimization for gov-ernment intervention to decrease the obese population. Historically it has been proven that the medicalization of conditions that are deemed socially undesirable, such as obe-sity, is a very successful strategy for legitimizing government intervention (de Vries, 2007: 56). Examples of cases where this has been done successfully are hyperactivity in children, alcoholism, gender dysphoria and child abuse (Conrad, 1992: 210).
Medicalization is a process whereby more and more of everyday life is subjugated to medical influence, supervision and scrutiny (Zola, 1983: 295). It is primarily a matter that consists out of defining a problem in medical terms, using medical language to de-scribe a problem and adopting a medical framework to explain a problem (Conrad, 1992: 211). In May 2004 the US Department of Health issued a statement in which it officially recognized obesity as a chronic disease (Stein and Connely, 2004). The justifi-cation of labeling obesity as a disease heavily hinges on scientific evidence affirming the negative health consequences of having excess body fat (De Vries, 2007: 57-58).
Obesity as a disease has been medicalized. This does not only show from it being defined as a chronic disease by the US Department of Health but also by the societal dis-course that accompanies it. It has become increasingly common practice for scholars and journalist to refer to obesity as an epidemic. It is important to reflect on the legitimacy of adhering to such a medicalized discourse for it has societal consequences.
3.2.2 Framing obesity as an epidemic
When doctors, scientists and even politicians frame something as an epidemic, this con-jures an image of a rapidly spreading infectious disease that affects people indiscrimi-nately (Anomaly, 2012: 217). Obesity is not contagious and does not affect people
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indiscriminantly, therefore it does not fit this image. Nor does it fit the technical defini-tion of an epidemic. According to the Oxford Dicdefini-tionaries Online an epidemic is a ‘‘wide-spread occurrence of an infectious disease in a community at a particular time’’. Scholars have been using the term epidemic more loosely so it includes anything that negatively affects a population. By invoking a language of infectious disease and contagion, gov-ernment intervention is more likely to draw support. Not only does it attract more atten-tion but most reasonable people would agree that restricting individual liberties to ob-tain goals that cannot be produced unilaterally is legitimate (Anomaly, 2012: 217-218).
I argue that obesity is rightfully defined as a medical problem and that the dis-course on obesity as being an epidemic is also justly invoked. There are two reasons for this: 1) obesity has been connected to a wide variety of detrimental health effects and diseases, ranging from cancer to mental illness and 2) the scale at which obesity mani-fests itself is so great, and it is such a pervasive part of society, that this warrants it being referred to as an epidemic. The use of the word epidemic in relation to obesity should therefore not be interpreted as referring to the contagiousness of obesity, but rather as having to do with the omnipresence and prevalence of obesity in society. The obesity epidemic discourse comes with an added strategic advantage, for it legitimizes govern-ment intervention in the food industry in order to decrease the overweight and obese population.
3.3 Defining obesity as a public health problem due to its scale
3.3.1The scale of the problem
Obesity has become a pervasive part of all affluent societies. Leading countries include the United States, United Kingdom, Australia, Mexico and Greece where more than two-thirds of the adult population is either overweight or obese. Since the 1950s the popula-tion of overweight people has grown from less than 100 million to over 1.6 billion. This means that there are now almost twice as many overfed people on earth as there are underfed people (Paarlberg, 2010: 81-84). Based on these figures, I claim obesity truly is a disease of epidemic proportions. Furthermore being overweight is no longer a privi-lege only reserved for those who live in wealthy societies.
An ever increasing amount of newly industrializing countries is also confronted with the same problem (Popkin and Doak, 2009: 106). These countries often struggle
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with, what has been deemed, the double burden of malnutrition. A situation where a part of the population is malnourished due to a lack of food, while the other part of the population is malnourished due to overeating on food that is lacking in nutritional value (Khan and Khoi, 2008: 116-118).
3.3.2 The Societal, environmental and economic costs of obesity
In addition, the pressing nature of the problem can partly be attributed to the tremen-dous societal, environmental and economic costs that come with obesity. One of the most obvious and most frequently referenced obesity related costs is health care. These costs have reached unparalleled heights.
Obesity has been linked to a plethora of diseases including diabetes, high choles-terol, cardiovascular diseases, cancer, psychological trauma and joint problems. If the current trend in obesity numbers continues, as is believed it will, the costs of health care will also keep rising (Arterburn, et al., 2005; Finkelstein, et al., 2009; Wang, et al., 2012). There are prognoses that stipulate that health care costs attributable to overweight and obese people would double every decade. This means that costs could reach 860.7– 956.9 billion dollars in 2030 in the United States alone. This would account for 16–18% of total US health-care expenditure (Wang, et al., 2012: 2323).
Obesity also comes at the expense of the environment. On a global scale, there is a shift in eating preferences from largely plant-based diets to diets higher in fat and meat and lower in carbohydrates and fiber. This shift can be attributed to changes in income, educational levels, food prices, food availability and urbanization. As people become wealthier they develop a taste, and are better able to afford, a diet consisting of animal products and processed food (Popkin, 2008: 13-15). In order to meet this demand the livestock sector is the fastest growing agricultural sub-sector. More intensive livestock farming leads to land degradation, water pollution, increased health problems and an increase in greenhouse gas emissions. Greenhouse gas emissions stemming from the agricultural and livestock sector, like health care costs, have reached unprecedented heights (Ilea, 2009; McMichael, 2007; Thorpe, et al., 2004).
Therefore the problem of consuming largely animal product based diets is two-fold: 1) it leads to the development of obesity and 2) the environmental costs of con-sumption are not reflected in the price of the products being consumed. Ultimately
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eties across the world are being confronted with the bill from this form of (over)consumption.
Furthermore it has also been shown that obesity has potential negative conse-quences for activities that relate to or take place at the workplace. Overweight and obese people are subjugate to higher absenteeism rates, are home ill for longer periods of time and sustain disabilities and injuries in the workplace more often. This makes obesity a driver of costs in the workplace. Overweight and obese employees also experience greater health-related work limitations. Specifically when it comes to time that is needed to complete a task and the ability to perform physical job demands. On the whole this leads to a loss in worker productivity, where overweight employees are significantly less productive than their colleagues with a healthy body weight (Gates, et al., 2008; Schmier, et al., 2006).
The reach of obesity, as a health problem, stretches far beyond its usually pre-sumed medical boundaries. The obesity epidemic leads to massive welfare loss; this is made up out of societal, environmental and economic factors. The above described costs are for the most part born by society in its entirety.
3.3.3 Defining obesity as a public health problem
Obesity can be defined as a public rather than a private health problem for three rea-sons. The first reason is that all taxpayers ultimately pay for obesity. When the govern-ment spreads the costs of risky behavior, it creates a situation where all citizens are es-sentially stakeholders in reducing that risky behavior. This means that the state essen-tially has the ability to turn all private goods into public goods by spreading the costs and benefits of an individual’s behavior among other members of society. It provides the state with an incentive and justification to want to change people’s eating behaviors. (Anomaly, 2012: 216-217). Considering obesity as a public health problem then be-comes largely dependent on the moral justification behind health care policies that de-termine who pays for obesity. Given the focus of this thesis I will not mixed up in the debate on who should pay for obesity. Instead I will assume that, given the current situa-tion in which society as a whole pays for obesity, obesity should be regarded as a public health problem.
The second reason is that obesity is a global phenomenon with many border-crossing consequences that do not reside or limit itself to any given nation state. This is
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especially true if one looks at the costs of consumption in environmental terms, of which increased greenhouse gas emissions and global warming are examples.
The final reason is that the net accumulative costs of consumption far exceed the sum of the individual costs of consumption. The individual consumer cannot be held ac-countable for the negative consequences and costs that come with obesity. Seeing how these costs are primarily caused by a malfunctioning food industry and collective con-sumer behavior. After all, one person consuming ten hamburgers and a gallon of coke a day does not necessarily constitute a problem, even if this results in the development of morbid obesity. It becomes a problem when this kind of behavior is engaged in collec-tively by a large group of individuals, because the accumulative costs exceed the indi-vidual costs of consumption. This goes for the social, economic and environmental costs that I have cited in this paragraph. Given the public nature of the obesity epidemic and the complex cause-effect relations that are at work in this field, government intervention is required.
3.4 The social construction of obesity and its real world effects
3.4.1 Obesity as a failure to reach a desired state
There are scholars who argue that the term obesity, as well as the problem definition of obesity, has a moral origin, in that it seeks to correct unwanted and immoral behavior (Campos, 2004; Fitzgerald, 1994; De Vries, 2007). In accordance with this perspective they frame obesity as something that is culturally contingent. Due to obesity partially being socially constructed into being a disease, they argue that the state contributes to creating and perpetuating the negative stigma on obesity if they engage in intervention (Vartanian and Smythe, 2013: 49-50). In this paragraph I will offer a critique on gov-ernment intervention in the food industry based on social constructivist arguments. I will show how these arguments have no merit when they are contrasted with the very serious negative health consequences of obesity.
Science does not merely study the world as it is but also plays an important role in the construction of the categories and the distinctions within that world (Ibidem: 56-58). From a normative perspective, problems with the body are usually defined as a dis-ease when they are deemed to be undesirable. The very appreciation of a problem as a problem is dependent on how it relates to failing to achieve a desired state (Engelhardt,
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1996: 196-217). Therefore being overweight is a problem because it is in sharp contrast with the current body ideal of being slender and fit. Diversion from this ideal is open to public scrutiny (de Vries, 2007: 60).
Obesity can then only be considered a pathological condition, in the sense that culture has arbitrarily defined certain levels of weight to be undesirable (Campos, 2004: 82-87). Related to this is the increased incompatibility between fat and beauty. In the twenty-first century the bodily ideal is focused on slenderness and fitness. But the cur-rent focus on thinness runs contrary to the twentieth century trend, when a round body was celebrated as the ideal body type (Kersch and Marone, 2002).
3.4.2 Turning people into patients
The medical battle against obesity could also be seen as an inclination to medicalize be-havior we do not find acceptable, instead of it focusing on the harmful effects of obesity (Fitzgerald, 1994: 196-198). By medicalizing a socially undesirable condition one pro-vides people with a justification for their condition and it assigns them a patient status.
The disease conceptualization of obesity transforms people into patients that suf-fer from a chronic disease and who require rehabilitative treatment. This has significant consequences for those who are affected by it. By assigning people the role of a patient this comes with a claim of how a person ought to behave, with regards to being treated. Given that sickness is a state that people do not want to be in. Thus there is the inherent assumption that sick people want to be treated in order to get better (Engelhardt, 1996: 196-217). If being obese, or being overweight, is defined as a disease then this is a state people could not possibly enjoy. The underlying assumption being that fat is something that endangers someone’s health and needs to be cured through weight loss.
In congruence with societal beauty standards, stigmatizing overweight and obese people appears to be one of the last socially acceptable forms of discrimination. Stigma-tization is based on the notion that obesity is a disease that is under a person’s control and that negative reinforcement through stigmatization should lead to the desired be-havioral change in obese individuals. Not only are obese people being evaluated more negatively, it is this negative evaluation that some hold to be an effective course of treatment or action against obesity. This also becomes evident from obesity stigma be-ing used as a public health strategy in public health campaigns (Vartanian and Smythe, 2013: 51-53). I do not approve of the discrimination or stigmatization of obesity as a
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public policy strategy. However this being said I do argue that government intervention is legitimate and necessary, though be it in a different form.
3.4.3 The claim for government intervention
If one accepts that obesity and being overweight have, at least partially, been socially constructed into being a problem, does this than leave any claim for government inter-vention? I argue it warrants intervention in cases where people have become over-weight due to irrational and sometimes involuntary acts or when they are unhappy with being overweight. Ideally individuals who have made the conscious choice to be over-weight should be exempted from government regulatory behavior. It could be very diffi-cult to reach agreement on when someone falls into the former or the latter category. Despite it being possible to distinguish roughly between these two groups, policy pro-grams are more likely to focus on adjusting practices and habits. This means either im-posing values of health on the latter group, or foregoing the opportunity to protect the former group from self-destructive behavior. I argue that the life of the involuntary obese individual is of greater concern than the preference of the moderately obese indi-vidual, all else being equal (Wikler, 1978: 310-314).
3.4.4 Obesity related health problems
The negative health consequences of obesity provide another legitimization for govern-ment intervention. Obesity has been connected with many different diseases and health problems.
The main etiological cause of Diabetes Mellitus, or type 2 diabetes, is obesity, rendering it a fatness related disease. Some scholars even propose adopting the term ‘‘diabesity’’ (Astrup and Finer, 2000). Both men and women stand a far greater risk of developing coronary heart disease when they are overweight, even being mildly-to-moderately overweight increases the risk significantly (Manson, et al., 1990; Hubert, et al., 1983). The obesity hypoventilation syndrome, which can ultimately result in pulmo-nary hypertension, cor pulmonale and probable early mortality, is directly caused by obesity (Olson and Zwillich, 2005). Obesity is one of the most common physical health problems among people with severe and persistent mental illnesses (Thakore and Leon-ard, 2009).Finally, obesity is associated with several forms of cancer among which co-lon, breast, endometrial, kidney and esophagus. Obesity might therefore be the largest
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avoidable cause of cancer in nonsmokers. It is estimated that obesity now accounts for one in seven cancer deaths in men and one in five in women in the United States (Calle and Thun, 2004). It is the preventable nature of obesity and its severe health conse-quences that underlines the need for government intervention.
3.5 Fighting obesity to reduce social inequality and create equal
opportunities
3.5.1 The unequal spread of obesity
Despite the fact that the costs that come with obesity are being paid for by society as a whole the disease itself affects specific parts of the population more than others. Women are affected more often than men, ethnic minorities more often than ethnic majorities, poor people more often than rich people, poorly educated people more often than highly educated people and children of obese parents more often than children with parents who have a healthy weight (Kopelman, 2000; Kumanyika and Grier, 2006; Levine, 2011; Magarey et al., 2003; Monteiro, et al., 2001).
Obesity generates and fosters social inequality, because the negative health ef-fects predominantly manifest themselves within specific social groups. These social groups are then confronted with the consequences of having limited or otherwise im-paired health. Examples of such consequences include shortened lifespan, inability to achieve certain conceptions of the good or not being able to access specific social posi-tions in society. Does it then follow that the state should be allowed to intervene in order to reduce these inequalities?
3.5.2 Obesity and the broader discussion on liberal egalitarianism
Obesity as a disease contributes to and deepens existing social inequalities and therefore it fits into the broader discussion on egalitarianism and justice. Hence there is a justified claim for government intervention in the food industry in order to reduce obesity.
Liberal egalitarian theories of distributive justice argue that public policy should be tasked with the objective to try and secure equal opportunities for all. To do this it should aim to eliminate inequalities that arise from factors that are outside an individu-al’s control. Inequalities from factors that are under an individuindividu-al’s control are deemed acceptable. Such an approach to health therefore consists of two parts: 1) the liberal
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principle that individuals should be held accountable for their own choices and 2) the egalitarian principle that individuals who make the same choices should be able to achieve similar outcomes (Cappelen and Norheim, 2005: 476-478). People are responsi-ble for making their own food choices, this seems to suggest that the inequalities that stem from these choices should be morally acceptable. On this basis government inter-vention to reduce obesity associated inequalities would appear illegitimate.
The liberal principle states that an individual should be held responsible for his choices, not for the consequences of his choices. It is hardly ever the case that an out-come depends solely on an individuals’ choice. Choices are often influenced and struc-tured by external factors and the context in which they are made. To hold an individual responsible for the consequences of his choices would therefore be holding him respon-sible for too much (Ibidem: 478-479).
The inequalities that are related to obesity are primarily caused by the conse-quences of people’s choices. In accordance with the liberal principle holding an individ-ual accountable for obesity as a consequence of his food choices would be too much. For instance this would seem to imply that individuals could be denied medical care for obe-sity related diseases. The debate on whether or not individuals should also be held ac-countable for the consequences of their food choices could be studied at far greater length. This however is not central to this thesis and I will assume that while we hold individuals accountable for their choices, we do not hold them accountable for the con-sequences of their choices. This means that in accordance with liberal egalitarianism there still is a legitimate claim for government intervention in the food industry to re-duce obesity related social inequalities and create more equal opportunities for individ-uals.
3.5.3 Choosing a conception of the good
According to Sen, equality of opportunity lies at the heart of any socially just society. People should be given equal opportunities to achieve specific results, the opportunity to achieve a result takes primacy over the result itself. An opportunity then refers to the ability of an individual to function in a certain way and through that functioning achieve a specific social position. If opportunities are roughly distributed equally, this means that individuals should have similar capabilities to achieve similar outcomes (De Beer and Pekelharing, 2006: 24).
