Lit cigarette with smoking billowing around it

When I flew home after taking my oral board exams in Emergency Medicine, one of the more stressful events in my life, I got assigned to a seat in the non-smoking section of the plane. It was the first row of the non-smoking section which meant that I was in the row behind the last row of the smoking section. Just in case you aren’t old enough to remember the bad old days of smoke-filled airplanes, let me point out that being seated right behind the smoking section meant that I got to inhale about the same amount of smoke as the wife of the chain-smoker in front of me. The difference was that she freely chose to sit next to him and get smoked out and I did not.

 

How many of our lifestyle decisions are really free choice?

So what’s that got to do with anything these days? Plenty. There are raging debates about how much of the current obesity epidemic is due to people freely choosing to eat more and move less and how much is due to societal factors that are really not in an individual’s direct control.

If I am fat because I must work two jobs to support my family, can only afford to eat at MickyDs, and can’t put 10 minutes together at one time to exercise, is it because I choose to be fat? Or is it something else? And if it is more than—or instead of—my free choice, what responsibility does society have to help me stay healthy?

Let me put my cards on the table: I am a staunch supporter of Public Health. And that means, in many cases, mandates.

  • Mandating vaccinations has reduced deaths and disabilities from certain childhood illnesses.
  • Mandating seatbelts and requiring airbags has changed many formerly fatal accidents into crashes people walk away from.
  • Motorcycle helmet laws save brains and save lives.
  • Smoking bans save lungs and save lives.

I say hooray for these laws and regulations that have spared so much human misery at the expense of a little less free choice.

 

Whose choice trumps whose?

But as I said before, when you talk about free choice, it is important to ask whose free choice we are talking about. Whose choice trumps whose? The smoker wants to smoke, but I don’t want to breathe in his smoke when I am in a restaurant or on an airplane. The motorcyclist wants to feel the wind ruffle his hair, but I don’t want to pay taxes to cover his long-term care in a nursing home after a crash ruins his brain.

Where do we draw the line? How do we draw the line? I believe it is only by a vigorous public debate with all sides weighing in. Because the “public health” side of these arguments tends to have much less money than the “corporate” side(s), it is important that everyone—individual consumers, advocacy groups, academics—weighs in so that all of the pros and cons are heard by the final decision-makers.

That’s what happened in the debates about smoking bans and motorcycle helmets. Sometimes the public health side wins and sometimes not. But as time goes by and more and more information accumulates, we often get to the “right” answer.

Take the trans fat debate. No question it is bad for us to eat transfats. In New York, the public was heard loud and clear. And, NY’s Public Health leadership made the right public health decision on behalf of its citizens. I am sorry, you guys who love to eat transfats. But I send no apologies to the food industry who should have done the right thing without having to be forced.

The Doctor Weighs In is committed to bringing you the information you need to get involved in food politics and food policy. We want to arm you with the facts (not factoids) and help you get active and going. After all, we have an epidemic to fight.