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New York City “Soda” ban is a missed opportunity

Two weeks ago, in an effort to curb rising rates of obesity, the New York City’s board of health banned the sale of “sugary drinks”, i.e soft drinks, in servings larger than 16 ounces. Predictably the cries of undue government infringement, a nanny state, and anything else you can imagine have dominated the media coverage. I think the NYC health board and health advocates can expect to spend the foreseeable future embroiled in lawsuits and targeted campaigns attacking the new law. NYC has a history as a trendsetter for public health initiatives.  They were one of the first cities to ban indoor smoking and, in 2006, were the first to ban trans fats. Both are great initiatives but the soda ban misses the mark. So before anyone gets excited about the new pop ban, or thinks about following suit, a second look at the ban is due.

The pop ban is about winning the “war on obesity”, an issue that that we’re not doing very well on.  After a few decades of attempting to educate people about the perils of obesity, 30 percent of North American’s are now overweight or obese, a rate that has essentially doubled in 20 years. We are starting to conclude that continuing to teach people on the harmful impact of being overweight is more effective at creating a culture of blame than actually helping people be healthy.

Adds like these fail to address why people consume unhealthy food, but make it their fault if they continue to do so. Shame by education has been a massive historic misfire of public health, and we have our track record of a bulging waistline to prove it.

Advocates are looking for new ways to make North American’s slimmer, and topping the list is altering consumer choices by changing social and economic factors. The goal is to make consumers move towards healthier products because they have become more accessible or affordable.

However, with a closer look, it seems as though the designers of the soda ban were determined to ignore all research on the topic, along with experiences and evidence from previous attempts.

Forget that many skeptics believe the ban will not be effective: people will exploit the numerous loopholes to get their soda elsewhere, or switch to other non-banned sugary drinks and products. The real issue is that the ban works on a superficial of level in that the BEST-case scenario people will drink fewer large servings of pop, less often. This will bring about a less-than-impressive impact. The ban does not effect a change in the factors that lead people to consume sugary beverages it just infantilizes them by limiting their choices to certain arbitrary products.

Under the ban you may buy two medium sized drinks, or simply get whatever size you want at a corner store or grocery store that are puzzlingly exempt from the ban.

If I am right, the ban is not just bad for progressive politics but is, frankly, bad policy.

The economics of body weight are actually well understood. Studies in the US and Canada have shown that there is a consistent relation between the price of food, weight and health. The lower the cost of fruits and vegetables, the healthier people are. The lower the cost of fast food and high-energy dense foods, such as soft drinks and processed carbohydrates, the heavier and less healthy people are. Further, modest changes in the price of foods cause corresponding changes in their consumption. Other factors, such as accessibility to food are key but less amendable to federal regulation.

The situation is not overly complicated and is quite intuitive. But, our governments continue to financially support the production of the ingredients used to make unhealthy foods, such as corn and soy, with commodity subsidies, as well as research and development grants. At the same time, farmers of a diverse array of fruits and vegetables are not supported with subsidies and R&D grants. In short choosing to grow non-subsided healthy food is riskier, and less lucrative.

Looking at examples of the subsidies is almost comical. Each year the US government gives farmers the equivalent of 29 cents per taxpayer to subsidize all fruit and vegetable production. When I say fruits and vegetables, I mean apples. Just apples.  Compare that to the 8 dollars spent per taxpayer on just the production of high fructose corn syrup – a big component of sugary drinks. We are eating a lot of unhealthy food because partly because our government, with some generous pressure from interest groups, make that food more accessible and affordable.

Working on changing agricultural subsidies is the best approach we have right now to combat obesity. This directly addresses the economic suprastructure in which people make decisions about the food they can and want to eat.  The NYC soda ban is a local issue; agricultural subsidies are a national issue, but the resources that have and will continue to go into advocating for the ban could have gone towards changing agricultural subsidies.

The costs associated with obesity are dire, and local action should be part of the solution. Then why is the soda ban so weak? Smoking indoors and trans fats were flatly banned in NYC. Is “big soda” more powerful than “big tobacco”, forcing the board of health tiptoe around with partial bans? More importantly why did NYC not opt for a soft drink tax, or an even more ambitious fast food tax? By throwing an almost unenforceable ban into the fray of food politics in NYC, another layer of bureaucracy has been added; it will distract from real issues like subsidies and have a limited impact.

It sounds like I am complaining that NYC is trying to ban the sale of pop rather than impose a tax. But it is not my point, what I am frustrated with is that designing health interventions to tell people what to do or actively limiting their choices is bad policy. It annoys consumers, galvanizes the right wing, and creates new problems. Changing the price of food through taxes or subsidies avoids the paternalism of directly denying people products but still achieves the end goal of decreased consumption, and hopefully healthier people.

I think the soda ban might have a modest impact on soft drink consumption but it will not be worth it, dollar for dollar. The ban passed unanimously with one absentee vote, a good indicator that more ambitious policy could have been pursued. I hope this is a stepping-stone in NYC to more aggressive policies. Instead of playing around with piecemeal local bans health advocates need to think more upstream and start changing consumption of all unhealthy foods by altering food subsidies.

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Anti-Trafficking Initiatives Hurt the Fight Against HIV/AIDS

By Kerry Porth

Recently, Washington DC hosted the 19th International AIDS Conference.  This was the first time the conference had been held in the United States since 1990 as the US had barred entry to any HIV-positive visitors for 22 years – this ban was lifted by President Obama in early 2010.  Sadly, the US chose not to lift two other immigration bans which precluded the involvement of two of the three “high-risk” groups, namely sex workers and drug users. Regardless, many sex work and drug policy activists managed to attend the 5-day conference and protested the US immigration ban and other ideologically-driven policies that are harming the fight against HIV/AIDS.

They found many opportunities to raise awareness of the harms that US policies, anti-trafficking initiatives, and stigma are having on sex workers (protest starts at 1:30).

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“We’ve told three lies”: When our visionaries take one step back in order to leap forward.

By Ashley White

When one has hit upon – or stumbled, whatever – their own version of meaningful, substantive work, one also usually finds for themselves visionaries in the field to look to as mentors.  Because we know thatattachment to the labour force is a social determinant of health, meaningful attachment, then, requires things like: leaders, opportunities for innovation and positive deviance, and trails half-blazed (pardon the pun).

For me, Mark Haden has been one of these visionaries since I first met him in 2008.  He’s a Vancouver drug educator, among many other things, who has changed his mind – and his presentations – on how to do drug education to adults and youth over the past 25 years.  In the video below, in an interview filmed and produced by the  Canadian Drug Policy Coalition’s Heiko Decosas for the CDPC’s Blog, Mark outlines three lies that have typically prevented the general public from engaging in meaningful discourse on drug use.  Without good information, we can’t have good dialogue and we can’t build smart policy.  The lies? Misconstruing the harms of drugs, not explaining the harms of prohibition, and not explaining the potential benefits of drugs.

Mark is making a real difference.

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The end of the journey to safe, regulated markets for sex work? No. It’s more like a stop-over.

For me, it’s been a passionate and outspoken six year crusade to improve the human rights, safety, and dignity of Canadian sex workers.  For others, it’s been decades.  For some, the issue is just beginning to register as mainstream.  On Monday, March 26, 2012, there was yet another exciting stop-over in a journey that has yet to reach an end.

I was up at 5:45am and sitting across from Rick Cluff at the Canadian Broadcasting Corporation (CBC) at 6:40am to discuss the constitutional challenge to Canada’s Prostitution Laws in Ontario.  Justice Susan Himel struck down three laws relating to sex work in September of 2010:  Keeping a Common Bawdy House (Section 210), Living off the Avails (subsection J of Section 212), and Communication for the Purposes of Prostitution (Section 213).  This was a historic victory for Canadian sex workers as these particular laws work both individually and collectively to prevent sex workers from taking safety precautions while engaged in an exchange of sex for money – an exchange which has NEVER been illegal in Canada.

Working at an indoor location, rather than on the street, is much safer and this is backed up by reams of evidence, both qualitative and quantitative. Working indoors means that sex workers have better control over their working environment including having someone else present if anything goes wrong.

The Living off the Avails law was enacted, in part, to protect sex workers from exploitative pimps.  In reality, this law can apply to ANYONE who receives financial support from a sex worker, including her partner or her children.  This law also prohibits sex workers from hiring individuals to provide additional safety such as security guards, drivers and receptionists.  I would also point out that there are violent, exploitive men living off the avails of women in a variety of professions – the financial exploitation of women is not restricted to the sex trade. Continue reading

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Radical Public Health

A genuine man goes to the roots. To be a radical is no more than that: to go to the roots.
~ Jose Marti ~