Tuesday, June 5, 2012

What is the role of public policy in public health and safety?

What a week to contemplate the role of public policy and the regulation of beverages, foods and other substances that have an affect on health!

First, on Friday our state ushered in a new era of private liquor sales, making it available in every gocery store, drug store, and big-box store that is at least 10,000 square feet -- which, in NE Seattle, is virtually every one.  Limiting alcohol availablity is one proven method for preventing underage drinking and excessive alcohol consumption.  Last year, Washingtonians decided that public health and safety risks were worth the convenience of easily accessible liquor. 

Many of the media stories about our new privatized system focus on the new taxes levied on liquor.  From a youth substance abuse prevention standpoint, these taxes are good.  Increasing taxes on alcohol is a proven method for reducing underage drinking rates. 

Today, Californians are voting on a proposition that would raise taxes on every pack of cigarettes by $1.00, yielding an estimated $735 million a year for the state. Tobacco taxes are a proven method for reducing youth tobacco use.

In New York City, their mayor is pushing to ban the sale of large sodas and other sugary drinks at restaurants, movie theaters and street carts.  A debate appearing in the New York Times, What's the Best Way to Break Society's Bad Habits?, includes a piece written by Daniel Okrent, the author of Last Call: The Rise and Fall of Prohibition.  In it he writes that Prohibition failed . . . "because you cannot successfully legislate human desire . . . if people really want to do something, and there isn't an immediate and universally acknowledged victim, they will find their way to do it, irrespective of laws and regulations."

While human desire may not be legislated, a balance needs to be found between human desire and public health costs.  When it comes to unhealthy habits, including underage drinking and excessive alcohol consumption (and I venture to guess many health advocates would include the excessive consumption of sugary drinks and the use of tobacco), there are universally acknowledged victims.  Laws and regulations are essential for keeping "human desire" in check so that it doesn't create harms including health care costs related to disease, injuries, accidents, and other consequences of unhealthy behaviors. 

What often does not appear in media stories about Prohibition is what Mr. Okrent told a reporter in 2010 about one positive outcome of Prohibition:

" . . . one of the very few positive consequences of Prohibition was the reduction in drinking. There was a very steep reduction immediately after it went into effect, but even the ensuing years of speakeasies, bathtub gin, cross-border smuggling, and every other manner of law-breaking did not bring drinking back to pre-Prohibition levels. At the end of Prohibition, Americans were consuming approximately 70 percent as much alcohol as they had in 1914.

In fact, it wasn’t until 1973 that we returned to pre-Prohibition levels of alcohol consumption, and only a few years later the per capita consumption figure began to decline again. Even now, we’re only inching our way back to the 1914 high-water mark.

One figure we’ll never reach again: the 7.5 gallons of absolute alcohol the average American drank in 1830 – the equivalent of 90 fifths of 80-proof liquor, or nearly three times as much as we consume today."

Don't get me wrong -- I do not think that we should go back to the days of outlawing alcohol use.  However, I think his statement points to the need for a debate that includes all of the facts.  We've heard plenty about how Prohibition failed, we need to hear more about how Prohibition and other policies may have created change for the good. 

The New York Times introduces their debate about sugary drinks by asking, "But is the government's role to change people's behaviors and make them live healther lives?  And if so, what's the most effective way to do so?"  It's an important debate that couldn't be more timely.

No comments: