Obesity and health care

McCardle is right that the government should not be in the business of hectoring people to lose weight, and I still affirm that "being fat" is one of the last vestiges of culturally and legally accepted discrimination. But I can tell you that she's wrong that "making vegetables available" doesn't work. I lived for several years above 120th Street in Manhattan and finding decent food to prepare and eat was a major chore. Far easier to go pick up something salty in a can down the corner at the bodega. And Ambinder's thoughtful rejoinder in exactly right. The whole thing is worth reading, but here's a snippet.

Labling obesity a "problem" isn't a behavioral intervention: it's a social structure intervention. And here's where the individual model really breaks down, even for those who don't blame obese people, per se, for their obesity. Obesity is highly correlated with socioeconomic status. And it is a most acute problem among young minorities: African American women, Mexican-American boys, and Native American children have much higher rates of obesity than white children do. Poor kids tend to be more obese than wealthier or middle class children. The reason for these disparities are both obvious and counterintuitive: in general, people tend to eat what they can, which means that they're buy the food they have access to. Wealthier people and people living in suburbs have access. Geographic location often correlates with lifestyle; history and social norms tend to be different, too, among ethnic groups.

McArdle is right that it it's not fair for government to lecture people about weight loss and exercise, but she's right for the wrong reason: policy choices -- ag subsidies, zoning laws, education and budget priorities -- create a flow that, absent any intervention, are sweeping many young kids, particularly poorer kids of color, into obesity. Government's role isn't to scold; it's to make better policy choices. She's wrong about the interventions, too: some, like a physical education project in Somerville, Mass., seem to be working. Taking fast food vending machines out of schools and weighing children at least once a year has arrested the obesity growth rate in Arkansas. Nationally, the obesity growth rate also seems to be be slowing.

Silencing the surgeon general

Why should that post be any freer from the political manipulation of the Bush administration than, say, Commerce Secretary?

"Anything that doesn't fit into the political appointees' ideological, theological or political agenda is ignored, marginalized or simply buried," Dr. Richard Carmona, who served as the nation's top doctor from 2002 until 2006, told a House of Representatives committee.

"The problem with this approach is that in public health, as in a democracy, there is nothing worse than ignoring science, or marginalizing the voice of science for reasons driven by changing political winds. The job of surgeon general is to be the doctor of the nation, not the doctor of a political party," Carmona added.

Carmona said Bush administration political appointees censored his speeches and kept him from talking out publicly about certain issues, including the science on embryonic stem cell research, contraceptives and his misgivings about the administration's embrace of "abstinence-only" sex education.

Public health, you say? Why should ideology not get in the way of good public policy?

But Carmona's statement does call to mind a question: why did he serve four years in a job the administration repeatedly undermined? This seems to a pattern among Bush appointees. At least Todd-Whitman had the good grace to get outta there, although it would have been more helpful if she had told the truth about why at the time.