New York State's highest court ruled on June 26 against New York City's proposal to limit the size of servings of sugary sodas. It's a ruling that raises real concerns about limiting the ability of municipal health departments to tackle 21st-century public health challenges. It also underscores the importance of creating a public climate in which those health challenges -- and the most effective approaches to disease prevention -- are better understood and appreciated.
What was so remarkable about the city's proposal is that it was only to limit the size of individual servings -- not to ban the drinks or to restrict the number of servings that could be purchased. It would simply have eliminated huge servings at restaurants, movie theaters, and stadiums. Yet that simple evidence-based proposal generated litigation over the role of health departments, and in this case, New York City's authority to implement it.
While the opposition, led by the soft drink industry, won in court, the more important lesson is that the public will need to be increasingly aware of the threats to its health, and the costs that those threats impose. The soft drink industry has protected its profits, but the public will lose if the epidemic of obesity continues unabated.
More than one-third of U.S. adults are obese, and the cost is extraordinary, according to the Centers for Disease Control and Prevention. The estimated annual medical expense of obesity was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight. And that's just the cost of obesity itself.
It is also clear that obesity is a cause of other diseases, conditions such as heart disease, stroke, type 2 diabetes and certain types of cancer, which are among the leading causes of preventable death. All of these take a toll on our health and productivity and add to the cost of preventable disease.
It is the responsibility of our health departments, our cities, and our states, to protect our health. New epidemics require scientifically based solutions to prevent disease effectively; some of those approaches must be designed to protect the whole population. With the courts placing constraints on our ability to take evidence-based, population-level approaches, the burden will shift to individuals, who will need to be especially thoughtful in considering how to protect themselves. Unfortunately, individual will power is powerless to control an epidemic.
Measures that limit choices are typically controversial and often opposed strenuously by special interests. Look at the opposition over decades to reducing smoking. But that doesn't mean that they aren't in the public interest. Often it takes time for the public to adapt, and that may be true even in the case of soda sizes.
That's why it's so important for the public to value the ever-changing role of health departments. Traditionally, health departments have been responsible for the operation of public hospitals, for responding to and preventing outbreaks of infectious diseases, and for ensuring safe food and water, workplaces, and sanitation systems. To that we must now add, preventing chronic diseases and conditions, including obesity.
One of the central lessons of public health is that more than half of health is created by factors that are not fully in the control of the individual. If streets are not safe or sidewalks are missing, the ability to go out and walk or exercise is limited. If fresh fruits and vegetables are not readily available, the opportunity to prepare a healthy meal is reduced. By the same token, if huge soda servings are the most readily available, they will be purchased -- and once purchased, they will be fully consumed.
In the 21st century, the future of health across the life course will be determined by the actions we take collectively, as societies and as a world, to create the conditions that make healthy choices the easier choices, and thus make health more likely -- and in some cases even possible. This latest court ruling limits what cities can do by executive decision, so more will need to be accomplished legislatively. In that arena, of course, the influence of special interests is especially powerful.
The public will, therefore, have to make up its own mind as to who is really looking after our interests. As New York City Health Commissioner Mary T. Bassett stated on Thursday, "Today's ruling does not change the fact that sugary drink consumption is a key driver of the obesity epidemic."
Accepting a smaller serving of soda is a small price to pay, when the alternative is a far greater cost -- and one that's growing steadily. With this court ruling, the public is still left bearing that growing cost.