2017.01.03
Tiffany Wu
Introduction
In the midst of the fast-paced, busy lives that society leads, it might be easy to overlook the place that law plays in our lives, especially with respect to our food and our weight. If you live in developed countries such as the USA or the UK or Australia, one thing you might have noticed over the years is that people are getting fatter. Data from about 10 years ago in the USA shows that obesity prevalence has increased, along with the incidence of obesity-related diseases, including Type 2 diabetes, cardiovascular disease, some types of cancer (endometrial, postmenopausal breast, kidney and colon cancers), musculoskeletal disorders, sleep apnea and gallbladder disease. As a result, obesity now accounts for approximately 400,000 deaths per year, second only to tobacco. 400,000 deaths per year was the figure from 10 years ago. Who knows what the figure is now, 10 years later?
There are three main roles that law plays in our health: (1) Regulating the healthcare system, (2) Targeting the behavior of individuals, and (3) Improving the quality of the economic, social, physical and policy environment.
(1) Regulating the healthcare system
Law plays an important role in improving the effectiveness of clinical care. An example of this is with respect to the sharing of and access to patients medical records by the health care team. Law is able to create concrete rules about sharing of patient data within an electronic health records system which gains and enjoys public trust. At the same time, these rules allow members of the health care team to best access patient data at all points of care. Regarding obesity and obesity-related diseases, New York City had an experiment where they extended notifiable disease reporting to chronic disease risk factors, through the mandatory reporting of hemoglobin A1c (glycated hemoglobin, a measure of blood glucose control). This helps to facilitate care for the estimated one-third of diabetics who are unaware of their condition.
(2) Targeting the behaviors of individuals
A much-heated area of debate is the extent to which government can use law to target the behaviors of individuals. Autonomy is so valued in some countries that any attempt by the government at using law to curb the behavior of individuals is seen by people as having gone too far. Indeed the balance is hard to draw. We value a persons autonomy to do whatever they want. But when doing whatever they want affects the rights of other people? That’s a different story. I would like to think that law has its place here.
Regarding obesity and obesity-related diseases, law is able to instruct education, financial incentives and disincentives. Food labelling initiatives encourage reformulation by food manufacturers, and educate consumers about the nutrient qualities of foods. Many people pick up a food product in the supermarket and check its list of ingredients, number of calories or fat and salt content. We may not all be nutritionists, but we have been educated enough to know that we should or should not eat something containing this or that, and food with high calories, sugar and salt are bad for you. This knowledge did not just appear out of thin air. It came from education. Furthermore, law can impose restrictions on taxpayer-funded medical procedures for obese patients and smokers, or elimination of community rating resulting in differential premiums for private health insurance, and other restrictions in coverage, based on ones obesity or health status. Law can also bring about policies that aim to nudge behavior in a healthier direction, such as imposing an additional tax on high-fat or high-salt foods.
(3) Improving the quality of the economic, social, physical and policy environment
Regarding obesity and obesity-related diseases, law can address the socioeconomic and environmental factors that are driving the increase in average weight gain. An example is advertising on television. Law imposes restrictions on advertisements of high-sugar, high-salt, high-saturated-fat foods to children such that these are only broadcast on television during certain hours. Law also gives economic incentives to employers in the workplace to encourage investment in workplace-based risk prevention and health promotion programs.
Conclusion
Law has a vital role to play in our health. Obesity prevalence has increased, along with the incidence of obesity-related diseases, including Type 2 diabetes, cardiovascular disease, and some types of cancer. As a result, people die from obesity. Three main roles that law plays in our health include: (1) Regulating the healthcare system, (2) Targeting the behavior of individuals, and (3) Improving the quality of the economic, social, physical and policy environment. Firstly, law can improve the effectiveness of clinical care by creating concrete rules with respect to the sharing of and access to patients medical records by the health care team. Secondly, law can target the behavior of individuals by instructing education, financial incentives and disincentives. Examples include food labelling, restrictions on taxpayer-funded medical procedures for obese patients and smokers, and policies which impose an additional tax on high-fat or high-salt foods. Finally, law can address the socioeconomic and environmental factors that are driving the increase in average weight gain. Examples include controlling when advertisements of high-sugar, high-salt, high-saturated-fat foods are played on television, and giving economic incentives to employers for investment in workplace-based risk prevention and health promotion programs. Indeed, law has a role to play in how fat you are.