July 31, 2020
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The coronavirus pandemic has cast a new light on the longstanding debate over the role government plays in promoting and regulating public health.
We want to do what’s best for ourselves, but it’s not always easy. Disciplined behavior is tough when we are bombarded by advertising and social norms that makes the bad behavior attractive.
When the negative consequences of our societal actions rise to a level of national concern, it can trigger calls for government action as a means to protect us from, well, ourselves. Nothing epitomizes this point more than our health, an area where our own behavior has the most significant impact.
Take smoking. After decades of mounting evidence on the health effects of cigarettes, warning labels were added to packaging, followed by smoking bans on flights and at public buildings and restaurants. Government regulation, education and private sector efforts combined to reduce the incidence of the habit.
It is a case study in the application of government intervention based on science and changing values among the American public. What once may have been viewed as an imposition on an individual’s rights has morphed into an accepted way of life that protects our health.
Most recently, COVID-19 has shined a light on behaviors widely considered necessary to stay healthy. By now, they are etched into our brains, or in the case of masks, displayed across our faces. Even with constant advisories offered by medical experts, adoption is hardly universal. Videos of young people partying without masks or social distancing are far too common, and increasingly evident in COVID-19 infection counts.
Paralleling COVID-19’s case study in behavior change is the obvious question of government intervention. Public officials at all levels are confronted with the task of formulating a response to protect their constituents, prompting a fierce intergovernmental debate on responsibility for action, and responses that range from voluntary advisories to executive orders that carry the force of law. They represent a mix of science, resistance, economic desperation and political ideology.
Regardless of how you feel about government control, one thing is certain: the pandemic has cast a new light on the debate over the role government plays in keeping us healthy. It's a debate that will intensify as America faces the impact of another alarming health crisis, obesity, where personal behavior also plays heavily.
First, let me draw the distinction between the health of Americans and our health care system. My focus here is on a person’s health. I will leave the means by which we pay for medical care to others. That said, there are a wide range of health regulations that go unnoticed, a staple of American safety and health security.
Since 1946, the federal government’s Centers for Disease Control and Prevention, an organization on the forefront of the pandemic, has worked to make it easier for all Americans to make healthy choices. Beyond studying disease, the CDC promotes and provides educational materials on eating well, being physically active, avoiding tobacco and excessive drinking, and getting regular health screenings.
Further, the federal government also oversees such health-related activities as the inspection of meat, poultry and other foods; the regulation of drugs, biological products and medical devices; and the regulation of biological agents that have the potential to pose a severe threat to public health and safety.
State governments regulate hospitals, license physicians and oversee a number of medical services like nursing homes. Local governments operate health clinics, inspect restaurants and also perform health education.
Together, Americans rely on a network of federal, state and local agencies to keep them safe and healthy – largely without controversary. So, when do government regulations designed to protect us begin feeling intrusive? That depends.
In November 2019, Gallup published a report showing Americans hold split views on the role that government should play in solving problems. There is no one-size-fits-all view of government’s role. COVID-19 has certainly provided a taste of that debate.
Both near and longer-term threats to our health will fuel the debate over the need for government action.
Of most immediate concern of course is COVID-19. According to a study from the Harvard T.H. Chan School of Public Health, intermittent periods of social distancing and mask wearing may be needed for another two years to keep the number of COVID-19 cases from overwhelming the health care system. With pandemic fatigue increasing, governments may require a heightened degree of compliance to control nonconforming individuals.
Another concern, the growth of obesity, will have increasing impact in the not too-distant future. During the COVID-19 crisis, a number of studies have pointed to obesity being a notable risk factor, and often the primary risk factor for younger patients. A Harvard study says that by 2030 nearly 1 in 2 adults will have obesity and the prevalence will be higher than 50% in 29 states and not below 35% in any state. Nearly 1 in 4 adults is projected to have severe obesity, which is likely to become the most common body mass index category among women, Black adults and low-income adults.
Obesity places individuals at greater risk for a host of health issues including hypertension, type 2 diabetes, coronary heart disease, stroke and many types of cancer, according to the CDC.
The confluence of COVID-19’s lingering effects, perhaps a successor virus, and obesity is certain to spur a public debate on curbing individual behavior and those elements of the economy that promote unhealthy lifestyles.
Consider the various constituencies: employers forced to spend more on health care, dietary advocates blasting fast food companies and soft drink manufacturers, and student proponents crying for more healthy foods in our schools.
We have already seen proposals to tax sugary drinks and add more nutritional information to food packaging. As our health problems grow, so too will the calls for government action as a means to change the personal behavior that seems beyond our grasp. Along with these voices will be the backlash decrying government overreach.
How much intervention is needed remains to be seen, but the data, and history, suggests that Americans will need some protection from themselves to be healthy.
Louis Bezich, senior vice president of strategic alliances at Cooper University Health Care, is author of "Crack The Code: 10 Proven Secrets that Motivate Healthy Behavior and Inspire Fulfillment in Men Over 50."
