Governments can try to counter obesity through preventive regulations such as sugar taxes, which appear to raise costs or reduce options for consumers. Would the regulations improve the welfare of adult consumers? The regulations might improve choice sets through a mechanism such as reformulation, but the scope for such improvement is limited. Otherwise, a paternalistic argument must be made that preventive regulations would improve welfare despite reducing choice. This paper connects arguments about obesity, health, and choice to a philosophically plausible (...) view of welfare. On the negative side, two errors to avoid are failing to see the limited value of health and thinking that findings of irrationality would alone settle arguments about welfare. On the positive side, preventive regulations could make people better-off if welfare is the satisfaction of preferences and if preventive regulations could better satisfy preferences by overcoming certain forms of irrationality. The leading evidence is from widespread attempts to lose weight. However, at least for the United States, most adults are not trying to lose weight, and that casts doubt on whether they would benefit from preventive regulations. If they would not, that seems a strong albeit not decisive reason against these regulations. (shrink)

It is generally wrong to manipulate. One leading reason is because manipulation interferes with autonomy, in particular the component of autonomy called ‘independence’, that is, freedom from intentional control by others. Manipulative health promotion would therefore seem wrong. However, manipulative techniques could be used to counter-manipulation, for example, playing on male fears of impotence to counter ‘smoking is sexy’ advertisements. What difference does it make to the ethics of manipulation when it is counter-manipulation? This article distinguishes two powerful defences of (...) counter-manipulative health promotion: that the counter-manipulation would prevent manipulation occurring, leaving people unmanipulated; and that the counter-manipulation would make people healthier without being any more manipulated than they would otherwise be. The article explains how counter-manipulation might work and the limits to its scope. The upshot is that counter-manipulative health promotion could respect the independence people are owed in virtue of their autonomy. However, autonomy is not the only consideration, and the article discusses further potential problems. Counter-manipulative health promotion might be misapplied, it might undermine trust, it might infringe on some norms for role behaviour and it might encourage a regrettable social practice. These objections are likely to be decisive against the counter-manipulation in some but not all cases. (shrink)

Obesity is often considered a public health crisis in rich countries that might be alleviated by preventive regulations such as a sugar tax or limiting the density of fast food outlets. This paper evaluates these regulations from the point of view of equity. Obesity is in many countries correlated with socioeconomic status and some believe that preventive regulations would reduce inequity. The puzzle is this: how could policies that reduce the options of the badly off be more equitable? Suppose we (...) distinguish: (1) the badly off have poor options from (2) the badly off are poor at choosing between their options (ie, have a choosing problem). If obesity is due to a poverty of options, it would be perverse to reduce them further. Some people in public health say that preventive regulations do not reduce options but, I shall argue, they are largely wrong. So the equity case for regulations depends on the worst off having a choosing problem. It also depends on their having a choosing problem that makes their choices against their interests. Perhaps they do. I ask, briefly, what the evidence has to say about whether the badly off choose against their interests. The evidence is thin but implies that introducing preventive regulations for the sake of equity would be at least premature. (shrink)

There have been calls for some time for a new approach to public health in the United Kingdom and beyond. This is consequent on the recognition and acceptance that health problems often have a complex and multi-faceted aetiology. At the same time, policies which utilise insights from research in behavioural economics and psychology have gained prominence on the political agenda. The relationship between the social determinants of health and behavioural science in health policy has not hitherto been explored. Given the (...) on-going presence of strategies based on findings from behavioural science in policy-making on the political agenda, an examination of this is warranted. This paper begins by looking at the place of the SDoH within public health, before outlining, in brief, the recent drive towards utilising behavioural science to formulate law and public policy. We then examine the relationship between this and the SDoH. We argue that behavioural public health policy is, to a certain extent, blind to the social and other determinants of health. In section three, we examine ways in which such policies may perpetuate and/or exacerbate health inequities and social injustices. We argue that problems in this respect may be compounded by assumptions and practices which are built into some behavioural science methodologies. We also argue that incremental individual gains may not be enough. As such, population-level measures are sometimes necessary. In section four we defend this contention, arguing that an equitable and justifiable public health requires such measures. (shrink)