The public is very supportive of government action aimed at changing lifestyle choices that can lead to obesity, diabetes, and other noncommunicable diseases—but they're less likely to support such interventions if they're viewed as intrusive or coercive, according to a new Harvard School of Public Health (HSPH) study. The study also found that support was higher for interventions that help people make more healthful choices, such as menu labeling requirements, than for interventions that penalize certain choices or health conditions, such as charging higher insurance premiums for obese individuals.
"Policymakers everywhere are looking for ways to use legal and policy levers to stem the rising tide of health care costs related to obesity and chronic disease," said Stephanie Morain, a doctoral candidate in health policy at Harvard University, who led the study. "They should be heartened by these findings—the public does see this as an appropriate role for government." That public support is important, the study authors wrote, because it may affect people's willingness to comply with the law.
The study appears in the March 2013 issue of Health Affairs.
In recent years, lifestyle choices such as overeating, physical inactivity, and alcohol and tobacco use have led to troubling increases in chronic ailments in the U.S. In response, health departments and legislative bodies have adopted policies aimed at combating the behavioral risk factors that lead to ill health, such as banning trans fats in restaurants, raising taxes on cigarettes, and screening schoolchildren for high body mass index.
But some have criticized such interventions, saying that they impinge on personal choice and exceed the scope of governmental authority. So the HSPH researchers decided to examine which factors play into public support for so-called "new-frontier" public health initiatives.
For the study, co-authors Morain and Michelle Mello, professor of law and public health in the HSPH Department of Health Policy and Management, analyzed the results of an online survey of 1,817 American adults conducted in October 2011 by Knowledge Networks (now part of GfK), a professional survey organization. In the survey, respondents were asked about their support for various types of public health policies, as well as the factors that influenced their support. There were questions about seven noncommunicable health conditions and 14 specific strategies to address them.
The researchers found a high level of support—between 70% and 90%—for government action on each of seven areas: preventing cancer, heart disease, childhood and adult obesity, and tobacco use; helping people control their diabetes; and reducing alcohol consumption.
Support was quite high for interventions that facilitate healthy choices, such as increasing the affordability of fruits and vegetables or requiring more instruction in public schools about the health risks of obesity. However, support waned when government actions were viewed as focusing on penalties or on limiting choices—such as adding insurance surcharges for obese individuals or making it illegal to smoke in private spaces.
The researchers also found that African-Americans and, to a lesser extent, Hispanics, are significantly more likely than whites to support government action to address noncommunicable diseases.
In addition, the survey indicated that people are much more supportive of government public health initiatives if they believe that "people like me" can influence public health priorities and if they think that public health officials understand the public's values.
"The message for public health officials and legislators is, if you want the public to buy into these legal interventions, you've got to engage them early on," said Mello. "You've also got to communicate about policies in a way that resonates with the public's values. For example, how does the intervention support healthy choices? Why is it fair?"
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"Survey Finds Public Support for Legal Interventions Directed at Health Behavior to Fight Noncommunicable Disease," Stephanie Morain and Michelle M. Mello, Health Affairs, March 2013.