How Hard Is It to Give Up on Failed Policies?

Today is a day of transition. But even when defeat is obvious, changing direction is hard. The whole world has seen a vivid illustration of this over the last two months around the U.S. Capitol. And when ideology creeps into the science of public health, we see it there, too. One becomes committed to a course of action. Then, when efforts have failed, it can be hard to know if the policies have fundamental flaws. The temptation is great to think that the policies are sound, but their implementation has been poor. That temptation leads people to press on in futility.

So it is with strategies to reduce the impact of obesity. Two new publications reflect on what’s working – and what’s not – in very different ways.

Lessons from Taxing Sugar-Sweetened Beverages

Barry Popkin and Shu Wen Ng reflect on policies for taxing sugar-sweetened beverages in PLOS Medicine. They see a bright future for such policies:

“Taxation of SSBs is an important start to using fiscal policy to correct the large human and planetary costs of the modern food supply chain and promote improved diet and eventually health. SSB taxes to date have varied in design, and continued assessments can allow us to better understand how to improve them to sharpen their effects.”

They write that these taxes are essential for reducing obesity risk and diseases that result from obesity – diabetes, cancer, heart, liver, and kidney disease. They note that effects on health outcomes will “take years to emerge,” so they focus on changes in sales patterns as evidence for the effectiveness of these policies.

Yet they also note that these changes might not be enough:

“While these taxes specifically affect high consumers, evaluations to date suggest that the reductions affected by SSB taxes translate to 5 to 22 kilocalories (kcals) per capita per day. These levels of reductions, even if sustained, are insufficient to meaningfully impact the broad swath of health outcomes in a timely manner, although research shows that the 10- to 20-year time horizon will produce important results.”

We do see one issue with this argument. Consumption of sugar and sugar sweetened beverages has been going down for two decades. Despite this, obesity prevalence climbed relentlessly at the same time. So we wonder if more sugar taxes will ever show an effect on health outcomes.

Examining an Evidence Base

We find a sharp contrast in researchers focusing on reducing obesity in young children. Lori Scott-Sheldon and colleagues recently published findings from a systematic review and meta-analysis. Their goal is to build an evidence base of tools that work for reducing obesity in children between the ages of two and five.

They looked at 51 studies and 58 different interventions. It is a huge undertaking. But the conclusion is relatively simple. Interventions for preschool children can be effective. In particular, programs that educate caregivers about reducing screen time may be especially important.

Learning and Moving On

On this day of transition, we wonder about the possibilities for people who want to change the world to learn from experiences that don’t live up to expectations. Failed policies can offer important opportunities to learn. But only if we take those opportunities.

If we are ever to reverse the harm that obesity is doing to public health, we will need to become more objective about failed policies and more curious about strategies that might work better. Taken together, objectivity and curiosity can be quite powerful.

Click here for the paper by Popkin and Ng, here for the paper by Scott-Sheldon et al. For further perspective on learning from failures in obesity policy, click here.

Defeated. Requiem. Painting by Vasily Vereshchagin / WikiArt

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January 20, 2021