U-Turn Left Straight Ahead

Difficulty in Reversing a Failed Public Health Policy

In his scientific autobiography, Max Planck wrote that “A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it.” Economist Paul Samuelson shortened this to say “science progresses one funeral at a time.” As cynical as this view might be, it certainly seems to apply in the application of science to public health – and in particular in coping with the complex chronic disease of obesity. So repeatedly, we see the great difficulty of reversing a failed public health policy.

The Case Study of BMI Report Cards in School

A new paper by Mary Kathryn Poole and colleagues offers a very helpful analysis of this difficulty in the case of BMI report cards in Massachusetts public schools. They conducted a qualitative study of the process that led to its implementation and then to its reversal.

First and foremost, they found that scientific evidence did not really drive this wild ride – either for adopting or reversing that public health policy. Instead, it was social pressure that spurred adoption of a problematic policy. In turn, that led to inconsistent implementation and widespread dissatisfaction. Then media, social, and political pressure led to withdrawal of this flawed policy.

Science was an afterthought. It took years for unmistakable evidence to accumulate, showing this policy has no merit.

Hanging On to Flawed Policies for Nutrition and Obesity

Unfortunately, this pattern repeats itself with public health policies related to nutrition and obesity.

For decades, public health advocates have advocated for policies to educate, persuade, or nudge people toward making better dietary choices and thus protect themselves from obesity. Even as science made it clear that this condition is not merely the result of bad personal choices, policies based on that flawed idea persisted.

Even today, policies aimed at getting people to “make the healthy choice” are dominant. FDA is working to put nutrition advice on the front of food labels to serve that purpose. Mexico has been taxing sodas and junk food now for almost a decade. New data tells us that obesity rates have kept rising there despite this policy. Yet public health advocates insist this only means the government should “redouble efforts” with more of the same policies.

The Residue of Bias

The residue of bias seems to stick in public health policy. Even as people realize they should stop presuming obesity comes from bad choices, policies continue with  a foundation of that presumption. True believers insist that the only problem with these policies is that we should push them harder. Tax the bad foods, call it out on menus and labels, promote the good stuff – sooner or later people will start making better choices.

This is a prescription for failure in public health.

Click here for the analysis by Poole et al.

U-Turn Left Straight Ahead, illustration by มองโกเลีย๔๔, licensed under CC BY-SA 4.0

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


June 28, 2023

3 Responses to “Difficulty in Reversing a Failed Public Health Policy”

  1. June 28, 2023 at 3:02 pm, Richard Atkinson said:

    Good column. There are several quotes that I have loved, in a similar vein to yours above:

    “When the human race has once acquired a superstition, nothing short of death is ever likely to remove it.” – Mark Twain

    “There are some people that if they don’t know, you can’t tell ’em.” – Louis Armstrong

    But my favorite of all times was validated by our experience with trying to convince scientists that obesity could be caused by a virus:

    “I know that most men, including those at ease with problems of the greatest complexity, can seldom accept even the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have delighted in explaining to colleagues, which they have proudly taught to others, and which they have woven, thread by thread, into the fabric of their lives.” -Tolstoy

  2. July 07, 2023 at 8:37 pm, Patrick Bradley said:

    While it is true that the paper by Mary Kathryn Poole and colleagues found that BMI report cards in Massachusetts public schools were counterproductive this in no way discredits public health policies to promote healthier eating choices.

    There is clear evidence that food availability and choices are linked to obesity and diabetes but the benefit from public health measures takes time. A reduction in deaths from lung cancer only occurred 20 years after cigarette consumption began to decline.

    According to US Department of Agriculture data after the 1960s there was a 500% increase in soft drink consumption, a 200% increase in sugar consumption and a 20% decline in fat consumption over the next 40 years. Rates of obesity in adults increased from 10% to 35% and rates of diabetes increased by 500% over those same 40 years.

    Between 2000 and 2008 added sugar consumption declined by 25% and sugar sweetened drinks consumption declined by 40% (Am J Clin Nutr 2011;94:726-34). Subsequently by 2016 diagnoses of new cases of diabetes had fallen by 25% (BMJ Open Diab Res Care 2019;7:e000657) and the incidence of obesity had stabilized in native born Americans between 2006 and 2012.

    • July 08, 2023 at 9:07 am, Ted said:

      I am genuinely impressed that you can skim the data below and come to the conclusion that incidence of obesity has “stabilized.” Thank you, Patrick, for illustrating how tightly people will hold onto old beliefs long after they have proven to be false.
      Trends in Sugar Consumption and Obesity