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

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June 28, 2023