Wednesday, June 6, 2007

Wine: Menace to Public Health?

So much for the notion that wine is good for your health. While in America fatty foods appear to be the next target of the public health crusaders, England seems to be gearing up to take on wine-drinking in the privacy of one's own home.

Today’s strategy, by the Home Office and the Department of Health, broadens the Government’s offensive against excessive drinking, with the focus moving beyond teenagers and the binge-drinkers to include those regularly sipping wine at home.

The motivation seems to be to save the National Health Service treatment costs for liver disorders, which is a slightly different emphasis from the straightforward public health rationales offered in the United States for bans on smoking, trans-fats, etc.

I'm not sure how I stand on this. Generally I am pretty sympathetic to efforts to reduce unhealthy behaviors. And I'm definitely in favor of smoking bans in restaurants and bars. But when the fight against trans fats starts to proscribe foods I like, I become a lot less enthusiastic. Ditto for wine. Of course this opens me to charges of hypocrisy, but there's a crucial difference between banning smoking and banning trans fats or "excessive" wine consumption.

The trouble with these public health campaigns is that they justify restrictions on "risky" behaviors by reference to social harms such as increased obesity rates or health-care costs that are easily identifiable (and often easily quantifiable) by third-party observers, while the benefits are appreciated by no one but the consumer and are totally unquantifiable. This creates a tendency toward overly-rigorous public health rules.

Moreover, it's not clear to me that the fact of public provision of health care is a legitimate justification for enforcing certain lifestyle choices. The idea of government-sponsored health care is to provide people a guaranteed minimum safety net no matter what their circumstances. That shouldn't be denied to someone who is predisposed to like wine anymore than it should be denied to someone who is predisposed to breast cancer. Of course, people can choose not to drink wine while they cannot choose not to have breast cancer, but to embrace that logic is to turn the arguments for public social provision on their head. The idea of the social insurance state is to provide benefits to citizens, not to justify re-ordering their lives. That the social insurance state has to operate in a world of individual lifestyle choices is just one of many factors that justify generous public health care expenditures. (The libertarian flip-side of this argument would be to cite it as a reason not to have public health care expenditures at all.)

Restaurant smoking bans are different in that their motivation is not only to save health care costs but to protect specific other individuals (ie those sitting next to the smoker) from the direct effects of smoking--ie to allow them to enjoy their Meursault without interference from noxious fumes. That's a far more legitimate goal and one I can embrace.

Of course, none of the specific proposals currently on the table in England are all that problematic on their own. The stuff about better labeling of alcohol content on bottles and in pubs isn't particularly objectionable. "Hard-hitting advertising campaigns" about the dangers of alcohol and targeted against so-called "binge"-drinking seem more foolish than anything else. And by definition, no one is planning to defend "excessive" public drunkenness. Rather, the problem is that these sort of policies are only the first steps rather than the last. Clearly the goal of this campaign is to change attitudes over time. "Excessive" is a term that lends itself to shifting definition--what we consider acceptable today may well become defined as "excessive" tomorrow. What I find particularly menacing is the suggestion that the ultimate targets include people drinking at home. While none of the currently proposed policies will prevent you from drinking in your home if you so choose, they are designed to generate a consensus willing to support more far-reaching policies in the future. That does not bode well.


lukeness said...

And even more importantly in the case of restaurant and other public place smoking bans, the motivation is not only to protect other patrons, who could, after all, simply go somewhere else, but to protect the workers in that establishment from a significant workplace hazard.

Anonymous said...

Please remember, England and Britain and UK are not synonymous (ask any Scot). In this instance, you need to use the UK, as it is a nationwide initiative.

Anonymous said...

"The idea of the social insurance state is to provide benefits to citizens, not to justify re-ordering their lives."

Come on Jeff, you're smarter than this. I'm hardly a right wing crazy and tend to think that people stupidly employ econ 101 arguments too often in the political arena, but this is just silly because it completely ignores that people respond to incentives such that having a social welfare state will inevitably cause people to reorder their own lives. You seem to assume that we should all act according to what you (debateably) term our genetic predispositions. But the amount of wine I drink will inevitably be affected by the costs I will have to bear as a result. If the costs are going to be borne by society, I have an incentive to drink more. I don't think this outweighs the arguments in favor of a safety net, but to treat the decision to adopt a social welfare state as independent from behavioral choices is just naive. Moreover, if society is going to bear the costs of the increased drinking that social welfare policies encourage, shouldn't it be allowed at least to regulate far enough to counter-balance that effect?