Legislating health

Mayor Bloomberg was lampooned as acting more like a nanny than a mayor, but the mayor responded that the suggested ban was "purely education," because New Yorkers would still be free to buy super-sized soda if they were willing to buy it in 2 containers. He compared his proposal to other laws instituted during his administration, including banning smoking in public places, outlawing the use of trans fats in restaurants, and requiring chain restaurants to post calorie counts.

This soft drink controversy is merely the most recent illustration of personal freedoms being weighed against the health of the public. The arguments against Bloomberg's proposal, in addition to those related to personal liberty, highlight the futility of isolating this one (albeit important) contributor to overweight and obesity and raise concerns about what's next (eg, will it be the size of slices of pie or pizza?).

We have considerable evidence that laws aimed at protecting the public from unhealthful behaviors can have important positive effects. Laws mandating use of bike helmets reduce head injuries; seat belt laws prevent motor vehicle injuries, and the more vigorously those laws are enforced, the more likely seat belts will be used.¹

Data regarding the effect of smoking ban laws on the incidence of cardiac disease are difficult to interpret because it's not easy to isolate the effect of the ban from other efforts to discourage smoking, but a recent meta-analysis demonstrated significant and growing reductions in acute myocardial infarction related to those bans.²

And infants benefit as well. A study from El Paso, Texas, demonstrated that in El Paso, where smoking is banned in public places, preterm births were 23% lower than in Pueblo, where no such ban was in effect.³

As pediatricians, we welcome legislation intended to improve the health of children. Some of those laws raise concern that personal liberty is being pushed aside, however good the intention of the legislation. Perhaps New Yorkers, as well as the rest of us, should be allowed to drink as much sugary soda as they like. But if Mayor Bloomberg's proposal does nothing but highlight the adverse health effects of large quantities of empty calories, perhaps he's proven that, sometimes, public officials have to act like nannies to make a point.

REFERENCES

1. National Highway Traffic Safety Administration. Primary enforcement of seat belt use laws saves lives and reduces injuries. http://www.nhtsa.gov/About+NHTSA/Traffic+Techs/current/Primary+Enforcement+of+Seat+Belt+Use+Laws+Saves+Lives+and+Reduces+Injuries. May 1995. Accessed June 13, 2012.

2. Lightwood JM, Glantz SA. Declines in acute myocardial infarction after smoke-free laws and individual risk attributable to secondhand smoke. Circulation. 2009;120(14):1373-1379.

3. Page RL 2nd, Slejko JF, Libby AM. A citywide smoking ban reduced maternal smoking and risk for preterm births: a Colorado natural experiment. J Womens Health (Larchmt). 2012;21(6):621-627.