Blog entry by Meguid El Nahas
A debate has been raging for years between those who advocate health through public and governmental policies and those who feel the public should be informed and left to choose what is best for its health.
A number of reminders have recently highlighted such dilemmas.
In a March issue of the NEJM, Kotchen and colleagues remind the readers of the issue of Dietary Salt in health and disease. http://www.ncbi.nlm.nih.gov/pubmed/23534562
They put forward an extremely balanced review of the arguments for dietary salt restrictions and the worldwide recommendations to reduce dietary salt intake (sodium chloride intake to around 5g/day). They also put forward the reservations some have about translating science into public policies as well as the potential risks associated with overzealous implementation; a J-shapes curve may for instance characterize the relationship between salt consumption and cardiovascular morbidity and mortaility.
It is also notable that in spite of worldwide salt restriction recommendations and public policies, that the public has not followed as shown by data from the US showing little change over the last decade in salt consumption; remaining around 8.5g of sodium chloride/day!? This is to a large extent the reflection of the very high salt content of processed and packaged food as well as the quality of fast food provided by restaurants and fast food chains...cheap food is salty! http://www.ncbi.nlm.nih.gov/pubmed/20577156
This debate and limitations of public health policies brought into focus the current difficulties the mayor of New York City (Michael Bloomberg) is facoing with his Soda Ban; the ban on serving in NY city sugary beverages in containers larger than 16 ounces (475ml). This initiative was successfully challenged in court as a judge judged it to be..."arbitrary and capricious...". Clearly, Big Soda (industry) won the first round! Mayor Bloomberg is appealing...
Big Soda like Big Tobacco industry before it is fighting back. Big Tobacco (industry) has fought ban on smoking in public places for decades only to loose such a battle in recent years when a growing number of countries have implemented a no smoking policy in public places. Whilst such ban remains subject to scrutiny and its impact on public health difficult to evaluate for years, initial analysis suggest major health benefits in the short and long term: http://www.ncbi.nlm.nih.gov/pubmed/21976052. In the meanwhile Big Tobacco (industry) has moved on to promote smoking in emerging economies where it is rapidly rising, along with the risk of cardiovascular disease!
The questions I really ponder are:
1. Is science directly translatable to public health policies?
2. Are public policies the answer to public health issues?
3. Are public health policies effective?
4. Why is the public so reluctant to implement them?
Ultimately should the Public be Forced, Coerced or Taxed to a better Lifestyle or Informed and Educated to choose for Himself...?