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Not down with the “nanny state.”

March 23, 2010

Somewhere along the lines I made an assumption.  I assumed that public health policy was meant to save us from highly infectious and imminently deadly diseases.

I assumed that the terms epidemic and public health crisis were restricted to a drastic increase of said highly infections and imminently deadly diseases.

When I went to wikipedia to research the term public health I learned of my mistake.  Turns out that we’ve conquered most of the really infectious diseases, so modern public health is now more focused on chronic diseases.

And, very recently, focused on preventable risk factors.  To all us laypeople, that just means telling us not to do those things that are bad for us.  Like smoking.  Or eating fatty foods.  Or being sedate.  Or being really fat.

They call this trend in paternalistic policy making the “nanny state.”  Like there’s this well intentioned nanny coddling all us childlike citizens.

See, the thing is, even if you believe fat is a choice and unhealthy, I still have to wonder how you can call it an epidemic or a public health crisis.

If I go into a crowded theatre, I’m not going to infect people with my fatness and they’re not going to die in the next week or month from my fatness.  And, if I stay at home, I’m not even going to die next week or next month from my fatness.

Even those who argue that fat is unhealthy, MEAN that fat is the result of behavior that’s linked to disease.  So, the public health policies about fat, are policing behavior.

In simpler terms, they’re telling us how we should behave becasue they believe they know what’s best for us.

But I’m of the opinion, long as I’m a law abiding citizen and my behavior is not harmful to anyone else, no one get’s do dictate how I act.  And, last time I checked, being fat was not against the law.

If you insist on believing fat is a choice, then you need to know that I FIRMLY believe it’s no one’s business what I choose.

Now, you may have heard the argument that fat people are a burden becasue they cost the healthcare system money.  Or fat people are a burden because they may one day need their families to take care of them.

But fat people are not the only group that this argument could be made about.  What about the elderly.  And the disabled.  And let’s not forget other people that choose to participate in dangerous behavior. Like motorcyclist or mountain climbers or firemen.

It sure seems like the arguments against fat include an undertone of disdain.  Fat people are not only to blame for their behavior but they’re also disgusting and they deserve what they get.

I have a problem with the suggestion that fat people don’t deserve equal access to health care or health insurance.  That those of us that are fat should earn our right to equality by loosing weight.

I mean, sure, it’s very American of me to think I deserve equal rights.  But, I do.  I don’t think I should be treated like a second class citizen becasue of my weight.  I deserve the same services that everyone else gets no matter how fat I am or how fat I get.

And it really doesn’t matter if fat is a choice or not a choice when it comes to my rights.

20 Comments leave one →
  1. March 23, 2010 11:43 am

    I agree that I have the right to choose to live my life however I want to. I agree that it is no one’s business other than my own on how I do this.

    The sad truth is that when people bring up that fatties take an unfair amount of resources from out health insurance system, they truly believe that we are making a choice that costs them money.

    As Shannon says, we need to educate folks. I think that the moral panic about fatness has so many dimensions, the cost of healthcare is just one of them.

    I think the Nanny State is going to grow and grow and grow. The moral panic will fuel it.

    Logic, science and free speech are some of the tools we will need to hone to educate and counter the misinformation that will lead to the nanny state enforcing its will against the fatties.

    Sadly, I think that we are not going to convince our opposition. I think that the best we can do is help our fat brothers and sisters find the self acceptance that our fat hating culture is intent on pummeling out of us.

    We are going to be subjected to more and more ridiculous oppression as we move deeper into the change of our healthcare system.

    I think the best we can do is go on record with the good science, expose the junk science and continue to network with each other for support and friendship.

    • March 23, 2010 4:04 pm

      Ivan –

      “The sad truth is that when people bring up that fatties take an unfair amount of resources from out health insurance system, they truly believe that we are making a choice that costs them money.”

      That is the part that drives me insane. You are so right, they really think that. And this is a CHANGE IN PERCEPTION. I watched the world go from not caring I was fat, to thinking that my fat was reaching into their pockets and stealing from them.

      Because, somehow, my fat is anthropomorphism and has the personality of kleptomaniac. I think I’ll name my fat George and pet it like the yeti in those Bugs Bunny cartoons.

      Sorry. Sidetrack.

      I try to have a little hope about our world. For all my love of Terminator type moves, I tend to believe that people like YOU AND I keep the world from turning to shit. We fight back.

      I don’t know when the tide will turn but I have hope that it will. I saw the change happen. I really want to believe that I will see things turn to a different direction, even if that belief is naieve.

  2. March 23, 2010 12:55 pm

    Do you think that, even if the government doesn’t directly intervene or outlaw certain behaviors, that companies, such as insurance companies, should be able to “subsidize” our fatness by charging us more for such things as insurance or airline seating or whatever?

    Just curious.


    • March 23, 2010 2:56 pm

      This is where “insurance” really gets screwy. Because in this economy… health care is a profit driven business. Profits have no place in health care, because when you go down that road, the only people anyone wants to treat or cover are people who do not need the service.

      This is why I favor centralized health care, just as I do centralized education, road building, and other large “public” works – it has to be done for the benefit of all.

      But instead, health care in this country is done for the benefit of the shareholders of insurance companies and big pharma.

      THAT should be outlawed.

      As to the airlines, etc… sadly, in our capitalist economy, they sell a service, and they are allowed to sell that service for whatever the market will bear. Private companies are currently not forbidden from acting like assholes. People have to “vote with their dollars”… that’s the price we pay for living in a capitalist economy. IF people want to change the nature of that economy, well, THAT’S going to be an interesting fight.

      • March 23, 2010 3:14 pm

        Centralized health care? Centralized education? Centralized road building?

        You’re talking about SOCIALISM!!!

        Get thee to a cash machine, you toad!


        • March 23, 2010 4:05 pm

          atchka –

          Sign me up for the toad parade.

          Wiki : “Socialized medicine is a pejorative term used primarily in the United States to refer to certain kinds of publicly-funded health care.”

          • March 24, 2010 8:22 am

            Hell yeah, it’s a pejorative term. This here’s ‘Merica and ‘Merica ain’t no Russia! In ‘Merica, it’s our God-given right to have our health treated like a rented mule, yoked to profit and beaten into submission. So, take yer Communism elsewhere ya danged hippy!


        • Bronwen permalink
          March 23, 2010 6:46 pm

          One of the things people forget when they talk about *gasp* socialized medicine is that we, in the US, already HAVE socialized medicine (before the Bill was passed on Sunday).

          It’s called Medicare and Medicaid.

          The saddest thing I saw in the last year was a group of people picketing about the health care reform bill. One of the people was an older gentleman, and his sign read, “Keep the government out of my Medicare!”


          • March 24, 2010 8:35 am

            Hey, nobody said you had to be rational or educated to be part of the rabid opposition. You just have to be filled with hate and free time.


    • March 23, 2010 3:49 pm

      atchka – Man. Big question.

      First off, two different kind of business.

      Insurance is the way the masses get health-care and I think equal access to health-care is a right. Therefore, I don’t think insurance companies should be allowed to charge extra, or deny, based on something like weight.*

      Flying is an option. There are planes and buses and boats. It is a service, not a right.

      But the way the airlines are charging extra to certain customers is clearly discriminatory. Their system is too subjective and it singles out those who LOOK FAT. And, In the past, the our legal system has supported the idea that people should not be discriminated against based on looks.

      If the airlines were practicing business in a way that was fair, like everyone get’s charged based on how many pounds they weigh, then I would still be pissed off but I’d also have a harder time considering their practice discriminatory, as is defined by the law.

      There is a whole thesis that could be written based on offshoots of your question. I tried to reign myself in cause I kept wandering off the path while writing this reply. But the above sums up what I think. Even shorter answer, “No.”

      *Here’s the thing about my viewpoint about insurance and health-care. I AM the person that masses want to leave on the side of the road to die becasue they don’t want to pay for me. I fat, poor, and chronically ill.

      I want our health-care system to be more like it is in Canada and England because I DON’T HAVE HEALTH INSURANCE. But, even when I DID have health insurance, I made choices about when I went to the doctor and when I paid for prescriptions based on how much money I had in the bank, which means I often went without.

      • Erin S. permalink
        March 23, 2010 7:23 pm

        Thats the thing that drives me insane right now, with people claiming this new bill is some great step forward as far as access to health care for the poor goes. It isn’t… this bill is actually from what I can tell WORSE than doing nothing at all!

        Because now, we have to pay for a service we still won’t be able to actually *use*. Someone working minimum wage part time, even if their health insurance is completely subsidized, is still going to be unlikely to be able to afford $30-100 for an office visit. So they are STILL going to be unable to get care for things when those issues are still in their infancy and can often be treated most effectively and for the lowest cost.

        And thats not even getting into the absurdity of thinking that people will be able to afford to pay for something that they couldn’t afford before, just because now the government is going to penalize them for not having the money in the first place. Sure, the bill says that people making under a certain amount will qualify for subsidized premiums… but how much you want to bet that their idea of subsidized premiums will come in the form of a tax break? Which is essentially useless, because that doesn’t address the fact that we still won’t have $500-1000 extra every month in the first place, even if we will be getting some of it back in the spring.

        Yes I know you can set up a savings account with the tax refund money and pay it out as needed, but lets be honest here, if it comes down to a choice between taking some money out of the health insurance premium savings account, or losing your house because your hours got cut at work and you’re short on the mortgage… nobody is stupid enough to think that being homeless is a viable option.

        Just frustrated and venting, pay me no mind heh.

        • March 24, 2010 8:44 am

          It’s not the best bill, but I think it’s the best bill we could have gotten under the circumstances. I think it was most important to win this legislative battle. Now the Democrats should have a little more room to rule the roost… that is, unless they botch it in November. Personally, I’m impressed that the Democrats were actually able to get their shit together long enough to pass this one. As we all know, Democrats are their own worst enemy.

          There was a story on NPR (it must have been On Point) where they were talking about how when Medicare and SS were being debated, they were significantly watered down from what Johnson and FDR wanted. Huge, sweeping legislation takes significant compromise, especially in this polarized environment. At least for SS and Medicare, some Republicans actually had the dignity to vote for the good of the nation and not in a sad, puerile attempt to derail the Obama Administration. The only good part is it’s going to backfire big time.


          • Erin S. permalink
            March 25, 2010 2:45 am

            Yeah I probably should have thought to mention that in actual reality I’m taking a very “this is the best we’re going to get right now, and I’ll wait and see how it unfolds because maybe it won’t be as bad as it looks on the surface” type of view.

            Don’t get me wrong, I do agree that something is better than nothing here, I really do. It’s just frustrating that it unfolded in such a way as to make me wonder if the idiots in Washington have ever even HEARD the term logic, much less have the ability to use it. If the problem is that too many people cannot afford health insurance, the solution cannot be to force them to buy it anyway. It just doesn’t make sense. And I’m gonna bet that the subsidy programs will be a lot like food stamps, in that they essentially won’t apply to people without children who are older than 19 and younger than 65.

  3. March 24, 2010 8:41 am

    I absolutely agree with your final point. I just don’t get a lot of the talk about ‘nanny state’ wrt public health policy stuff in the US. From the viewpoint of many of those in public health, obesity is a health crisis, but even so most of the actions taken amount to little more than suggestions or reminders.

    Or to ask an annoying question, are posters encouraging people to wash their hands or cough into their sleeves nanny state-esque? They’re about trying to change behavior. I mean, no one’s taking away my right to rub my hands all over the floor of the bus station and then go around touching things, they’re just reminding me that it’s not a great idea. If the gov’t forces restaurants to post calorie counts, or runs endless ads about the importance of exercise, they’re not taking away my right to order whatever I want or sit on my butt all day if I choose to. I guess I’m just not sure what exactly people mean when they use invoke that ‘nanny state’ phrase.

    Now I do have a problem with how overly-simplified a lot of public health suggestions are when it comes to weight and health. I wish they could manage to include messages about nutrition and exercise without it being all about fat.

    • March 24, 2010 3:12 pm

      attrice –

      Your right about the propaganda just being pushy and not really being good evidence to support a “nanny state” argument. I have the ability to think for myself and research issues so that I form my own opinions.

      For me, at least, the “nanny state” in relation to public health is about policy.

      Policy for medical establishments, like hospitals or doctors offices. Doctors are told to follow certain procedures and to weight the cost effectiveness of their treatments. It’s really cheap to tell fat people to loose weight and just assume that all their problems are because they are fat.

      There is a lot of stuff that goes into medical policy, but one important step on that leader is decries by agencies like the CDC and from people like the surgeon general. If they say “focus on obesity” then the people in our healthcare system listen.

      Also, agencies like the CDC fund important public health programs. And, in recent years, the CDC has shifted a lot of it’s money to focus on the “obeisty epidemic.”

      The CDC has implemented programs like a website to calculate the cost effectiveness of fat people, aimed at employers. Get thin, or you won’t get hired. Or, if you are fat, get thin or we’ll fire you. I consider that little bit of propaganda an argument for the “nanny state” idea.

      And, finally, there is the policy of business that are not being stopped becasue it’s legal to describable against fat people. Like Whole Foods giving a bigger discount to it’s thin employees as a reward. A little policy that says a whole lot about what employers are allowed to get away with.

      Now, down at the bottom here, I’m going to admit that I am not a Libertarian. I am not against ALL government involvement. I’m not against the existence of agencies like the CDC.

      I am specifically against policing personal behavior that does not directly affect other people. For these purposes “directly effect” does not mean a money trail.

      BTW…great counter point question. And you know I totally respect your right to have your own perspective on this matter.

      • March 24, 2010 4:30 pm

        Does the CDC have a lot of authority in determining how most doctors and hospitals treat their patients? Honest question cuz I have not a single clue.

        I see more of where you’re coming from now. That LEAN works site is a bit…naive to say the least. The idea that having an obesity calculator with the stated goal of encouraging businesses to put money into healthy living/obesity prevention programs kind of made me roll my eyes. Like, convincing businesses that fat people are costing them tons of money will make them spend money on wellness programs rather than just want to avoid hiring fat people? Especially when we don’t have legal protection against discrimination in this country?

        However, that link to junkfood science made me feel very confused. I suspect part of it is that the divide between those who think fat is never (or is rarely) unhealthy in and of itself and those who don’t…but I read this part that she quotes from a CDC program:

        “The program’s focus is on policy and environmental change initiatives. These initiatives help support the following ‘behavioral targets’: increasing physical activity; the consumption of fruits and vegetables; and breastfeeding initiation, duration, and exclusivity; and decreasing television viewing, the consumption of sugar-sweetened beverages and the consumption of high-calorie/low-nutrient foods. The program seeks to address health disparities and requires a comprehensive state plan.”

        with “behavioral targets” highlighted like it was a scary phrase and I was like…So what? I mean, if the issue is that the CDC believes fatness to be a health risk and that’s the problem then I get that. But if you accept that the CDC does consider fatness to be a health risk and that, in that framework, a lot of people are at risk, then their actions make sense.

        I mean, if the problem is that talking about ‘behavioral targets’ seems nefarious and like big brother-type stuff, then I would argue that the food industry’s tactics are all about changing people’s behavior. I just see programs aimed at changing an “obesogenic” environment as a balance to those tactics. So long as I’m not legally prevented from exercising a choice, that is.

        For the record, because I do think the ‘obesity epidemic’ has been overblown, I personally don’t agree with all of the public health ideas and policies aimed at curbing/preventing obesity. And I would rather have a lot of these programs divorced from the goal of decreasing weight by x amount or whatever.

        • March 25, 2010 8:36 am

          I wrote this satirical piece about that LEANworks site. It pissed me off too. I find it funny that there’s all these disclaimers that employers shouldn’t FIRE THE FATTIES. Um, yeah, that’s the message this website is sending.

          I have no problem with programs to improve health generally, but I’m with you Attrice… tying it to lower BMIs or a thinner population is counter-productive. It’s just a nationalized diet and we all know how that story ends.


        • March 25, 2010 4:15 pm

          attrice –

          Far as I can tell, the CDC’s has influence not authority. They set the agenda of what’s important to public health policy in the US and then work at the Federal and State level to push through that agenda.

          They’re like a really big, federally funded lobbyist. But they’re not a corporation, like those in the food industry, they’re a government agency. To me, that distinction make a difference.

          (I try to tackle one subject at a time, which is why wander off into talking about CDC in my original post.)

          I don’t want things to get to the point where fat is illegal. That may seem like an exaggeration, but the CDC is one of the agencies involved in pushing forward things like the food tax.

          I understand if you don’t have a problem with what the CDC is doing…but I do.

  4. March 24, 2010 9:21 am

    I have a devil’s advocate question… how would you answer people who say that universal health care is by definition a nanny state?


    • March 24, 2010 3:18 pm

      atchka –

      YOU CAUGHT ME. I’m not ACTUALLY a Libertarian.

      As I said in my reply to attrice, I use the ‘nanny state’ argument in relation to policing of behavior, not as an argument against big government.

      Some might say I’m diluting the argument or choosing the parts of the argument I like…AND THEY’RE RIGHT. I am, becasue I’m evil like that.

      Yep. Can’t really sidestep that pothole in my argument. You’re just that good, Shannon.

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