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  • Writer's pictureNick Allen

How can we improve health at the societal level?

Those who go out of their way to read health-related material and follow the latest recommendations are (unfortunately) a small sliver of the population. What about everyone else? Our goal is to improve health at both the individual and the population level, so this is something we think about often. The reality is that, with some exceptions, health at the societal level is determined by policy.


The classic success story in the United States is tobacco smoking. Though smoking remains a major health concern, especially among those of low socioeconomic status (SES), the progress is undeniable. The percentage of U.S. adults who smoke cigarettes has declined from 42% in 1965 to 11.5% as of 2021. What led to this progress? It took a multi-pronged attack from the U.S. government once the data had clarified that smoking causes lung cancer and other adverse health outcomes.


Although controversial, taxes on cigarettes were undoubtedly a crucial component of this attack. Not only did they discourage use, especially among young and low SES individuals, but they also raised money which was funneled into other anti-smoking measures. This tactic is being tried again in the present, with multiple cities in the U.S. enacting variations of a sugary drink tax in the last decade. Though smaller scale, these financial measures again seem to be succeeding.


Other laws and government tactics also proved to be crucial to the reduction of smoking. Ever seen a commercial for cigarettes? If you have, it was likely before 1971. Since then, advertising of these products has been illegal in the United States. Replacing these ads were aggressive campaigns against smoking, showing horrifying images of smokers following a cancer diagnosis. While no one enjoys these “scare tactics,” it’s difficult to dispute their efficacy.


Layered on top of these measures were clear warning labels on tobacco products, smoke-free zones in public places and workplaces, youth anti-smoking education programs, and more. A critical element was the culture change that occurred over these decades. Smoking went from the norm to something that was frowned upon.


I’m of the opinion that if we’re going to see serious improvements in longevity and quality of life on a societal level, it’s going to take a similarly aggressive attack on the part of the government against today’s clear killers — sugar, inactivity, and depression/anxiety come to mind. And don’t worry, I’m not suggesting we take sodas off the market or mandate that every citizen take 10,000 steps/day.


As with tobacco, these policies aren’t intended to take away freedoms or limit one’s ability to choose what’s best for them. In many cases, they’re just leveling the playing field. Take sodas, for example. A bottle of Coke is cheaper than a carton of milk, and probably a third of the cost of a high-quality protein drink. If these things were similar in cost and the soda had a clear warning label, we’d definitely push some people in the right direction. On top of this, I think there’s already a culture shift going on towards avoiding these high-sugar drinks. Adding fuel to this fire through strong advertising campaigns and youth education programs would undoubtedly help accelerate the progress.


While these strategies won’t completely eradicate obesity or the other major health threats of our generation, there’s no reason that we shouldn’t at least start by employing the tactics that have worked in the past. So why haven’t we done so already? Well, sticking with the sugar example, companies like Coca-Cola and Pepsi have a remarkably loud voice in Washington. Overcoming their influence will require legislators to work together, across party lines, to prioritize public health. Though some in Congress seem interested in making this happen, thus far the effort has not been anywhere near as strong as it will need to be to substantially improve longevity and quality of life at the population level.






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