Health Law and Ethics

HSC3001: Health, Law and Ethics: AT2: Major Paper

You are the advisor to the Victorian Minister for Health. The Minister has asked you to develop a policy statement for Obesity.

The significance of Obesity:

Obesity and overweight is defined by the World Health Organization as an excess in the amount of fat accumulation within one’s body, which has the potential to cause negative health outcomes for that individual (2013). Body Mass Index (BMI) is the most commonly used tool to measure and classify a person’s weight and whether they are overweight or obese (Australian Institute of Health and Welfare, 2013 & WHO, 2013). This measure identifies that any individual who is equal or greater than 30kg/m2 as obese and anyone within the range of 25kg/m2 and 29kg/m2 is overweight (WHO, 2013).

Obesity is a serious concern within Australia, and in particular Victoria. Although ranked 25 in the world in terms of obesity (Ng et al, 2014), Australia is ranked one of the biggest and obese nations in the developed world, taking over from the United States of America (Monash Obesity and Diabetes Institute, 2013). In the past 30 years, obesity rates within Australia have increased by more than 80% (Ng et al, 2014), making this a significant and serious issue. Today, within Australia, almost one in three people are classified as obese, creating enormous repercussions and pressure on the government financially. According to a variety of studies and research, it is estimated that obesity costs Victoria approximately $485 million in direct health care costs and up to $800 million in excess health care costs per year (Access Economics, 2008 & Colagiuri et al, 2010). For Australia as a whole, obesity is costing the government around $21 billion annually, and thus there is a serious need to reduce obesity rates for numerous reasons.

Obesity not only contributes significantly to our burden of disease financially, but it is also a risk factor for many other diseases. Those who are obese are significantly at a higher risk of being diagnosed with cardiovascular disease, type 2 diabetes mellitus, hypertension, stroke, dyslipidemia, osteoarthritis and some cancers (Must et al, 1999). The following table (table 1) illustrates the relative risk that obese and overweight individuals have to other specific health conditions.

Table 1: The Relative Risks per unit increase in BMI by age and specific conditions

Source: Public Health Group, 2005

 Due to the significant risk that obesity can predispose individuals to, this further puts a pressure on the government, both financially and physically due to more people suffering from disability. As a consequence of this, targeting the issue of obesity within Victoria is a key factor in reducing other associated conditions and improving the overall health of Victorians.          

Ethical Issues on Obesity:

Paternalism

There are a number of ethical issues surrounding the debate on obesity and intervening on this issue. One major issue is paternalism and the idea of intervening on people’s own health and wellbeing when they do not want this (Holm, 2007). Finnish philosopher, Heta Häyry (1991), has identified and distinguished three separate forms of paternalism: hard paternalism, soft paternalism and maternalism. Understanding these three separate forms is crucial when analysing and intervening in public health issues. Hard paternalism is one extreme, which involves direct enforcement or influence; soft paternalism involves providing unwanted information and providing options for change or action; and maternalism involves creating change or action via using guilt (Holm, 2007). These three practices can be utilised within public health and intervention all in separate ways.

In regards to the obesity issue, it is hard to know when to draw the line when intervening. The constant deliberation of information to the general public on the harms of junk food by providing evidence and studies that illustrates the negative impact that these foods can have on our body is an example of maternalism; using guilt to try and create change. Moreover, encouraging those to make healthier choices by taxing junk food or decreasing the promotion of junk food on television and other forms of media is a soft paternalism method. Whilst completely banning the production of unhealthy foods to ensure that everyone is eating healthier would be classified as hard paternalism. The latter two issues raise some ethical concerns as they begin to take away an individual’s choice. It is difficult to suggest a hard paternalism method, as people have the right to their own decisions and the freedom to consume what they like. By completely banning fast food and other unhealthy options such as sugary drinks would be a breach of our human rights. However, utilising a soft paternalism method is one way of targeting this issue. By taxing junk food, this still provides the people with a choice. Although on the more extreme end of soft paternalism, people are still given the option on the matter and there is still a sense of control by the people to make their own decisions. Creating a tax on junk food still allows for decision; people can still purchase junk food, but at a heftier price, and places the onus back on themselves.