25 April 2013

Obesity is like poverty or climate change: there's no obvious cause

Everyone thinks he or she understands obesity. Believe it or not, this is one of the harder medical conditions to comprehend. Why? Obesity is a combination of several factors: physics, biochemistry, endocrinology, neuroscience, psychology, sociology, and environmental health, all rolled up into one problem. Robert H Lustig, Fat chance, December 2012
Obesity is much like any social or environmental problem. There's very little point in government picking a particular theory or approach and backing it with taxpayers' funds. There's no obvious causal relationship. The best government, or any interest group can do, is to stimulate diverse approaches that adapt over time to changing circumstances and our expanding scientific knowledge.

It wasn't always like that. In health care it's now widely accepted and has been clearly shown that, for example, decent sanitation is essential for good physical health. Society and the environment were, generally, less complex in those days. But there is a lot more complexity now. Government would do better, when dealing with very complex concerns, to target outcomes, rather than the supposed means of achieving them.

Social Policy Bonds allow government to do this in ways that channel market forces into socially useful directions. When it comes to obesity, government should think clearly about what it wants to achieve, then reward those approaches that most efficiently achieve it. It might be that obesity itself is not a problem, but rather a marker of other health problems, as Dr Lustig says in his book. In that case, government should directly target those health problems for solution.

A Social Policy Bond regime would not prejudge the ways of tackling complex health problems. It would focus entirely on society's health goals and put in place a system of cascading incentives rewarding those who achieve them in the most cost-effective ways. For more information, check out my book or other papers, which can be freely downloaded from my Social Policy Bonds website.

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