Is a fat tax fair?

I’d been to write on this since a few weeks ago when I caught myself in an interesting, uh, thought quandary. I’ve long been a big proponent of taxing cigarettes, and taxing them heavily. I wrote my college application essay about my experience campaigning against Proposition 10, which would have repealed California’s tobacco tax in 2000, and have since then defended to anyone listening the right of the state to tax something that caused such a burden on the state (in health costs for smokers and those exposed to secondhand smoke). The initiative failed miserably; it was hopeless from the beginning and

Cigarettes are addictive

Cigarettes are addictive

Big Tobacco ended up losing 72% – 28%. But I do remember my own dad threatening to vote for the measure: his argument was that individual freedoms are important, and people should have the right to do what they want as long as it doesn’t harm others. It’s a noble sentiment, but smoking, I argued then (and now), does harm others through secondhand smoke, it costs the state (read: California taxpayers) money via all of the health problems accrued by smokers without health insurance (it similarly increases the costs to everyone with private insurance, so long as their plan allows smokers to join), and smoking is really such a poor choice, healthwise, for an individual that the government should do what it can to provide a disincentive to purchasing another pack of cigarettes. After all, alcohol is robustly taxed by states, and many other addictive/unhealthy substances (even one that isn’t as unhealthy as tobacco) are outright prohibited by the Federal government. A good portion of California’s tobacco tax go to programs to help people avoid tobacco addiction, and quit if they are. It’s a good tax, I believe, because smoking is really bad for you. It increases the risk of becoming afflicted with essentially a who’s who of the worst health problems you can think of, from diabetes to heart disease to any number of cancers.

Should we also tax this unhealthy stuff?

Should we also tax this unhealthy stuff?

But I just can’t seem to really get behind taxing/otherwise regulating another thing that has shown to be really unhealthy for people: food with excess fat or sugar. Like smoking cigarettes, obesity is a huge risk factor for getting a similar set of those diseases that you really don’t want to have (and can be really expensive to treat). And consumption of certain types of food, such as foods with large amounts of high fructose corn syrup, trans fats, or large amounts of other saturated fats, is obviously implicated with becoming obese and afflicted by all those bad diseases. But while I’m totally fine with taxes and regulations of cigarettes, I feel defensive when I hear about the excise taxes being proposed on soda or other fast/unhealthy foods. Could this be because while I am a non-smoker, my taste french fries, chips, and corn syrup has caught me hypocritically biased in favor of taxes against smokers, but not junk food eaters?

No. Although I do have a certain visceral prejudice against taxing foods I like because, well, I like them, I don’t think that support of cigarette, but not junk food tax is unjust or illogical. My argument rests on a the following points:

  1. All deaths attributed to smoking cigarettes are necessarily related to buying and smoking those cigarettes, but all deaths attributed to obesity cannot be attributed to buying/availability of certain foods. While there is only one way to smoke a cigarette (real but small factors related to depth of inhalation aside), there are many ways to become obese. Sure, people who drink a ton of big gulps become obese, but people who drink a ton of diet big gulps can also become obese, because they always pick up a large order of nachos and a hotdog with their diet soda. Similarly, someone who
    Equally unhealthy, but way more expensive.

    Equally unhealthy, but way more expensive.

    leads a sedentary lifestyle, eats only gourmet restaurant food, and drinks fine wine may well become obese without having ever touched corn syrup, trans-fats, or a big mac to his or her lips. Taxing only certain unhealthy foods, namely cheap ones (soda, trans-fats that were often used in fast food joints) thereby runs the risk of ending up to be in practice incredibly regressive: unless you want to tax the brie, truffle butter and wine the big fat gourmand uses to get fat, it is unjust and paternalistic to only tax the foods that poor fat people eat. 

  2. Smoking is dangerous to all consumers of cigarettes, but consumption of unhealthy food is not dangerous to some individuals. If a person smokes any cigarettes (on a normal basis), he or she sees the relative risk of many diseases and mortality begin to increase (according to the level of smoking: light, moderate, etc.) necessarily. On the other hand, the major, palpable risks associated with unhealthy food consumption are those that are connected to obesity, or what usually, but not always happens with the habitual consumption of unhealthy food. For example, a healthy, athletic teenager can easily burn away the calories from drinking one or even a few sodas (or a gatorade, etc) a day; even adults who exercise regularly and have a somewhat balanced diet can eat some pretty bad stuff without becoming obese, and facing the increased risk factors of disease and death associated with obesity. There may be some risk from just drinking soda on a normal basis prima facie, but the risks of obesity are much worse. But even if you work out regularly and have a great diet and are not obese, habitual smoking of cigarettes exposes you to the greater risk of disease that I have mentioned. 
  3. Cigarettes and other tobacco products are much more addictive than junk food. I understand that certain people may develop unhealthy eating problems and addictive relationships with certain foods, but these problems are relatively rare compared to how many people develop addictions to tobacco. This mainly has to do with the physiologically addictive properties of nicotine. The idea here is that while occasional “use” of unhealthy foods is pretty much ok, occasional use of cigarettes greatly increase the chance of addiction and in turn, heavier use of cigarettes. The relative danger (and eventual cost to society), then, of the sale of every pack of cigarettes is much more acute than the sale of every Coke, even if we were to say that the risk factors of eating unhealthy food and smoking are the same…
  4. …Which they are not. First of all, as I discussed above, consumption of unhealthy food does not equal obesity, but cigarette smoking does equal cigarette smoking. But even if we presuppose that everyone who eats (certain) unhealthy foods becomes obese, cigarette smoking (I believe) has a higher relative risk factor for all cause mortality than obesity (relative to non-smokers and people with BMIs in the “normal” range”). I threw in the “I believe” there because I’m not a public health expert, and I don’t have access to the full texts of scientific journals, but some preliminary research of the literature indicates that obesity (BMI > 30kg/m^2) and overweight (25 < BMI < 30) are associated with relative risk of all cause mortality of around 1.75 and 1.25, respectively. On the other hand, relative risk of all cause mortality of smoking seems to be from 2 – 3, depending on usage. It doesn’t seem like much, but even an increase of .5 is big; the reference for relative risk (even odds) is 1. And again, these numbers are for obesity and overweight, not “soda drinkers” or “trans-fat eaters.” If anyone is better versed in public health, feel free to help me out  (I couldn’t seem to find straight up relative risk of all cause mortality from smoking, even though I know its out there – most papers I read were using that figure to come up with another figure). 

 

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