Tackling obesity -- should the public pay?

The demand by AMA Victoria that the State Government fund bariatric surgery for the chronically obese is no doubt motivated by compassion, but illustrates some of the ways the debate about obesity has become severely distorted.  Obesity is not a public health problem and should not be treated as one.

Until relatively recently, the phrase "public health" indicated health problems that were actually public problems -- sanitation, the control of epidemics, water quality, airborne pollution and so forth.  But increased obesity is not a public health crisis like an outbreak of bird flu would be.  Obesity is not contagious -- when one person over-indulges on fast food, their colleagues and neighbours aren't put at risk.  And, in 2008, nobody orders pizza without being fully aware that cheesy crusts can lead to weight gain.

For these reasons, obesity is too often tragic, but it is first and foremost a private problem.  Medical campaigners who seek to redefine the parameters of public health are eliminating the crucial policy distinction between public and private health concerns.  When every health problem becomes a national crisis, no medical treatment is ineligible for government funding.  Bariatric surgery may be an important, even necessary, tool to treat obesity, but it does not automatically follow that it should be paid for directly by the taxpayer.

Of course, the most common objection to this line of reasoning is the simple calculation that the cost of treating obesity now is far less than the cost of treating the consequences in the future -- resolving heart disease and diabetes may be more expensive than bariatric surgery.

All public policy should be subject to economic assessment.  But this is a slippery slope.  Britain's National Health Service shows what can happen when the government makes all health problems its business -- those calculations rapidly lose their compassion and become cruel assessments of moral, rather than medical, questions.  Last week British PM Gordon Brown hinted that individuals whose lifestyle choices had created their health problems -- obesity is the classic example -- may be refused treatment in order to cut costs.

The only way to avoid this trap is to drop the conceit that all medical problems are public problems, and to reintroduce the idea that individuals should be responsible for their own health.

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