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Bloomberg, Nannying, and the Symbolic Value of Food Choice

I mostly agree with Lawrence Gostin’s paean to outgoing New York City Mayor Michael Bloomberg in the Hastings Center Report. Like Gostin, I see Bloomberg as a public health innovator who has tested the boundaries of government power in productive ways. Gostin helpfully summarizes—and then refutes—the ethical objections commonly raised to Bloomberg’s policies, including the old chestnut that they are paternalistic. “The societal discomfort with Bloomberg’s agenda is grounded, at its core,” Gostin writes, “in distrust of government influence on how autonomous adults conduct their lives. . . .”While I agree with this analysis, I think it is incomplete. The charge that Bloomberg is a meddling nanny reflects not just distrust with government influence on our lives; it also expresses indignation at Bloomberg’s putative attitude towards us: like little children being minded by a nanny, we can’t be trusted to make decisions for ourselves. What troubles some citizens about Bloomberg’s policies is not just the material impact of these policies on their choices and pocketbooks but also the symbolic value of these policies.
A persistent criticism of Bloomberg’s obesity prevention policies is that they are “nannying” and “infantilizing.” A related criticism is that his policies are demeaning or “treat you like you’re stupid.” People are offended by the policies. To claim that a policy treats you like you’re stupid is to say that it is belittling and disrespectful.
At the root of such criticisms is a view about the symbolic value of choice and the social meaning of policies that limit choice. Choice has value to the individual in part because making our own choices allows us to enact our preferences but also because choice has symbolic value. When having a choice is the social norm, being denied that choice suggests that there is something about the individual that makes her unable to handle that choice. We deny children certain choices because we believe they lack the capacity to make good choices for themselves. Denying an adult a choice could be taken to express the same judgment.

Food choices are some of the most familiar choices we make throughout our day, and food is one of the first spheres in which we begin to exercise choice as children. Policies limiting food choice—such as Bloomberg’s trans fat ban, proposed soda portion ban, and proposed SNAP sugary drink exclusion—might be interpreted as sending the message that we are incapable of making even the most basic choices for ourselves, as I have argued elsewhere with Katherine King.

At the same time, policies limiting food choice could be interpreted as sending the message that the food choice is not worth having. For example, excluding sugary drinks from SNAP could be interpreted as, “Sugary drinks are nonnutritive and harmful at current levels of consumption, and shouldn’t be included in a nutrition program.” In my opinion, this is the better interpretation of Bloomberg and his policies. But many people appear to be making the less charitable interpretation, seeing Bloomberg as a nanny and seeing his policies as belittling. Arguing that the policies’ impact is acceptable—“Bloomberg’s policies are not all that intrusive, and certainly not as burdensome as the underlying diseases,” in Gostin’s words—is a necessary but not sufficient response to the charge that Bloomberg is a meddling nanny.

Anne Barnhill is an assistant professor in the Department of Medical Ethics and Health Policy in the Perelman School of Medicine at the University of Pennsylvania.

Posted by Susan Gilbert at 12/20/2013 10:35:01 AM |

Published on: December 20, 2013
Published in: Health Care Reform & Policy

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