Free A Big Fat Crisis by Deborah Cohen

summer, there were no falls from buildings that had the new window guards. Subsequently, despite a protest from landlords, the requirement for these $3 devices was added to the city’s health code. One landlord filed suit against the city, claiming the regulation was unconstitutional on the grounds that the new health code shifted the obligation for the care and protection of children from parents to the real estate industry. 2 He lost.
    The story of the “Children Can’t Fly” campaign is an apt analogy for the problem and the solution to the obesity epidemic. Children are born curious and may wander to an open window even if (or because) we tell them to stay away. All of us were born with the capacity and inclination to eat more than we need. In a world where there is toomuch food, we have no constraints that limit our natural tendencies to eat what is readily available.
    In the case of the open tenement windows, if we simply blamed the families and didn’t hold the landlords accountable, children would still be falling to their deaths. And similarly, in the case of obesity, restaurateurs and purveyors of food need to be held responsible for what they serve. The amount of food we eat depends on the conditions in which it is served and sold. If the food industry wasn’t selling us so much food that makes us sick, we wouldn’t be sick. Together, as a society, we have the power to change the conditions that favor overconsumption—for our own protection and preservation.
    The public health experience is that blaming people for their own problems rarely yields any fruitful solutions. Indeed, throughout history, the lack of self-control has been blamed for nearly every poor health behavior and human failure—alcoholism, smoking, sexually transmitted diseases, injuries, and car crashes.
    One approach to addressing these societal ills is to focus on individuals and to motivate them to change through either incentives, negative consequences, or education. In contrast, the public health approach usually focuses on the conditions in which people live and seeks to address the upstream forces that lead individuals to behave the way they do. For example, public health approaches to alcoholism, smoking, sexually transmitted diseases, injuries, and car crashes are not to punish, incentivize, or educate people, but rather to regulate alcohol and tobacco availability; give sex partners prophylactic treatment; and make products, cars, and roads safer.
    In the nineteenth century, before germ theory was understood and bacteria and viruses were discovered, poor health behaviors, moral turpitude, the lack of discipline, and even belonging to certain racial or ethnic groups (inherited genetic defects) were cited as the causes of diseases like tuberculosis, cholera, and smallpox. Blaming individuals for their own health problems also fit in with prevailing religious views that God was simply meting out consequences for bad behavior. Individual responsibility has often been the default position when we don’t really understand what is going on.
    Yet the great advances in public health have all occurred whenentire societies took monumental steps to change the conditions in which people lived. Regulations that mandated standards for sewerage systems, housing, working conditions, food storage and preparation, and air and water quality were not timid, incremental steps. These regulations were bold leaps whose impacts have extended our lives and reduced untold human miseries suffered by populations a century ago. We no longer have exceptionally high rates of occupational injuries, with workers falling into rendering tanks or becoming ground meat, as muckraker Upton Sinclair described in The Jungle , his 1906 book about the meatpacking industry. Nor do we have the level of industrial pollution associated with the London smog that killed between four thousand and twelve thousand people in five days in December 1952 and sickened more than one