Legislating health

Everyone's surely heard, by now, that New York City's Department of Health has two proposals pending that, if passed in December, will regulate the city's restaurants. One proposal bans the use of artificial trans fats, and the other mandates the posting of calorie information on menus. It's the former that's gotten the most press, particularly since KFC announced that they will eliminate trans fats from their restaurants nationwide.

The KFC news is interesting because of the effort they went through to find alternatives that don't appreciably change the taste of their food — and that wasn't easy. For a random restaurant, where the food may vary from day to day, there's somewhat more flexibility. The chef still wants the food to taste a certain way, to be sure, but variability is expected, and the chef can play with the flavours. But for a fast-food chain, consistency — both geographically and temporally — is demanded. If the trademark taste of their food changes, customers will complain, at best, and may leave for other chains, at worst. So this was a bold move by KFC.

It's also a welcome one. Make no mistake: the stuff's not health-food, even after the change. Still, when the medical establishment is recommending total avoidance of trans fats, and a daily maximum of 2 grams in any case, reports are that a three-piece chicken meal at KFC today contains 15 grams of trans fats. Pushing that to zero is a big change, and one for which the company deserves credit.

But that was their choice. Whether this should be legislated is a much broader question, and not a simple one. Considering the proposals in NYC, I see three ways to handle it from a public health point of view:

1. Do nothing, and let the market decide entirely.
2. Require that information be posted, and let the market decide from there.
3. Restrict or ban the unhealthy substances.

A problem with option 1 is that without information, it's hard for the market to decide. It would seem, then, that we should at least require labelling. But, while labelling might be practical when there's a corporation behind it, with mass production of food and ingredients, it's much harder for the corner bistro to comply with that, with changing menus, daily specials, and much more variation in ingredients and portions. Banning trans fats entirely may fix that, but don't people have a right to make the choice themselves? If someone likes the taste of chicken fried in trans-fatty oil, shouldn't informed consent be enough? Or does the government have a say in it because public money is going into health care, and is partly paying for those coronary-artery bypass operations?

Then, too, where do the bans stop. There are a great many unhealthy substances that we could try banning too. I can't imagine that a total ban on cigarettes would work. And I would scream loudly if the government, in an otherwise-appreciated effort to keep my arteries clear, should try to take triple-crème cheese off the market. How about caffeine? No, it seems that outright bans can take us places we don't want to go.

Option 2 sounds best: label, and let the market decide. But what happens when there's no choice for the market to make? Now people can know that what they're eating is deadly, but, well, if all the fried potatoes are equally icky, the only choice is to give them up — switching to healthier ones isn't an option.

The usual answer to that is a financial incentive. Require labelling. Then don't ban the unhealthy ingredients, but give restaurants and manufacturers financial incentives to switch to healthier ones. That seems to be the right compromise between maintaining social health and avoiding excessive legislation.