Todayâ€™s biggest public health concern in the advanced capitalist world is fast becoming the rise in obesity. If waist lines continue to expand, the life expectancy of current generations may actually fall into decline, an occurence unseen in more than a century of advances in public health promotion.
The underlying causes of rising obesity have recently garnered attention. Too often, however, news and books on the topic have focused solely on food consumption. Some of the better reports have highlighted the incessant advertising of the junk food industry, particularly the encouragement of larger portions. Rarely, however, has urban planning, a realm intimately linked to the expansion of capital, received much attention.
The viability of walking or biking is a major determinant in peopleâ€™s health. A study released in September showed that in the 25 most sprawling U.S. counties people were on average six pounds heavier than in the 25 most compact counties. (1) Not surprising, since the suburban landscape is almost entirely subservient to the car. Sidewalks are non-existent or disconnected, crosswalks are absent or poorly marked, and the speed and volume of vehicular traffic is overwhelming, which makes walking and biking either impractical or dangerous. (Still though, contrary to what the media reports, the longer time spent in a car makes suburbia more dangerous than living in the inner city. Residents of inner cities in Baltimore, Chicago, Houston and Philadelphia are up to 50% less likely to be killed by either a murderous stranger or an automobile accident than their suburban counterparts.).
So people who might otherwise walk drive even short distances, and kids who could easily walk to school are chauffeured. In the past 20 years the number of trips taken on foot in the U.S. has dropped by 42%. (2) Now, fewer than 10 percent of children walk or bike to school regularly, down from 66% 30 years ago. (3)
How the suburban landscape as we know it came to be, is told in part, by Colleen Fuller in Caring for Profit ; â€œBeginning in the 1920s, General Motors president Alfred Sloan and top company executives masterminded a scheme to create a consumer market for automobiles in the United States. At the time, nine out of 10 people relied on the trolley networks that crisscrossed cities across the country. GM first purchased and then dismantled the nationâ€™s trolley companies, ripping up tracks and setting bonfires composed of railcars. In thirty short years GM succeeded in destroying a mass-transit infrastructure that would cost many billions of dollars to resurrect â€” more money than municipal governments could raise.
â€œThe trolley cars were replaced with GMâ€™s diesel fuel buses, service was cut back, air pollution increased, and people began buying cars. National Car Lines (NCL), a company controlled and funded by GM, soon operated public transit in 80 cities. A propaganda campaign-including the slogan â€œWhatâ€™s good for General Motors is good for Americaâ€ â€” was mounted, depicting private automobiles as a modern, timesaving alternative to supposedly inefficient, slow, public transportation systems defended by a behind-the-time municipal authorities and citizens.â€
After all was said and done, GM was found guilty of anti-trust practices for their actions in destroying public transportation and fined a few thousand dollars. Nevertheless, GM continued to push the restructuring of the transportation landscape. According to Fuller again: â€œIn the 1950s the powerful American highway lobby launched an aggressive campaign for public funds to underwrite the construction of an Interstate road system. Charles Wilson, GMâ€™s President at that time, was appointed secretary of defense in 1953, and he argued that a national highway system was a national security issue. Federal highway administrator Francis DuPont, a member of GMâ€™s largest shareholder family, was given a green light and $50 billion to begin construction on the interstate highway system. Across the United States, people fought plans to build freeways through their towns and cities, but Washingtonâ€™s ear was attuned only to the corporate sector.â€
The benefits to the corporate sector have been astounding. According to Allan Engler, in Economic Democracy: The alternative to Capitalism, â€œthe private automobile has been the single most important source of capitalist profit for nearly 100 years. It has sustained automobile manufactruing, as well as steel, plastic, rubber, glass, and upholstery manufactureres, advertising, insurance, credit companies, and of course the petroleum industry from exploration, refining, distribution, and service stations.â€
Still, however, Engler asks has â€œthe building of freeways that separated neighborhood from neighborhood, the paving of millions of square miles of land, and the scouring of the planet for petroleum reserves…been worth it? When the hours that a woman or man of average income must work to purchase a private car, to pay for the fuel, insurance, and repairs are added to the time spent in traffic gridlock, fueling, cleaning and looking for parts to the car, the distance they travel in all this time is little more than four miles an hour, the speed of a healthy walk.â€ Capitalismâ€™s need for constant expansion requires the construction of more express lanes, that this may be a breeding ground for unhealthy human lifestyles is irrelevant.
The auto industry (broadly defined) is not the only culprit, other industries have participated in the reorganisation of cities in a way that encourages obesity. Land developers are notorious for buying up cheap agricultural land on the outskirts of cities and pressuring politicians for land rezoning and the extension of public amenities to these plots. There is substantially more money to be made from selling houses or commercial space than there is in harvesting vegetables. Similarly, today in many towns Wal-Mart has played no small role in undermining the downtown core, one of the only places where people regularly walked.
Whether or not one attributes the obesity epidemic to urban planning, TV watching, poverty, changes to the workplace or consumption patterns one thing is beyond dispute; the rapid rise in obesity is the byproduct of social determinants rather than a sudden change in human biological functions. Yet by and large governments, especially in North America, treat the obesity epidemic as a function of individual choice or biological deficiency.
Sure governments have allocated a few million to promoting vegetables and exercise (Peanuts compared to the money poured into ads for junk food and cars. GM, Ford and DaimlerChrysler, for instance, are all top 5 spenders in the U.S. advertising market.). Likewise, some politicians have put a wrench into further sprawl and backed increased money for public transit. (Though less money than for roads, and while weâ€™re on the subject, why is it exactly, that roads are free to travel on yet weâ€™ve got to pay to ride the metro?) But maybe the biggest indication of governments lack of political will to combat the social (political, sociological and historical) determinants of obesity (and other health matters) is the massive funding discrepancies between research into biological or genetic determinants of health and social determinants.
In the past six years, the U.S government has doubled funding to the National Institute of Health to approximately $25 billion. (4) Yet funding for the National Endowment of Humanities (NEH), according to Robert Frodeman in Issues in Science and Technology, â€œhave in real terms been cut by almost half since 1994.â€ â€œIn 2003, less than 1% of the $100 billion investment of public resources in knowledge is being devoted to the fields making up the humanities.â€ Frodeman further explains that, â€œif the federal budget is an accurate reflection of priority then policy makers view the humanities as having at best a marginal role in meeting the challenges facing our nation.â€ (5) (A similar trend is apparent in Canada and probably throughout the capitalist world depending upon the degree to which the medical sector is based upon private profit. For instance, recently the Canadian government put 75 million dollars into genome Canada, the same amount as the annual budget of the social science research council, despite any certainty that the genome project will be of significant benefit. (6))
Biologically focused health research receives almost all government health research funding even though we know that social determinants are central to an obesity epidemic that may reverse life expectancy gains. Also we know social determinants â€“ from clean water to stressful environments to pollutants to inequality – are determinants of most other health concerns. Estimates vary on the effectiveness of public health promotion compared to curative medicine practices. However, health â€˜expertsâ€™ agree that the majority of life expectancy increases over the past century are the result of improved public health promotion not curative medicine. Nevertheless, public money is put into basic biological research used to develop cures – drugs, invasive apparatuses such as heart replacements and other fancy technologies – irrespective of their long-term effectiveness. (For instance, US citizens are the biggest consumers of curative medicine in the world yet their life expectancy is on par with Costa Ricaâ€™s, a country that spends not even a tenth as much on medicine. In addition, while curative medicine has its usefullness, its direct downside receives inadequate attention, namelly the 44 000 to 120 000 deaths caused by medical errors each year in the U.S., making medical errors possibly the countryâ€™s third biggest killer. (7))
Considering the overwhelming influence of the for-profit (usually curatively focused) medical establishment, especially in the U.S, this skewed research funding isnâ€™t surprising. According to Acumen Journal, â€œsince late 1999 health care lobbying spending has consistently passed that of any other industry. In 2002, that amounted to expenditures of $264 million….the health care industry as a whole accounted for 15% of the $1.8 billion in lobbying spending for 2002.â€ (8) The bio-medical industrial complexâ€™ influence goes beyond political donations. It now accounts for nearly 15% of the U.S economy, which is expected to rise to around 17% by 2008 and if a recent projection in the journal Health Affairs is believable health expenditures could reach an astounding 38% of U.S GDP by 2075. (9)
Governments funded the automotive sectorâ€™s rise to dominance in the 20th century with little concern for its effects on peopleâ€™s health (not to mention ecological or other social costs). Today it seems governments are subsidizing the health indusrty’s’ expansion, ironically, with little concern for peopleâ€™s health. I guess so long as the corporations are well human health really isn’t that important.
yves engler is a montreal based activist author. he can be reached at [email protected]
1.NY Times 2. Food Fight p.72 3 Food Fight p.72 4. Issues in Science and Technology, Fall 2003 5. Issues in Science and Technology, Fall 2003 6.Health Affairs, March 2003 7. Le Devoir Oct 30 8. Acumen vol.1 no.4 9. Health Affairs, July 2003