Archive for December, 2011

Julie Guthman on health care

In a chapter of Weighing In titled “Whose problem is obesity?” Julie Guthman objects to the idea that “the costs of dealing with obesity are substantial and that the broader public pays for obesity because medical costs are pooled, so that the healthy pay for the unhealthy.” She writes,

So engrained are these ideas that Michael Pollan has chimed in on this too, with an editorial in the New York Times in which he used the platform of rising health care costs to link obesity and type 2 diabetes to “big food.” Remarkably the piece was expressing skepticism of Obama’s early proposal for health care reform because it focused too much on regulating the insurance industry and not on diet. As Pollan put it,

to listen to President Obama’s speech on Wednesday night, or to just about anyone else in the health care debate, you would think that the biggest problem with health care in America is the system itself–perverse incentives, inefficiencies, unnecessary tests and procedures, lack of competition, and greed….No one disputes that the $2.3 trillion we devote to the health care industry is often spent unwisely, but the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained…by our being fatter.

This came not too long after Pollan defended the natural food supermarket Whole Foods against a proposed boycott. The boycott was initiated in response to the Wall Street Journal editorial by Whole Foods’ CEO, John Mackey, in which he attacked the “public option” under the supposition that “health care is not a right.” On the blog spot New Majority, Pollan wrote that “Mackey is wrong on health care, but Whole Foods is often right about food, and their support for the farmers matters more to me than the political views of their founder.” (49)

To understand this criticism, some context may be helpful. Guthman explains that this notion that obesity presents a sort of free-rider problem is rooted in an ideology called healthism. This term, she explains, “was first coined by the sociologist Robert Crawford in 1980 to ‘describe a striking moralization of health among middle-class Americans,’ so that health became a ‘super value’ that trumps other social concerns.'” In the United Kingdom, this ideology inspired government programs to educate people to make healthier choices, but its consequences have been more problematic in the United States:

In the United States…healthism helped legitimize a much more serious decommitment to state-mandated health services, taking the form of the “managed care” system, which, among other things, can exclude from care those with preexisting conditions, including obesity. The logic of managed care, as has now become evident, is to avoid unprofitable patients and/or shift costs back to patients, and thus to provide health care mainly to the healthy and wealthy, belying the idea that the public pays for obesity.

In any case, seeing care for certain groups as an excessive cost reflects an arguably perverse way of thinking about health care in terms of human need. You can see the moral hazard when you apply the same logic to education–for example, arguing that slow learners are a burden to the education system. It also neglects the role that the health care system plays in economy stability. The health care system provides an enormous number of jobs, particularly in labor-intensive primary care. In other words, care for the sick is an economic burden only in health care systems where profit is the bottom line and public services are underfunded and politically unsupported–that is, systems in which only market logic is considered legitimate. Nevertheless, the internalization of this logic helps explain the broad acceptance of the idea that obesity is the biggest economic health problem facing the United States. (54)

Thus, Guthman sees Pollan’s stances on health care as problematic because they play into this idea that health should be largely a matter of personal responsibility. By justifying a shoulder shrug at John Mackey’s opposition to public health care with the assertion that “Whole Foods is often right about food,” Pollan seems to subscribe to the idea that the problem of health care can be largely solved by individual agency. To Guthman, this reasoning is problematic in large part because it is blind to issues of social justice. I’ll write more about Guthman’s arguments about social justice in a subsequent post.


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Julie Guthman’s “Weighing In”

Twice before, I’ve featured the work of Julie Guthman, an associate professor in the  Community Studies  Department at UC Santa Cruz. Earlier this year, Guthman published a new book, Weighing In: Obesity, Food Justice, and the Limits of Capitalism, which challenges much of the popular discourse in the food movement, particularly as it pertains to obesity and food justice. With chapters bearing such titles as “Whose Problem Is Obesity?” and “Will Fresh, Local, Organic Food Make You Thin?”, Guthman takes issue with many of the axioms that lie at the foundation of today’s food movement. Although there were some parts of the book that I found less than convincing, Weighing In changed the way I look at food politics.

For instance, about a year ago, I criticized Michael Pollan for tending to write about meat-based meals even as he advised others to eat mostly plants. I concluded that the best way for him to improve his advocacy was “by talking about some inexpensive meals that are compatible with his dietary advice.” Having read Guthman’s book, I no longer believe that to be the case. I still see something deeply obnoxious in the inconsistency between Pollan’s dietary advice and his published accounts of his own eating, but Weighing In convinced me that the tendency of food movement leaders such as Pollan to focus on individual behaviors is itself deeply problematic.

This blog is not the place for a review of Weighing In, but since the book contains a number of direct criticisms of Michael Pollan’s work, in the coming days I’ll be posting a series of entries featuring these commentaries.

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