Tuesday, February 06, 2007

The state, no-smoking policies, obesity, and the control of the body.

Apparently Blair "wants Britons off the sofa", as the news reported.
The author of this blog is quite near to positions of ethical perfectionism, and to the centrality of the idea of the good life for ethics. Still, the emerging "perfectionist" tendencies in society and politics, for example in its dealing with issues such as smoking and obesity worries me a bit.

What one notices is first of all a significant tendency of political institutions to deal with people's bodies and the issues concerning it. Recently, the Italian Ministry for Youth Policies, decreed that models can work only if they have a BMI (Body Mass Index) higher than 18. This policy is aimed at reducing anorexia both in young models and in younger and less young women that may be influenced by such models.

The body is therefore an "object" to be legislated upon. Laws both against anorexia and against obesity consider it as an object to be measured. It is striking that policies are concerned with both types of excess. The state, therefore, exert a pressures on either boundaries (against too much weight and against too little). This amounts, from the logical point of view, to endorsing a model of normality.

Should a government push the citizens to realize "healthy" life-styles? And does it not amount, also in view of the previous example, to imposing to its citizens a specific model of how their body should be? One almost gets the feeling that the body represents the new frontier of control by the state, after that the absorption by most democratic societies of liberal political ideas made the control of people's minds off-limit.

The most traditional forms of liberalism sees the role of the state described in the former paragraphas illegitimate. But the government may invoke different justifications for their policies, justifications in terms of political justice and economic efficiencies. For it is usually assumed that economic efficiency can be defined in value-neutral terms (in so far as people preferences are taken into account as they are , and not evaluated in terms of a pre-defined notion of the good), and that there are fairness-based laws which do not require substantial and controversial moral assumptions in order to be accepted by everybody.

One such justification starts from the existence, in most European democracies, of state-founded health care. It regards the issue of a fair distribution of its costs (fairness-based justification) or the issue of the minimization of its cost (efficiency-based justification).

The efficiency based justification first: states (that is, all of us, as taxpayers) have an interest in reducing avoidable health-care expenditure, in order to cut fiscal pressure or devote it to other social goals. Physically fitter citizens, it is often assumed, means reduced health expenditure. Or at least this is assumed to be true for what regards certain habits, like smoking, or the habits connected to obesity, for which extensive statistical research has been carried out.

Against this, it may be argued, does the state have an absolute obligation in favor of efficiency?

Because of the issue about financing health care, governments can justify policies apt to discourage the adoption of certain habits. The efficiency – based argument can ground a fairness-based argument: people who incur into “self-inflicted illnesses” represent a cost to the state that is more than what these people are entitled to receive.

Governments can therefore refuse the claim that are trying to push individuals to pursue what they see as “good” habits, in absolute terms. Certain eating habits, they can claim, are not good or bad in absolute terms, but only vis-a-vis the avoidable additional costs that smokers and people who eat in excess produce. The issue is an issue of justice: the state must prevent people who inflict harm to themselves to deprive others of otherwise available public resources. They can appeal to a liberal principle, the principle that social costs should be divided equally, or in a fair way. They must also appeal to intuitive notions about responsibility: the state should not pay (in the form of health care services) for solving every problem of which the individual can be held responsible.

In other words, the justification adduced by the state touches the big philosophical issue about the relation between responsibility, free will, and determinism. And this may represent a point of weakness, in so far as this issues are far from being well understood both philosophically and scientifically.

Another philosophical difficulty is the following. As we have seen, a liberal state professes not to be guided by value-judgments in its choice of behaviors or habits that ought to be penalized or promoted. The state penalize a certain habits, not because the majority finds it objectionable, or repellent, but because – so it is argued – they are linked – demonstrably, in statistical terms - to bad health and higher costs for the community. (Notice that the connection here is statistic.)

But is it really so? I'm not challenging the validity of statistical law. The point is that we have so many statistics about these two issues: smoking and eating habits, but there are other correlations between habits and health that are not as much studied, maybe because these habits are assumed to be legitimate. (Think about sports whose impact on health is more negative than positive, in statistical terms, at least when practiced above a certain age or for too many years. Or think about risky sports like free-climbing.)

The above referred attitude (what to study, which correlations to focus upon) must be understood in terms of commonly shared values. Western societies are – sociologically speaking – developing a perfectionist attitude towards the body. It is as if, having satisfied his or her needs as primate – food, family and house – human beings in the west need to set themselves higher goals. TV and other media present a very easy perfectionist goal: that of a beautiful, fit and healthy human body. This perfectionist ideal, more than any other, is apt to be picked up by the masses.

It requires only one instrument: the body that each of us has. It may require a bit of money for the gym, but basic physical exercise can be made at a little cost (jogging). And since the ideal is usually superficially presented (it is more an ideal of “beauty”, not of “health”), there is always the possibility to achieve it by not eating. Perfection in the body, as opposed to perfection in music or poetry, does not require musical instruments, libraries, and expensive teaching.

(This process may have occurred in history already. I'm thinking about Hegel's remarks in the “lectures on the history of philosophy”, about the ideal of the body and gymnastic in early Greek thought.)

Where am I going with this? It is in the nature of democratic governments to pick up societal tendencies, urges and values. Moreover, in the last 50 years we saw the fall of traditional ideologies. As an effect of this, of course, religious values came up on the scene. But religious values are not a viable option for our secularized societies.

Governments need to direct their actions through values that form consensus. In expressing policies directed to favor certain ideals of physical fitness and beauty, the government picks up and relates to a set of ideals which are, and are becoming increasingly popular. This of course creates a circle, a positive feed-back effect.

In conclusion, the regulation of “healthy” practices by the state may not be completely neutral in terms of values, because of the political pressure to adequate their conduct to the conceptions of the good that are widely shared. There is a legitimate suspicion that the government's action directed to deal with this issues is conditioned by widely shared value-judgments which escape the net of political values such as fairness and efficiency.

I'm not claiming that a state should be neutral, and avoid this sort of policies. But I think we should try to understand their meaning, and maybe complement them in some way. Recognizing them for what they are (or may be), namely, policies with a perfectionist background, may force us to open our eyes on their adequacy as the expression of a good perfectionist ideal.

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