Opinion: Healthy living

POSTED: 06/20/12 12:08 PM

Paco, the Pan American Conference on Obesitas sounded the alarm once more this past weekend in Aruba: there are too many children around that are seriously overweight or obese. Action is needed. We’ve heard all this before, and nothing happened.

In the Netherlands a taskforce charged with keeping expenditures in the healthcare sector under control recommended in a report it published just before the weekend that the government increases taxes to stimulate healthy behavior. There were some other recommendations as well, but let’s stay with this one for starters.

The report notes that according to the Oeso (the Organization for economic cooperation and development) prevention through higher taxes is a cost saving measure that works. Based on this assumption the taskforce advises the Public health ministry to look at higher taxes as an instrument to stimulate healthy behavior. The report mentions in this context the announced increase of taxes on alcohol and tobacco, and plans to keep taxes on soft drinks in place. Next to this, the government ought to make agreements with supermarkets about offering and promoting healthier food.

Unhealthy lifestyles are no stranger to St. Maarten, Just look around in town and count how many out of, say fifty people that pass by on Front Street are overweight or obese. Obesity has on occasion been discussed, even in the now defunct parliament of the Netherlands Antilles. But afterwards, politicians went home, they drank another glass, and basically cheered the good life. No one has ever come up with drastic measures to turn the tide.

What will taxation of unhealthy products achieve? First of all, it will put some of these products out of reach for low income families. Families with higher income, or double incomes, will not be affected at all.

The key question is obviously how these low income families are going to react to higher prices.

The thought that they will drop certain habits (drinking, smoking, eating fatty products) could very well prove to be an illusion. Just think about low income families that always seem to have the largest flat screen TVs in their living rooms. Their priorities are not necessarily the same as those of our public health officials.

Also, higher pricing of unhealthy products comes across as a punishment. Why not make healthy food cheaper? Such a measure feels more like a reward, and it may even entice low income families to change their habits.

Unhealthy living is not only about smoking and drinking – it is mostly about our eating habits. Old habits die hard, but once they are gone there is no army in the world able to turn back the clock.

The famous Mediterranean diet for instance is touted as an example of healthy living. The people of that embattled country called Greece were the champions in this field. But when economic development, fueled by the tourism industry, gave the Greek population more disposable income, they turned away from their healthy habits. These days it is normal to see Greeks wolfing down souvlakia (the Greek word for what we know as kebab) on open markets at ten o’clock in the morning.

In the time they entertained healthy habits, Greeks hardly ate meat, because they could not afford it. They drank their home made wine because they could not afford foreign booze like whisky. Now that the country is in dire financial straits, many Greeks have turned their backs on the big cities to return to their villages where they are once more growing their own food. While the crisis itself is not good at all of course, this side effect could easily lead to a healthier population.

The Netherlands is not that deeply in crisis that it forces the population back to the provinces and to growing their own food. That’s why the technocrats in the taskforce are proposing to increase taxes. For alcohol, that won’t work. Just look at the Scandinavian countries where taxes on alcohol are among the highest in the world, but the number of alcoholics is also abnormally high.

The taskforce also has other recommendations: taking the general practitioner out of the basic insurance package for instance. This means that people would have to pay themselves for visits to these first line healthcare providers. Next to that, people will have to contribute more for certain treatments and contributions for long term treatments become dependent on someone’s income – meaning that patients with a higher income will pay more than low income earners.

All these recommendations are food for thought, also for St. Maarten’s public health system. With the National Health Insurance system in the making, the government will have to evaluate what is desirable and what is affordable. At the end of the day, public health is a national interest and for that reason alone it is tricky to put a too heavy burden on citizens. But at the same time, and here we agree with the Dutch taskforce, it is about time that citizens also take their own responsibility and, if they don’t, to face the consequences.

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