“City Health” in San Antonio: a Case Study of Ideology Veiled as Science
City health in San Antonio
The American Health Podcast is produced by the Johns Hopkins Bloomberg School of Public Health. Last week, they posted a podcast called “What’s up in San Antonio?”
The host, Josh Scharfstein (Vice Dean for Public Health Practice and Community Engagement at JHSPH), interviews Health Commissioner Colleen Bridger and Mayor Ron Nirenberg about their plans to improve public health in San Antonio.
To start, Dr. Scharfstein briefly describes how these two are working to advance several policies to improve health of San Antonians, including:
- Increase age for tobacco purchase to 21
- Expand access to high-quality Pre-K
- Increase opportunities for walking, biking, and public transport
- Expand access to healthier food choices
In the ensuing discussion, Dr. Bridger talks enthusiastically about advancing these policies in San Antonio, and about trying to become the first city in Texas to “get the overall gold medal” (what that is and who issues it wasn’t specified). Mayor Nirenberg alludes to giving Dr. Bridger considerable leeway (“the science behind the work that Dr. Bridger is doing has free reign”). The host mainly asks his guests to describe their policies, while occasionally asking about potential controversies.
Pizza parties
At one point, Dr. Bridger discusses efforts to implement a policy requiring the city to offer healthy food options at city-sponsored events.
“One of the things that kind of hit us out of the blue… Someone from the senior services programs said, ‘Well does this mean we can’t have pizza for birthday parties anymore?’”
(laughs)
“We’re like, ‘Well, you can still have pizza, but why don’t you add some fruits and vegetables, and just serve water instead of soft drinks?’”
It’s hard to believe this concern could be considered “out of the blue.” You’ve got city workers ordering what they like (or perhaps what the guest of honor likes) for office parties, and you’re proposing a policy to add restrictions.
Quite the opposite of reflecting a rare minority opinion (a laughable one, apparently), logic would suggest that a majority of those affected would oppose the policy. The menu at an office party reflects the preferences of its workers. Barring that a fat- and sugar-loving bully has overwhelmed the health-conscious majority, we can assume that the boxes of pizza and bottles of soda sitting on the conference table suit the tastes of the people around it.
Policies for the greater good
Asked about potential concerns related to individual choices, Mayor Nirenberg said:
“It’s a personal struggle sometimes, too, because I am a big believer in personal freedoms….your ability to make choices as it relates to your own personal life. But the truth of the matter is, it costs us a lot of money annually — taxpayers, the public in general — to have poor health.”
Rather shockingly, the mayor is suggesting here that certain policies might constitute an unwelcome restriction of personal freedoms, yet be justifiable on the basis of reducing financial costs to society. This sort of utilitarian thinking is typically very unpopular.
Not much science
The pizza example illustrates the ideological rather than scientific nature of such policies. From a public health perspective, the effect of making fruits and vegetables available to city workers (<1% of city population) for, say, one meal per month (~1% of their meals) is presumably negligible.
If we did take a scientific view, I would venture that the cost/benefit of healthifying office party menus is far lower than for other initiatives the city could devote resources to.
The proof of the science is in the estimating
A scientist’s training and expertise are extremely relevant for estimating scientific quantities, but largely irrelevant for assessing legislation based on those quantities. Scientists weigh the pros and cons and apply their world view to reach a conclusion just like everyone else.
Scientists used to to avoid opining on partisan issues, for fear of losing the public’s trust in their objectivity. Now, they often help to push an agenda for which their expertise is not particularly relevant.
What’s wrong with bike lanes?
Nothing in particular, except that resources are finite and there may be more worthy causes. According to Rivard Report, installing a 3-mile protected bike lane in one area of San Antonio will cost $97 million, or enough to prevent roughly 40,000 deaths due to malaria through the Against Malaria Foundation.
I know, those funds wouldn’t be re-allocated to mosquito nets. Then again, why not? Wouldn’t it be cool if a city was debating a hotly contested issue, and ended up deciding to use the funds for some non-partisan, objectively “good” endeavor?
(Eh, not really… “forced charity” etc...)
Back to reality. In the bike lane example, the “scientific” part basically boils down to two questions:
- How much will bike lanes will increase cycling rates?
- What are the health benefits (and risks) of cycling?
Answers to these questions might inform the debate, but won’t settle it.
Summary
The scientist’s role in public discourse should be to objectively estimate relevant scientific quantities. For traffic fatalities, how probability of death varies with vehicular speed; for drunk driving laws, how response times vary with blood-alcohol levels; for gun storage laws, how many children are killed each year in accidents. Apart from having the expertise to estimate those quantities, scientists’ views on policy issues aren’t especially noteworthy.
