Using Rose’s “Whole Population” Strategy to Tackle the Globesity Epidemic
The global obesity epidemic is the perfect testing ground for Rose’s whole population strategy because an individual’s weight is affected by a number of risk factors, such as social and cultural norms surrounding diet and activity, that can be affected by population-scale interventions.
Rose’s “whole population strategy” posits that population susceptibility to a certain disease is shaped like a bell curve, with those in the top percentiles having the highest relative risk and prevalence of illness. While treating those at the top of the distribution is important, shifting the entire population down the bell curve through public policy and other forms of interventions can reduce the overall number of people suffering from a disease, improving the health of the entire population. Even a 2% shift downward could lead to significantly improved health outcomes.
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Currently, 39% of the world population is either overweight or obese, a problem that has been dubbed the “globesity epidemic”. This problem is not just among adults; as of 2016, 340 million children and teenagers ages 5 to 19 and 41 million kids under five and were classified as either overweight or obese. Obesity can lead to drastic health consequences such as cardiovascular diseases, depression, stroke, type 2 diabetes, certain types of cancer, and premature mortality. Creating successful interventions at the population scale could have massive societal impact, drastically reducing the medical complications associated with obesity.
The globesity epidemic is associated with a number of risk factors including the availability of cheap, highly-processed, nutrient-poor food. While some individual-level risks such as genetics and certain diseases cannot be prevented (yet), others, including low-physical activity, little or excess sleep, and low education, can be targets for whole-population interventions. This epidemic has provided a platform for cities and countries around the world to enact different kinds of whole population interventions to see what can have the biggest impact. While the problem can seem daunting, researchers estimate a reduction of 100 kilocalories per person per day can prevent weight gain for the majority of the population; this could mean just 15 minutes of walking or eating slightly smaller portions at meals which are relatively attainable outcomes.
On the individual level, the most effective way to lose weight is through lifestyle modification which includes three key components: diet, exercise, and behavior therapy. Therefore, governments have been developing interventions to target all three of these aspects from taxing unhealthy foods to encouraging biking or walking instead of driving and updating health guidelines so they are simple to understand and follow.
However, even if governments are able to develop and implement policies which successfully influence consumer behavior towards healthier options, there are issues surrounding consent. Many people do not want the government interfering in their lives and see these public health initiatives as an infringement of their individual rights as consumers to eat whatever they want. Changes to nutritional labeling and increasing public education regarding healthy nutrition habits merely make for a more informed consumer, but policies such as sugar taxes and soda bans actively restrict customers’ volition. According to a poll from The New York Times, 60% of the city’s residents opposed the soda ban with many stating they felt the government overstepped their bounds of authority and that choices of consumption should be left to individuals.
While some of the policies governments implement, such as nutrition labeling, directly target food corporations, the ultimate goal of interventions like these are changing individual consumption patterns, not targeting the food industry. The largest corporations in the food and beverage industry, such as Kraft Heinz, Nestle, and Coca-Cola, are primarily concerned with profits, not the health of their consumers. These companies employ food scientists to develop addictive snacks and food marketers to ensure their products catch our eye in the store to entice us to buy them. Between 2011 and 2015, Coca-Cola and PepsiCo combined sponsored almost 100 national health organizations fighting against the globesity epidemic; during that same time, the two companies also fought against 29 public health bills that aimed to improve nutrition.
The burden of obesity is often put on the individual, but behavioral economics and the concept of choice architecture allow us to see how our environment can drastically influence our everyday actions. Instead of targeting individuals or implementing “sin taxes” that increase prices for the consumer instead of the manufacturer, a more effective, but also more difficult, solution is to target food companies to cut down on the number of unhealthy options and increase healthier options, targeting the whole population in a different kind of way. Approaching an intervention from a higher level like industry regulation will still lead to behavioral changes across the population but will stress the significance of environment’s role in the globesity epidemic and lessen the burden on individuals, shifting social norms to potentially cause a larger shift in behavior than previous approaches.
Charlotte Notaras studied psychology and cognitive science for four years, before enrolling into an MSc in Evidence-Based Social Intervention and Policy Evaluation. Her undergraduate thesis focused on understanding the psychology behind the STEM gender gap, and found a significant positive correlation between having a fixed mindset and endorsing traditional gender stereotypes. Going forward, she hopes to pivot towards researching achievement gaps in education and finding evidence-backed solutions for addressing them.
The views expressed in this article are the author's own and do not necessarily reflect any editorial policy.