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Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
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Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco

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Should governments regulate lifestyle by developing a lifestyle policy, affecting tobacco, alcohol and diets? Should they be allowed to change individual behavior to attain legitimate public health …

Should governments regulate lifestyle by developing a lifestyle policy, affecting tobacco, alcohol and diets? Should they be allowed to change individual behavior to attain legitimate public health goals, such as higher life expectancy and improved public health?
The European Union has recently recognized the growing impact of NCDs, including cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, on the EU's economy and the well-being of its citizens and has consequently started to develop policies intended to tackle the four main factors to which they are linked. Nevertheless, if common themes emerge between the different EU policies intended to promote healthier lifestyles, no attempt has yet been made to systematize them.

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  • 1. Regulating Lifestylethe case of unhealthy diets, alcohol and tobacco Alberto Alemanno HEC Paris
  • 2. (short) premise
  • 3. structure< I > setting the scene< II > the EU experience< III > the behavioural turn of (risk) regulation
  • 4. <I>
  • 5. Market liberalisation efforts provide economic prosperity, and
  • 6. world life expectancy
  • 7. technological innovation
  • 8. world food pricesThe relative price of food in the United Statesdropped by 15 percent from 1980 to 2000.
  • 9. not
  • 10. happiness
  • 11. well-being
  • 12. but
  • 13. greater consumption.
  • 14. Increases in the foodsupply are the dominantdrivers of the weight gain in population
  • 15. Tobacco use
  • 16. Harmful use of alcohol
  • 17. Unhealthy diets
  • 18. Lack of physical exercise
  • 19. <lifestyle risk factors> leading causes of NCDs
  • 20. NCDs, like heart attacks and strokes, cancers, diabetes andchronic respiratory disease accountfor over 63% of deaths in the world today- 80% in low and middle-income countries -
  • 21. Global burden of mortality, morbidityand disability attributable to NCDs has rapidly increased also in developing countries (‘double burden’)
  • 22. UN General Assembly
  • 23. 2011 UN General Assembly Political Declaration on NCDs
  • 24. ‘regulatory mix’Evidence-based, cost-effective, population wide and multisectorial intervention through ‘the implementation of internationalagreements and strategies, and education, legislative, regulation and fiscal measures’ (great faith in the power of law)
  • 25. addressees Governments and ‘all relevant stakeholders’, including individuals,families and communities, NGOs, civil society, academia, and – where appropriate – the private sector
  • 26. Regardless of the moral, philosophical and social reservation you might have
  • 27. an international‘LIFESTYLE REGULATION POLICY’ is emerging today
  • 28. <II>
  • 29. The EU is gradually stepping in into the regulation of ‘lifestyle risks’
  • 30. Risk factors in the EU• EU Tobacco: – Largest risk factor – 650.000 deaths per year (out of 6 million www) – Tobacco prevalence around 29% – Costs: 125 billion – 1.3 EU GDP
  • 31. Percentage of daily smokers (males) aged 15+ in the EU-27 Source: WHO-HFA, 2007 38
  • 32. Male smoking
  • 33. Female smoking
  • 34. Risk factors in the EU
  • 35. Male obesityGlobal Prevalence of Adult Obesity International Obesity Taskforce, 2008
  • 36. Female obesityGlobal Prevalence of Adult Obesity International Obesity Taskforce, 2008
  • 37. Risk factors in the EU• EU Alcohol: – 3rd largest risk factor – 195.000 deaths per year – Costs: 125 billion – 1.3 EU GDP
  • 38. Alcohol consumption per capita WHO Global Status Report on Alcohol 2011
  • 39. As a result…growing awareness of need totackle NCDs, but What kind of action?
  • 40. <EU Action>
  • 41. Historically the EU has been regulating: – Tobacco – Alcohol – Food as goods that had to circulate freely
  • 42. Now increasingly interested in reducing their consumption
  • 43. To what extent the EUmay develop a lifestyle (health) policy?
  • 44. Legal Basis - 168 TFEUNo legislative harmonisation on public health grounds
  • 45. Legal Basis- 114 TFEUonly on internal market ground
  • 46. Yes
  • 47. No
  • 48. Yes
  • 49. No
  • 50. A way out… While the EU approach to tobaccoproducts remains based on regulation,self-regulation characterises the EU emerging policy vis-à-vis obesity prevention and alcohol
  • 51. Alcohol & Health Forummulti-stakeholder, partnership approach leading tocommittments: - by companies - by governments and other stakeholders
  • 52. Committments
  • 53. food reformulation SELF-REGULATION
  • 54. EU Framework for National Salt Initiatives:minimum of 16% over 4 years, against the individualcountry baseline levels in 2008.
  • 55. Committments• Consumer information• Voluntary labeling
  • 56. marketing restrictions SELF-REGULATION
  • 57. Committments• Marketing to children
  • 58. Contested• Fear of regulation  self-regulation• Some, not all companies• Weak enforcement record• Coverage of committments (TV not internet: adgames/mobiles): loopholes• Credibility of committment by industry – inherent conflict? – Article 5.3 FCTC
  • 59. new initiatives
  • 60. fat taxes ?
  • 61. Ongoing revision of the tobacco products directive
  • 62. Plain Packaging
  • 63. Australia PP
  • 64. US new packs (22.09.2012)U.S. District Judge Richard Leon ruled that the requirement ran afoul of the First Amendmentsfree speech protections and blocked the requirement. The government appealed.
  • 65. Plain packaging of food?
  • 66. Plain packaging of alcohol?
  • 67. Visual Display Ban
  • 68. To sum up• Coexistence of regulatory & self-regulatory schemes• Coexistence of EU-wide & national initiatives
  • 69. <III>
  • 70. <a few more ideas>
  • 71. legitimacyGenerally dismissed as nannying (paternalism)
  • 72. effectivenessTo what extent lifestyle policy interventions work?
  • 73. designHow to realistically expect that regulation mayrequire people to, or not to eat, certain foods and to do exercise
  • 74. role of the industryWhat should it be the role of the industry?
  • 75. At a time in which international community legitimised regulatory action vis-à-vis lifestylechoices, some countries are experimenting new forms of interventions
  • 76. ‘Libertarian paternalism’
  • 77. By changing the environment in which thechoice is made, a nudge-inspired policy steerspeople - who are placed in this environment - towards making positive decisions while preserving individual choice.
  • 78. examples
  • 79. The classics
  • 80. the location of food items in acafeteria
  • 81. produce some unexpected impact
  • 82. i.e.
  • 83. you’re able to increase/decrease the consumption of many items by as much as 25%
  • 84. Lesson learnt from classicseven smallapparently insignificant detailscan have major impacton people’s behaviour
  • 85. The Brit Nudges
  • 86. Diet & Weight
  • 87. By filling in a questionnaire, people can getaccess to a £50 vouchers giving money offhealthier food & activitiesNHS with the industry
  • 88. Diet & Weight (2)
  • 89. Information at-a-glance: making it easier for consumers to see what proportion of their daily nutritional needs are met.
  • 90. What if no traffic light?
  • 91. Diet & Weight (3)
  • 92. Visual prompts• Already widely used by supermarkets and manufacturers• Used now by ASDA and DoH to advertise social norm messages:
  • 93. Alcohol
  • 94. Binge drinking
  • 95. Binge drinking• Need to correct the false perception of how much students’ peers drink, how?• By making it less salient:Communication campaign of accurate drinking levels to all university students in Wales
  • 96. Lack of physical activity
  • 97. The Stockholm piano stairsMUSICAL TUNES PLAYED WHEN PEOPLE CLIMB THE STAIRS NOT WHEN ESCALATOR
  • 98. The features of Nudge
  • 99. Nudging• Its intervention does not restrict choice• It must be in the interest of the nudgee• It involves a change in ‘choice architecture’• It implies strategic use of some patterns of human irrationality• The action it triggers does not stem from a fully autonomous choice (especially about the context)
  • 100. The appeal of Nudge
  • 101. Paternalism Nudge• Reduce the options set by • Changes the environment in legislating against risky which the choice is made to behaviour make risky behaviour less likely • Rests on the assumption that• Rests on the assumption that people conditioned by people behave rationally environment• Top-down: requires bureaucratic • Bottom-up: less funding oversight• Exaggerates the prevalence of • Play down the reality and depicts risky behaviour abstention as the social norm• Evidence-based (real) • Evidence-based (laboratory- setting)• Adversial to the industry • Cooperative with the industry
  • 102. The flaws of Nudge
  • 103. • New paternalism• Intrusiveness: a threat to liberty!• Ineffective/lack of evidence• Non transparent• Ethical unacceptable• Unintended side effects: – Infantilization – Hindrance to moral development• Corruptibility
  • 104. 1st assessment of Nudge-inspired policies
  • 105. 3 main conclusions• Mixed results: – Nudges are less effective when used in isolation: call for their integration with traditional forms – Being controversial need to be evidence-based – Overall less effective than behavioural marketing
  • 106. should authorities ‘nudge’ people towards the ‘right’ choices?
  • 107. should they rely on findings of cognitivescience to nudge people towards the ‘right’ choices?
  • 108. How to turn behavioral insights into policymaking?
  • 109. Thank you! Comments welcome at alemanno@hec.fr More info atwww.albertoalemanno.eu