That Word Doesn’t Mean What You Think it Means…

The title of this press release from Living Streets Aotearoa – “Helping Kiwis Choose to Walk More Often” – nicely illustrates how seriously most public health advocates, environmentalists, and other do-gooders take the concept of choice.

If you want to help someone make a choice, you could give them information or point out any flaws you find in their reasoning; but when you’ve decided in advance what the right choice is, you are not taking their capacity as a person capable of agency seriously. You know what the right choice is and want to manipulate people or alter the incentives people face in order for them to do what you want. What the press release really means is “Making Kiwis Walk More Often Without Using Force.” That’s not a goal I find particularly objectionable, but it has nothing to do with helping anyone choose anything.

At least in this case nobody seems to be using coercive means such as sin taxes to “empower” smokers or fatties to make the right choices.

Moral Monopolies of Church and State

Benito Arruñada has a fascinating post at Organizations and Markets:

Moral codes can be produced and enforced through markets or through organizations. In particular, Catholic theology can be interpreted as a paradigm of the organizational production of morality. In contrast, the dominant moral codes are now produced in something resembling more a market.

The organizational character of Catholicism comes from its centralized production and enforcement of the moral code by theologians and priests and the mediation role played by the Church between God and believers. (…)

Instead of centralized decisions by popes, councils, and theologians, the moral code is now written by millions of human decentralized interactions of all sorts. Now that there are thousands of gods, including the environment, mediation has also been transformed or disappeared. These market features make for lesser specialization. Most morality producers also play many other functions, from teaching to advertising.

Thinking about the production of moral norms in these terms certainly seems like a useful way to approach the problem, but I’m not so sure production is really so decentralized today.

My historical knowledge is weak, but I doubt that the moral authority of the Church was anywhere near complete in even the most ardently Catholic societies. The Church claimed a monopoly on morality, and many people went along with it to a greater or lesser degree. This seems pretty close to what government does today. The state doesn’t simply create laws aimed at resolving the inevitable conflicts among people, but attempts to influence public opinion through various types of propaganda – telling people not to smoke or get drunk and dance, for example.

Of course, government is the emergent (and I would say dysfunctional) product of the decentralized interaction of many individuals, rather than a unitary decision-making entity. I would suggest, though, that this is also true of the Catholic Church. The church claims to derive its authority from God, but the economics of religion teaches us that churches do not survive unless they meet the needs of practitioners. The Catholic Church would not have become so dominant in so many places if it weren’t attuned to the preferences of many people, even if its later market power increased the slack available to the clergy.

Church and state both claim a monopoly over legitimate morality, and have often done so quite successfully. Catholics in Ireland and Italy will almost universally pay lip-service the religious diktat against birth control, for example, and it will affect their behaviour somewhat. The same seems to be true of contemporary government diktats against smoking or getting drunk. The moral scope of the government in Western democracies is probably less than that of the Catholic Church at various times and places, but that scope is endogenous and increasing.

Whither Moderate Smoking?

A doctor writing for New Zealand’s Department of Health in 1953:

Cut down your smoking. Heavy smokers have more coronary disease than light ones … there is a growing body of opinion that the circulation and lungs may be affected … and there is some connection between excessive smoking and cancer of the lungs. … Tobacco has its uses. As a social habit it has become accepted by both sexes the world over. It is used to relieve tension and help relaxation. … What is moderation? The latest American thought is – limit yourself to, say, six or eight cigarettes a day.*

I can’t imagine a similar statement today. Health promotionists now focus exclusively on encouraging people to quit smoking altogether. The framing of the tobacco question has shifted from smoking as an activity to the Smoker as a deviant identity. Cue Foucault:

The nineteenth-century homosexual became a personage, a past, a case history, and a childhood, in addition to being a type of life, a life form, and a morphology, with an indiscreet anatomy and possibly a mysterious physiology. Nothing that went into his total composition was unaffected by his sexuality. … Homosexuality appeared as one of the forms of sexuality when it was transposed from the practice of sodomy into a kind of interior androgyny, a hermaphrodism of the soul.  The sodomite had been a temporary aberration; the homosexual was now a species.**

Update: The Rest of the Story has some related discussion:

The real danger here, however, is not in the possible misrepresentation of the scientific evidence. It is, rather, the possibility that in making this statement, the ACS might actually play some part in convincing smokers who would otherwise continue to cut down on the amount they smoke that it is simply not worth it because they aren’t going to see any health improvement anyway. Given the addictive power of nicotine and cigarette smoking, it is far more likely that these discouraged smokers will simply continue smoking at their current amounts then that they will quit smoking entirely. And they may even increase their cigarette consumption, since it may appear from the ACS statement that the amount smoked does not relate directly to disease risk.

Very good throughout. Read the whole thing. 

*Quoted in Thomson and Wilson, 1997. A Brief History of Tobacco Control in New Zealand,  p. 9.

** Foucault, 1976. The History of Sexuality, Volume 1: An Introduction. (Robert Hurley Trans.), p. 43.

Quote of the Day: Healthism Edition

Health education should provide useful, factual information to enhance rational decision-making, that is, reasoned choice. One of the possible outcomes of such a decision is to ignore the health warning and to accept the risk. Health promotionists would see such an outcome as the failure of their efforts and would describe such a choice as ‘irrational’. The resulting frustration of health educationists leads to the advocacy of more ‘efficient’ methods, that is various forms of coercion by means of legislation, moral pressure and the use of sophisticated, manipulative techniques developed by the advertising industry.

Petr Skrabanek. The Death of Humane Medicine and the Rise of Coercive Healthism, p. 142.

The book used to be available for free download from the Skrabanek Foundation, which has disappeared from the Trinity College Dublin site (I call paternalist conspiracy, by the way). A large (51.6MB!) pdf is mirrored here. Another of his books, Follies and Fallacies in Medicine is here. [Update: get ’em here.]

Devil’s Kitchen makes essentially the same point more directly in the final paragraph of this post.