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Governor of the Nanny State

bloombergcold.JPGNational politicians have made some serious strides on health-care reform, or if you want to be even more specific, health-care insurance reform. But no one can touch Mike Bloomberg when it comes to actually improving his city's health:

First New York City required restaurants to cut out trans fat. Then it made restaurant chains post calorie counts on their menus. Now it wants to protect people from another health scourge: salt.

On Monday, the Bloomberg administration plans to unveil a broad new health initiative aimed at encouraging food manufacturers and restaurant chains across the country to curtail the amount of salt in their products.

The plan, for which the city claims support from health agencies in other cities and states, sets a goal of reducing the amount of salt in packaged and restaurant food by 25 percent over the next five years.

And that doesn't even go into the efforts on congestion pricing, bike lanes and all the rest. You can support these efforts or oppose them as paternalist overreach, but Bloomberg is one of the few politicians in the country who has decided to make public health -- as opposed to health-care coverage, or health-care costs -- a major feature of his administration.

Photo credit: By Mike Coppola/Getty Images

By Ezra Klein  |  January 11, 2010; 2:27 PM ET
Categories:  Health  
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Don't forget the smoking ban which hit the city in 2002. That alone -- relatively early for such an ordinance -- was a game changer.

Posted by: leoklein | January 11, 2010 2:42 PM | Report abuse

Cracking down on salt strikes me as something that might be regarded as a "bridge to far" even if the NYC public supports the other ideas. Kind of like how Giuliani got a lot of accolades for cracking down on minor "quality of life" issues but then faced a public outcry when this escalated to handing out jaywalking tickets.

Posted by: constans | January 11, 2010 2:46 PM | Report abuse

i'm usually so "anti-nanny state" its not funny but the conflict I have is that I'm much more "anti-obesity" and realize how much a problem it is now and how much greater its going to be 10,15,20 years from now. Good work Mr. Mayor.

Posted by: visionbrkr | January 11, 2010 3:00 PM | Report abuse

True I went to a second-tier medical school, but I was taught that salt intake isn't a problem unless you have cardiovascular or kidney disease. I know there's the BMJ study showing a correlation between salt intake and stroke, but I'm skeptical because of the potential for confounding variables. I think Bloomberg is jumping the gun on this one.

Posted by: bmull | January 11, 2010 3:00 PM | Report abuse

I know there will be lots of complaining about this, but speaking as someone who worked in the restaurant business for a few years, I can report that the amount of salt that goes into a restaurant entrée dwarfs the pinch or two a person eating at home would use on his own dinner. Watching chefs prepare things would often put me off eating said dish unless I made it myself, and that's because many, if not most, professional chefs are extremely overgenerous with the butter and salt, two ingredients (among many) about which one can say, "a little goes a long way".

Adding salt, butter, and sugar are quick and sure ways to make something taste "yummy" and "more-ish" (i.e. addictive). Adding large amounts of salt also masks any less-than-fresh flavors and inferior ingredients. The practice is extremely commonplace, and it's a badly-kept secret in that industry (read Anthony Bourdain if you don't believe me).

Salty food also makes one thirsty, meaning one will order more beverages. Can you say *monster mark-ups*?

Since Mr. Bloomberg hasn't announced a ban on putting salt shakers on the table, what is the problem? If individuals like their own food extra-salty, they can knock themselves out when their dinner is placed in front of them. Yes, you need to use a certain amount of it at the cooking stage, but the levels of salt in processed food and restaurant meals is almost always far more than that.

Posted by: litbrit | January 11, 2010 3:04 PM | Report abuse

Even though I actually support these ideas, I doubt there is any evidence of any positive health effects that have been achieved.

Posted by: AuthorEditor | January 11, 2010 3:11 PM | Report abuse

I think the interesting thing is that many of the public health issues have been addressed from property right and consumer information angles. They might improve market efficiency!

Posted by: ideallydc | January 11, 2010 3:13 PM | Report abuse

Is this only about the sodium content inherent in salt, or is it more based on getting the right potassium to sodium ratio like what has worked so well in Finland?

Posted by: williamcross1 | January 11, 2010 3:21 PM | Report abuse

Reducung salt is important in reducing blood pressure. If you look at food labels, the amount of salt in most soups, chilis etc is horrendous. One has to seek out low-sodium kinds, which can be challenging, thpough less so lastely. I'd welcome much less in packaged food. Making soup at home is possible, but requires blocks of time.

And I can't believe how thirsty I get after eating restaurant food of any kind--fast food or gourmet. T%his is a very good effort. Many people who are reflexively anti-nanny state don't really understand health and food issues and how the food industry at all levels already determines our choices.

Posted by: Mimikatz | January 11, 2010 3:46 PM | Report abuse

Seems to me that a study was just completed about the impact of posting calorie counts on consumer eating behavior, and that the impact was slim to none. The counts are important to people who are already health-conscious, and everyone else doesn't give a fig (or a Big Mac).

Posted by: Policywonk14 | January 11, 2010 3:47 PM | Report abuse

I won't really believe it until there are some back end studies that show an effect. As far as food regulation goes I haven't seen any evidence that regulating producers with calorie counts, trans-fats or sodium intake has an effect on public health. The smoking ban was great for this, but I'm not sold on producer regulations as effective for reducing consumption of unhealthy food.

Posted by: tmorgan2 | January 11, 2010 4:29 PM | Report abuse

Apparently the average NY'ers lifespan has increased by 18 months so this must be working.

Posted by: MerrillFrank | January 11, 2010 5:03 PM | Report abuse

A couple of interesting studies:

An October 2009 study in Health Affairs found that for 4 fast-food restaurants (McDonald's, Burger King, Wendy's and KFC) located in poor areas, the average calorie count for meals actually ROSE 2.5%.

A study Stanford U. researchers released last week found that at Starbucks, calorie posting led to a 6% reduction in calories per transaction, from 247 to 232 average calories per transaction; almost all of the effect was related to food purchases; average beverage calories per transaction did not change substantially, while average calories from food per transaction fell by 14%, of which 10% is due to people buying fewer items and 4% is due to people buying lower-calorie food items; For those consumers who averaged more than 250 calories per transaction, calories per transaction fell by 26%; the calorie reduction persisted for at least 10 months after calorie counts were first posted.

(So at Starbucks, people are cutting down on the treats but not on the extremely calorie-laden foo-foo coffee drinks. Apparently we aren't gonna give up our beloved Frappucinos, no matter how caloric they are.)

Another study by Tufts University researchers issued a few days ago indicates that the calorie counts in restaurant meals were commonly underestimated by about 18%.

I wonder if the slight reduction in calories consumers choose and the calories restaurants underestimate is pretty much a wash.

Posted by: Policywonk14 | January 11, 2010 5:12 PM | Report abuse

Is there evidence that these measures have actually improved the health of the residents? I'm pretty sure I remember reading an entry in this blog on how little difference calorie count labels made?

From a research perspective, however, it's great that NYC is providing a large test group for some of these theories about public health.

Posted by: TWAndrews | January 11, 2010 5:27 PM | Report abuse

These policies are evidence that Bloomberg cares about public health, but they are not evidence that Bloomberg is actually improving public health.

The efficacy of these policies will have to be evaluated retroactively. Still, they're interesting experiments in public health and it would be nice if they were successful.

Posted by: zosima | January 11, 2010 6:29 PM | Report abuse

I think Mayor Bloomberg is a coward for devoting his energies to marginal issues like transfats and salt intake while spending no political capital on the uninsured, medical costs, and much bigger fish in the health policy debate. You are giving the man credit for fishing in the public health pond but he's casting for guppies.

Posted by: jamusco | January 11, 2010 7:51 PM | Report abuse

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