A survey analysis finds both that the public is supportive of government action to curb obesity, diabetes, and other noncommunicable diseases - but don't like interventions that appear intrusive or coercive.

The Harvard School of Public Health (HSPH) analysis also found that support was higher for interventions that help people make more healthful choices, such as menu labeling requirements, than for interventions that penalize certain choices or health conditions, such as charging higher insurance premiums for obese individuals.

There's no question that government wants to use legal action to stop any public health choices that could cause taxpayers to foot the bill - and with the Affordable Care Act the demographic most likely to be obese is almost most likely to get far more than they spend in government health care programs.

In recent years, lifestyle choices such as overeating, physical inactivity, and alcohol and tobacco use have led to troubling increases in chronic ailments in the U.S. In response, health departments and legislative bodies have adopted policies aimed at combating the behavioral risk factors that lead to ill health, such as banning trans fats in restaurants, banning Big Gulps in New York City, boosting 'sin taxes' on cigarettes and screening schoolchildren for high body mass index. 

More conservative pundits and government officials have criticized such social authoritarian mearues, saying that they impinge on personal choice and exceed the scope of governmental authority. HSPH scholars decided to examine which factors play into public support for the "new-frontier" of public health initiatives, where government tells you how to behave, and it can lend insight into how heavy-handed government can be using the Commerce clause of the Constitution to force personal compliance.

Co-authors Stephanie Morain, a doctoral candidate in health policy at Harvard University, and Michelle Mello, professor of law and public health in the HSPH Department of Health Policy and Management, analyzed the results of an online survey of 1,817 American adults conducted in October 2011 by Knowledge Networks (now part of GfK), a professional survey organization. In the survey, respondents were asked about their support for various types of public health policies, as well as the factors that influenced their support. There were questions about seven noncommunicable health conditions and 14 specific strategies to address them.

The researchers found a high level of support—between 70% and 90%—for government action on each of seven areas: preventing cancer, heart disease, childhood and adult obesity, and tobacco use; helping people control their diabetes; and reducing alcohol consumption.

Support was quite high for interventions that facilitate healthy choices, such as increasing the affordability of fruits and vegetables or requiring more instruction in public schools about the health risks of obesity. However, support waned when government actions were viewed as focusing on penalties or on limiting choices—such as adding insurance surcharges for obese individuals or making it illegal to smoke in private spaces.

The researchers also found that African-Americans and, to a lesser extent, Hispanics, are significantly more likely than whites to support government action to address noncommunicable diseases. In addition, the survey indicated that people are much more supportive of government public health initiatives if they believe that "people like me" can influence public health priorities and if they think that public health officials understand the public's values.

"The message for public health officials and legislators is, if you want the public to buy into these legal interventions, you've got to engage them early on," said Mello. "You've also got to communicate about policies in a way that resonates with the public's values. For example, how does the intervention support healthy choices? Why is it fair?"

Published in Health Affairs.