The burden of choice

Consumers are ultimately responsible for ‘behavioural’ risks to their health, but the behaviours in question are also those of manufacturers and governments, and the burden of choice on consumers is lighter when shared. Governments, in particular, have the motives, means, and powers to intervene between commercial supply and consumer demand. Among the most effective instruments of government are taxation and regulation, especially for the control of single, major causes of illness such as tobacco and sugar. Taxes put a value on the future, today: consumers and manufacturers can choose to pay immediately for the costs incurred to society in future, or switch to healthier lifestyles and business practices. In practice, governments under pressure from lobbyists tend to under-tax harmful commodities, so other enticements are needed too. In this context, empirical studies show health promotion is complementary to disease prevention—making health gains while avoiding health losses—especially when the joint benefits for health are large.