Many public health advocates feel you need to be nudged for your own good, by law if necessary, into making better choices about what to eat and drink. Have you heard about their latest triumph, the Howard County Miracle?
NPR reported on it in March: "A three-year campaign in Howard County, Md., aimed at curbing the community's sweet tooth led to a significant decline in sales of sugary drinks." The public-private effort "led to a 20 percent decrease in sales of soda and a 15 percent decline in fruit drink sales between January 2013 and December 2015," as reported by local grocery stores.
In the past, not all government efforts to change the public's sipping habits have gone smoothly. New York Mayor Michael Bloomberg's battle against supersized drinks was widely joked about and eventually struck down in court. Philadelphia's new soda tax has driven many residents to shop at suburban grocery stores.
But the Howard County experience "provides a road map for other communities to reduce consumption of sugary drinks," according to one of its many favorable write-ups.
So what happened in Howard County?
It began with the sort of public-private partnership where the exact line between private and public can seem to blur. The Horizon Foundation got its start in 1998 when Johns Hopkins acquired the county's public hospital and sweetened the deal with a $70 million endowment to advance the health of county residents. That combination of hefty funding and vague mission allows Horizon, along with supporting local endeavors in fields from geriatrics to mental health, to march off in directions pretty much of its choosing.
Horizon enjoyed extensive local political connections, and county officials were glad to team up with it. One distinctive thing about the resulting campaign was how many different channels it got into: social media, TV and outdoor advertising, visits to pediatricians urging them to counsel patients about childhood obesity and beverage choices, and much more.
At the same time, the government actors moved forward on policy ideas to restrict beverage availability in schools and public property such as parks, as well as vending machines. Howard County had no authority under state law to impose a soda tax, so that idea was out. But the constant activity on multiple fronts helped build momentum and, perhaps, roll over what scattered opposition there was.
Assuming the steep drop in beverage sales to be accurate, it's hard to know what the ultimate impact was on calorie intake. (Dieters shooed away from one source of calorie intake have been known to turn in solace to another.) It's also hard to know to what extent the effect will last now that the campaign has ended.
What we do know is that Howard County is not at all statistically typical of the United States.
It routinely figures in lists of the ten highest-income counties in the country, on best-places-to-live lists, and on lists of the best public schools. It has been named the nation's healthiest county. Its largest community, Columbia, was founded in 1967 as a planned city ("The Next America!") and from the start has attracted residents interested in social progress, self-improvement, fitness and the outdoors, and other causes. While racially diverse it is not notably economically so, with a heavily white-collar workforce and low poverty rate. Its electorate is rich in independent "swing" voters who keep up on the news. The most popular bumper sticker representing the county carries the slogan "Choose Civility." Admirable? In many ways yes. Typical? No.
One ploy used in the campaign to get residents' attention was for cheerful young people to wander public parks going up to complete strangers who they saw drinking high-calorie beverages and in what NPR describes as a "playful, polite" way, offer them a bottle of something else with few or no calories. Let's just say this technique may not scale to a full national roll-out.
In one curious way, however, the campaign broke sharply from the reasonable tone for which the county is known. Along with other, less controversial messages, the campaign designed both advertisements and media-friendly live demonstrations attacking soft-drink companies as heartless villains, and vilifying their executives personally. The ads ran in the pricey Baltimore market, most of which reaches viewers outside Howard County. These ads and demonstrations followed the model pioneered in "tobacco control" campaigns, and sporadically deployed since by public health campaigners against the vendors of fast food, beer, salty snacks, and ice cream.
Need it be pointed out this is ugly stuff, which sits uncomfortably with the "Choose Civility" stickers?
Now, a private nonprofit answerable to not much of anybody is perfectly free to concoct "Two Minutes Hate" stunts attacking fellow citizens. It's far more doubtful that a local government should be lending its imprimatur to such efforts. And here's where the blurring of private-public lines comes in handy: if a message is too hot, it can be assigned to the private side of the partnership. Likewise, the private message money can help promote the passage of legislation, which is kind of like lobbying, even as the public expenditures support the private messaging, and so on — 'round and 'round in a convenient circle.
It's not as if Howard County Unsweetened, as the campaign was called, escaped an eventual pushback rooted in public opinion. As things got underway, then-County Executive Ken Ulman, who later ran for lieutenant governor as Anthony Brown's running mate in an ill-fated campaign, made the cause his own. Ulman's appointees put county government resources at Horizon's disposal.
But Ulman's successor, Republican Allan Kittleman, elected in 2014, tapped into voter sentiment that the paternalism had gone too far: "I trust Howard County residents and employees to make their own decisions about what to eat." On taking office Kittleman overturned the parks policy, lest it threaten to banish the sorts of ordinary refreshments that families were used to having available at Fourth of July festivities and other community celebrations.
Yes, the vaunted Howard County plan probably had some good elements with the bad. But it sowed divisiveness, put government resources to improper purpose, and rested on a premise of frank paternalism. When it arrives in your community, you might want to respond as you might to a second pitcher of cola — by pushing it away with a polite, "no thanks."