Healthy Reform, Healthy Cities: Using Law and Policy to Reduce Obesity Rates in Underserved Communities

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1. Addressing Disparities Through Obesity Prevention Policy

As noted above, obesity policies generally act by prioritizing public resources, influencing private decisions, or both. Obesity policy influences disparities through these same mechanisms. For example, local governments can reverse health disparities by prioritizing public resources to support healthy behavior on the part of those experiencing the negative effects of the disparity. An example appears in the context of crossing guards. Research shows that children who walk or bike to school experience lower rates of obesity than those who do not. (154) Crossing guards can make the experience of walking or biking to school safer (155) and can increase parents' willingness to allow children to walk or bicycle to school. (156) In Florida, crossing guards at intersections near schools are currently paid for by a state fund. (157) But in larger jurisdictions, like Miami-Dade County, the fund cannot cover the entire cost of a crossing guard and schools must close the funding gap or have fewer crossing guards than they need. Lower income schools in the City of Miami have particular difficulty closing this funding gap. (158) A change in state law would authorize the city to levy a surcharge on fines for school zone traffic offenses, enabling the jurisdiction to supply additional crossing guards to low-income neighborhoods and improve safety for children walking or biking to school. (159) This change in state law would give local jurisdictions a new potential source of revenue to support safer walks to school in low-income neighborhoods.

Policies that influence private decisions can also affect disparities. Such policies generally create incentives for health-promoting activities or deterrents for disease-promoting activities. These incentives or deterrents can be for businesses or individuals. New York City offers tax and zoning incentives to grocery store owners who open or expand locations in food deserts, (160) addressing inequitable access to fresh fruits and vegetables. (161) Incentives such as these are intended to make neighborhoods with limited food access more attractive to business owners by decreasing the cost of development. (162) Other policies, like labeling menus with calorie counts and nutrition information, are intended to influence the behavior of individuals. (163)

Policy change can also be a hybrid of these two categories, affecting both public and private actions. Taxing sugar-sweetened beverages to reduce their sale and consumption is an important obesity prevention strategy that affects both public and private actions. (164) Such taxes generally affect private behavior by increasing prices, thereby reducing consumption. (165) Sugar-sweetened beverage (SSB) taxes also affect public resources by generating revenue for the government. (166) A proposal in Vermont, for example, would have allocated one-third of the tax revenue raised to obesity prevention initiatives for low-income residents, including subsidies for fruit and vegetable purchases. (167)

These tax proposals typically generate a strong reaction. Opponents of SSB taxes criticize them for being regressive, disproportionately hurting low-income people and people of color who can least afford it. (168) A regressive tax is one for which low-income people pay a higher percentage of their income than high-income people. (169) For instance, lower-income people spend a larger share of their income on food and beverages and consume more SSBs than their higher-income counterparts. (170) African Americans are more likely to be regular SSB drinkers. (171) Thus, opponents argue that a SSB tax would affect low-income people and people of color more than people who are wealthier and white. A similar argument was raised concerning tobacco taxes, but was successfully challenged by proponents, who pointed out that low-income people have a higher prevalence of smoking-related illnesses. …