Lifestyle-related diseases: Responsibility and ethics, Helsinki 11-12 June 2018

The conference was opened by NordForsk Director Arne Flåøyen, who stressed the need to clarify the concept of lifestyle diseases in Nordic context. The introduction was provided by Chair of the NcBio Prof. Ingemar Engström, who discussed about the relationship between society and individual. Should society care for the individuals who choose to live unhealthy life, and what kind of options there are for intervening? There is a debate between those who are in favor of solidarity and extensive welfare system, and those who advocate freedom of choice and market-oriented welfare provision. The former raises the issue of paternalism, and the latter emphasizes autonomy.

Keynote speech for the conference was provided by Prof. Kirsi Pietiläinen (Helsinki Obesity Clinic). Obesity is on the increase both in US and Finland (country with most obesity in Nordics). Societal cost from obesity is a high one, (427.8 billion dollars in the US alone).  There is an urban planning environment in which people use cars to travel supermarkets, from which they buy large amounts of food. Not much calories are consumed, when the food is picked up. Package sizes have also increased (both in soda and snacks). The role of taxation and economic policies should be noted, in addition to effective preventive policies. Obese people should always be treated fairly.

Obese people are often shamed about their condition, even though there are numerous factor in play when gaining weight that one cannot necessarily influence: genes, family, personal finances (healthy food is often more expensive), opportunities for physical activity, etc. Even sexes are treated differently with regards to obesity: obese women are shown headless, but obese men have faces in the pictures. Every obese person is different, and may suffer multiple conditions (co-morbidity). However, treatment is available to only for a fraction of those who could benefit.

Second talk was provided by Morten Nielsen (University of Copenhagen). There are reasons derived from responsibilities that speak for or against effective public policies. Legitimacy of liberalism is grounded on idea that one must offer reasoning that all involved persons may evaluate. The question is whether personal responsibility is a good ground for justifying a public policy. If we recognize that there are external influences when obese condition is developed (cf. talk given by Pietiläinen), there is less room for personal responsibility and subsequent blame from others about past events. There exists also a forward-looking approach to responsibility, in which person is held responsible to the extent the actions promote a certain state of affairs deemed appropriate. But this may complicate discussion, as it invokes more questions related to autonomy, privacy, and stigma.

The first three talks related to Nordic governmental interventions in the end of the day one of the conference were given by the CEACG (Helsinki University Center for Research on Addiction, Control, Governance) Director Matilda Hellman, Prof. Kalle Grill (Umeå, Sweden) and Prof. Helgi Gunnlaugson (University of Iceland). Hellman explained the changes in lifestyle governance in Finland, related to the wider social and health field reorganization in the Nordics. Prof. Grill addressed the problematic issue of nudging and its ethical implications. Prof. Gunnlaugson informed the audience about beer ban in Iceland (effective until 1989) and led the participants to contemplate what can be prohibited in the Nordic countries in our liberal times.

The fourth lecture about Nordic governmental interventions (at the start of conference day two) dealt with cannabis and drug use, and it was a talk provided by Senior Researcher Jasmina Burdzovic (FIH/Oslo). Cannabis is the most commonly used drug (after alcohol, in case one counts that) and the recreational use is increasingly permitted especially in the US. Canada also is in process of changing its legislation, and it is envisaged that cannabis debate will expand also in Europe. Public health impact has been that cannabis-related emergency room admissions have increased in the US. In the US state of Colorado, there are noticeable increases in offences and other negative results from legalization.

Much of the discussion about cannabis has revolved around medical use of cannabis. The difficulty is that research lags behind (e.g., in the US cannabis was not extensively researched before legalization processes were initiated). Approach to cannabis use is changing also in Nordic countries, and for example in Norway the trend is to move from criminal justice system to provision of health care and treatment. Alcohol use is decreasing especially among those who are young, but use of cannabis is increasing.

The final part of Nordic government interventions was dedicated to talks about food, diet and healthy living. Prof. Pia Jallinoja from the University of Tampere presented data about dietary fats consumption and vegan eating. There is a dichotomy of preferring health or pleasure: it is about finding about balance between taking care of one’s health, but not worrying too much. Health promotion has been successful e.g., in Finland in relation to consumption of fat that is in milk, but lay people are increasingly at odds with experts on how to advance health. Advocating veganism began already in 1847 (UK Vegetarian Society), but it is only now a trendy option. Vegan campaigns apply to emotions and it is a way to socialize, and it is a popular movement, although inclusive one. In other fields of health promotion, the debate is polarized. There are those who claim that public health establishment as biased toward what lay people think about the issues.    

The last lecture about Nordic government interventions was given by Prof. Nanna Lien from the University of Oslo. It focused on diet and physical activity programs in schools, and what is possible to learn from them. In the past the Nordic governments had to work with undernutrition, but now the issue is more of over nutrition. There is a need to train teachers, and involve also parents. The objective of schooling system is to increase knowledge, and not change behavior.

The final part of the conference program addressed the issue of responsibility. First talk about it was provided by the Chair of Research Council of Systembolaget (Swedish alcohol monopoly) Maria Renström. She questioned the notion of responsible consumption, and draw attention to fact that there is no clear-cut definition about it. Public health information about alcohol is capable of reaching out those who are already educated and well-informed. Availability has to be reduced.

Second talk about responsibility was provided by Prof. Christopher Newdick from University of Reading (UK). Newdick asked the question whether corporate freedom and individual responsibility should mean individual freedom and corporate responsibility instead. In the 1930s and 1940s it was possible to talk about community interests, but neoliberalism has enabled a framework in which individuals are the ones who seek their own interests at expense of others.

The final talk of the conference was given by Prof. (emeritus) Pekka Sulkunen from the University of Helsinki. According to Sulkunen, the public authorities have the data, trends and methods, but fail to act. There should be an ethical state that revises the thinking of Adam Smith, happiness of necessity involves also thinking of happiness of others. Public interest approach is a way forward.

The end panel of the conference had a topic of public health vs. private health and it was chaired by Matilda Hellman (CEACG). Participants (Kalle Grill, Christopher Newdick, Nanna Lien, Maria Renström and Isabelle Bjudin Ljosne) stressed the need for academics to communicate with public. Certain lifestyle changes are also more popular than others, for example tobacco compared to alcohol. One has to find out how to regulate in times when deregulation is the favored option.