限售含糖飲料,何錯之有?

It has been a frustrating week for well-intentioned and interventionist political leaders. Michael Bloomberg and David Cameron have been roundly defeated in their efforts to prod citizens into health.

對於那些好心好意、奉行干涉主義的政治領導人而言，有件堪稱令人挫敗的事。邁克爾•布隆伯格(Michael Bloomberg)和戴維•卡梅倫(David Cameron)逼民衆過健康生活的努力遭遇慘敗。

Both the mayor of New York, who wants to limit the size of sugary drink cups in restaurants and cinemas, and the UK prime minister, who sought a minimum unit price for alcohol, lost the argument. They were portrayed as social nannies pushing policies that discriminated against the poor and minorities, who deserve some pleasures.

紐約市長希望限制餐館和影院含糖飲料杯的最大容量，英國首相則試圖爲酒精飲料設置最低單價，二者均在爭論中敗北。人們說，兩人好像“社會保姆”，推行的政策對那些理應享受一些樂趣的窮人和少數族裔人羣構成歧視。

They were still right. Societies should try to limit alcoholism and obesity, as they have cracked down on tobacco use. Freedom matters and the ideal policy is both effective and unobtrusive, but they both managed to tread the line between illiberalism and irresponsibility. As with tobacco proscriptions, they will probably be accepted in the end.

但兩人仍然沒錯。各國社會已經採取嚴厲措施禁菸，也應當嘗試針對飲酒和肥胖問題做出限制。自由彌足珍貴，理想的政策也應當既有效、又不唐突，但布隆伯格和卡梅倫都在不自由和不負責任之間找到了微妙的平衡。與禁菸措施一樣，這兩項政策最終可能將被接受。

John Stuart Mill defined it nicely in On Liberty : “The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.”

約翰•斯圖亞特•穆勒(John Stuart Mill)在《論自由》(On Liberty)中的闡述頗爲精闢：“對於文明羣體中的任一成員，違反他的意志、正當地對其施加權力，唯一的目的是防止他對別人造成危害。個人自己的好處——無論是物質上還是道德上的——不足以構成正當理由。”

Targeting non-communicable health conditions such as obesity, diabetes, high blood pressure and alcoholism is an especially sensitive issue since – to put it bluntly – rich people tend to live more healthily than poor people. Any tax or regulation that penalises the latter must have demonstrable benefits for society as a whole.

將矛頭對準肥胖、糖尿病、高血壓和酗酒等非傳染性病症是尤爲敏感的問題，因爲坦白說，富人的生活往往比窮人更健康。任何針對窮人的課稅或懲罰性規定，必須從整體而言對社會有明顯益處。

After his regulation was overturned by the New York Supreme Court, Mr Bloomberg published research on how obesity correlates with consumption of sugary drinks, and where they are concentrated. Both are low in elite districts of New York City such as the Upper East Side and Greenwich Village, and high in poorer areas such as the Bronx and Bedford-Stuyvesant.

在自己推出的法規被紐約州最高法院(New York Supreme Court)駁回後，布隆伯格發表了一份研究報告，該報告探討了肥胖與含糖飲料攝入量的相關關係以及不同區域的肥胖人羣比例。兩項指標在上東區(Upper East Side)和格林威治村(Greenwich Village)等上層社區都數值較低，在布朗克斯(Bronx)和貝德福德-施託伊弗桑特(Bedford-Stuyvesant)等中下層社區則數值較高。

There is thus a clear link between social status and health. Call it the Lloyd Blankfein principle. The chairman and chief executive of Goldman Sachs grew up on a public-housing project in East New York – close to Bedford Stuyvesant – but now lives by Central Park. He was once overweight but he dieted and exercised to get in shape as his fortunes rose.

因此，社會地位和健康之間存在明顯相關性，可將其稱爲“勞埃德•布蘭克費恩(Lloyd Blankfein)原則”。這位高盛(Goldman Sachs)董事長兼首席執行官在紐約布魯克林區東紐約（East New York，靠近貝德福德-施託伊弗桑特）的公租房中長大，但現在住在中央公園附近。布蘭克費恩曾經超重，但隨着個人財富的增加，他通過節食和鍛鍊恢復了正常體型。

Societies would be healthier if everyone followed his path but it isn’t possible. In practice, people enjoy – or find comfort in – sugary drinks and fatty foods or cheap alcohol. The Institute for Fiscal Studies in the UK estimates that a “fat tax” would cost the poor seven times as much as a proportion of income as the wealthy.

如果每個人都遵循布蘭克費恩的足跡，社會將變得更加健康，但這是不可能的。事實上，人們可從含糖飲料、高熱量食品或廉價酒類中獲得快樂或安慰。英國財政研究所(Institute for Fiscal Studies)估計，窮人繳納的“肥胖稅”佔其個人收入的比例可能是富人的7倍。

Mill’s principle and the social effects make blunt intervention to force people to eat and drink more healthily hard to justify. In November, Denmark dropped a “fat tax” that it imposed in 2011 on foods with a high fat content. Shoppers had evaded the tax by driving over the border to shop in Sweden, and it had other unintended effects.

穆勒提出的原則、以及各種社會效應，使得以直接干預方式強迫人們採取健康飲食習慣的行爲很難站得住腳。去年11月，丹麥撤銷了2011年開徵的一項針對高脂食品的“肥胖稅”。此前，購物者逃避這項稅的方式是，開車越過國界，前往瑞典購買被課以“肥胖稅”的食品。徵收這項稅還曾導致其他一些意料之外的效果。

But the New York ban on serving soda in paper cups larger than 16 ounces – three times the old standard size – would hardly be a draconian clampdown. It would not prevent anyone slurping their way through 24 ounces of Coca-Cola while watching a film or having a meal. He would merely face the inconvenience of buying two cups.

但紐約禁止售賣單杯容量大於16盎司（這是舊式標準杯容量的三倍）的紙杯裝汽水，這項禁令很難算嚴厲，不會阻止任何人在看電影或吃飯時咕咚喝下24盎司可口可樂，他們只需要忍受買兩杯的不方便。

Mr Bloomberg’s plan is thus a “nudge” proposal of the kind now favoured by psychologists and behavioural economists. It does not impose a ban on an activity – it simply adjusts the environment to give people incentives to make better and healthier choices.

因此，布隆伯格的方案正是心理學家和行爲經濟學家如今熱捧的“輕敲”型方案。這種方案不禁止某項活動，只是調整環境，激勵人們做出更好、更健康的選擇。

Little measures such as changing a cup size sound absurd, but they can be very effective. “We are exquisitely sensitive to environment,” says Theresa Marteau, head of the Behaviour and Health Research Unit at Cambridge university. “We are just like rats – energy misers and cognitive misers. If there is a shortcut, we will take it.”

更改飲料杯容量等小舉措雖然聽上去荒唐，但可能非常有效。“我們對環境極爲敏感。”劍橋大學(Cambridge University)行爲與健康研究中心(Behaviour and Health Research Unit)主管泰雷扎•馬爾託(Theresa Marteau)表示，“我們像老鼠一樣——是精力吝嗇者(energy miser)和認知吝嗇者(cognitive miser)。如果有捷徑，我們就會抄近道。”

Nudges are less blunt than laws, since they still permit people some discretion – they merely try to guide them. Mr Cameron’s coalition is keen on the approach, declaring in 2010: “Our government will be a much smarter one, shunning bureaucratic levers . . . and finding intelligent ways to encourage, support and enable people to make better choices for themselves.”

“輕敲”型方案不像法律那樣生硬，因爲這種方案仍然爲人們留出一些自由——只是試圖去引導人們罷了。卡梅倫的聯合政府熱衷於採取這種方案，曾在2010年宣稱：“我們的政府將是一個聰明得多的政府，迴避官僚手段……並尋找明智的方法，鼓勵、支持和幫助人們做出對自己而言更好的選擇。”

The minimum price per unit for alcohol was more of a lever than a nudge. The idea was to curb the UK tendency toward binge drinking by barring supermarkets from heavily discounting alcohol. It would not have encouraged people to stop buying booze cheaply – it would have prevented them.

爲酒精飲料設定最低單價，更像是一種官僚手段而非“輕敲”型方案。該政策的理念是，禁止超市以高折扣出售酒精飲料，從而遏制英國人的豪飲傾向。這種政策不會起到鼓勵人們停止購買廉價酒的作用——而是會阻止人們購買廉價酒。

You need a very good reason to intervene so forcefully in people’s choices, especially when it amounts to a regressive income tax. It puts alcohol firmly in the same category as cigarettes, a pernicious form of good that a government will tax not only to raise revenues, but actively to curb its consumption.

我們需要非常充分的理由，才能如此強勢地干預人們的選擇，特別是當這樣做的效果等同於徵收累退所得稅時。這種政策毫不留情地將酒精飲料與香菸劃爲同類，即一種要被政府徵稅的有害商品，政府對這種商品徵稅，不僅是爲了提高財政收入，也是爲了主動控制其消費量。

I still think the idea was justified. Even a law-abiding drunk drowning his sorrows at home imposes health costs on others – as does the person who contracts type 2 diabetes by ingesting too much sugar. New York City incurs an estimated $4.7bn in annual costs due to obesity, much of it paid by public programmes such as Medicare and Medicaid.

我仍然認爲，這種理念是有道理的。即便是一位遵紀守法、只是在家裏借酒消愁的醉漢，也會給他人造成醫療費用的負擔——就像因攝入糖分過多而患上二型糖尿病的人一樣。據估計，紐約市每年發生由肥胖導致的成本47億美元，其中大部分由美國聯邦醫療保險計劃(Medicare)和美國聯邦醫療補助計劃(Medicaid)等公共項目埋單。

With obesity, the social cost more or less stops there, apart from bad parental influence on children. With drunkenness, it often goes further – alcoholism triggers crime, and turns accident and emergency departments in UK hospitals into bedlams.

除了肥胖父母對子女的不良影響外，肥胖的社會成本差不多僅此而已。但醉酒的影響往往更加廣泛——酗酒引發犯罪，並讓英國醫院的事故與急救部門亂成一團。

Liberty and social equality mean that governments should adopt the lightest methods possible to address such social ills – they should label and advertise before nudging and banning. But both Mr Bloomberg and Mr Cameron struck a fair balance – or they at least tried.

自由和社會平等意味着，政府應當使用盡可能溫和的方法解決此類社會痼疾——在推行“輕敲”型方案和頒佈禁令之前，政府應當進行說明和宣傳。不過，布隆伯格和卡梅倫都已平衡得不錯——或者說，至少他們努力了。