This article addresses an issue that is really much more general than cycling and cycle campaigning, but I think it is highly relevant to cycle campaigning. It’s something I’ve been thinking of writing about for some time, but a recent, very thought provoking article prompted me to get on with it.
Public health campaigns and “victim blaming”
Before I talk about the subject of that article, I want to start with a different example to illustrate the point I’m going to try to make. Earlier this year, I was treated for Prostate Cancer by means of some brutal, though very advanced and precise, surgery carried out by fantastic surgeons at Christie Cancer Hospital with the aid of an impressive robotic system:
That’s not actually me on the table, but you get the picture. This is bloody serious, life-threatening stuff, and the consequences of this kind of surgery are a bit crap, but thankfully I’m still here and hopefully will remain here for a long time now. Nine years ago, my lovely wife was treated in a similarly brutal, though different, way for breast cancer, and she also seems to be fine. Neither of us can ever be certain that it is gone, but statistically the outlook is good. I mention statistics at this point because that is at the root of the main point of this article.
Ever since my wife was diagnosed in 2009, I have kept abreast of developments in cancer research and noticed a particular phenomenon whenever causes of cancer are in the news. One recent occasion was this headline that appeared in September on the BBC:
The headline contains the usual crass nonsense that is prevalent in the British press, including the BBC News: the only reason it “doesn’t apply” to male cancers is because more men than women smoke.
However, the thing that I want to focus on here is the reaction that often follows such news, whereby the people pointing out the connection, as well as people who actively advocate lifestyle changes to reduce cancer risk, get accused of victim blaming. There’s a lot been written about this, as this google search shows, and I found this article in The Conversation illuminating. I was also struck by this very heartfelt personal article on the same topic.
So, as a “cancer survivor”, how do I feel about all the publicity given to research linking cancer to lifestyle choices? Things like being fat (as I certainly was before I started cycling and still weigh a little more than I’d like), eating red meat, drinking alcohol, etc., etc., etc. Do I feel they are blaming me for the fact that I got cancer? Do I feel shamed for not doing all the things that would have reduced my risk? Do I think that public health campaigns should stop suggesting that people change their lifestyle to reduce their risk of getting cancer because they are victim blaming? No, I damn well don’t, because I understand the difference between risk and cause; I understand the difference between population level studies and individual cases. I know that there are things I do that might increase my risk of getting cancer, but that’s a long way from saying that I, through my choices, have caused my own cancer; there is absolutely no way of knowing that; the bottom line is that it was just bad luck.
It was my experiences with cancer – my wife’s and then my own – and the reactions I often saw from people in forums related to breast cancer and later prostate cancer, that got me thinking about writing on this topic. But the article that caused me to move on from thinking about it to writing something down was this very thought provoking article on “fat-shaming” and its relationship to cycle campaigning. The article is well-researched and well-written and is well worth the read, and I agree with almost everything in the article. The issues it highlights are real and should be addressed; making individuals feel ashamed because they have a particular body shape is bad. One of the questions it raises for me, though, is around the assertion, in the title of that article, that we should “retire the obesity crisis argument” – that we should give up using “the obesity crisis” as a lever to bring about the kinds of change that are needed to enable people to adopt more active, healthy lifestyles.
I’ll come back to that point later, but first I think it is worth looking at the fallacy behind the commonly made association between: research results linking health to lifestyle, the resulting campaigns to encourage people to change their lifestyle choices, and the idea of victim blaming and shaming.
In fact, there are two closely related fallacies involved in this. The first is formally called “the fallacy of division”. It is explained very concisely in this page, and is defined thus:
“Inferring that something is true of one or more of the parts from the fact that it is true of the whole.”
An example of this that we all know only too well from the cycling context is the fallacious argument:
“Cyclists are often seen jumping red lights; Grahame is a cyclist; therefore Grahame often jumps red lights.”
To anyone who is even remotely capable of logical thought, this is plainly nonsense, yet I see this fallacious argument being made time after time to justify bigotry against people who ride cycles.
The second fallacy, which is even more relevant, is rather complex, subtle, and more difficult to understand fully as it requires a knowledge of statistics, but it is closely related to the fallacy of division. This is “the ecological fallacy”, which can be defined thus:
“A formal fallacy in the interpretation of statistical data where inferences about the nature of individuals are deduced from inferences about the group to which those individuals belong.”
The Wikipedia article on this one is very good, but not for the faint-hearted. It is easy, though, to see the connection to the fallacy of division, and indeed the red light jumping nonsense can be formulated in a way that makes it a very simple example of the ecological fallacy:
“Cyclists have been observed jumping red light 18% of the time, therefore Grahame, who is a cyclist, must jump red lights 18% of the time.”
To me, this statement seems obviously fallacious, but there are many people for whom that seems not at all obvious; and I’m sure there are others who know very well that it is fallacious but find that ignoring the fallacious nature of their argument serves their purpose very well.
As a final example to illustrate the ecological fallacy, I think it is useful to refer to the failure of people like Donald Trump to understand the difference between climate and weather when they are denying the existence of man-made climate change. In December 2017, Trump posted this message on Twitter:
On 22nd November this year, he reinforced this stupidity with the following tweet:
This is, again, nonsense. The temperature in my own part of the world typically varies between about 35C and -8C (the latter being the coldest morning on which I cycled to work), and that’s in a temperate climate. Friends I know in Finland can experience variations between 35C and -30C. I remember on one occasion I arrived for a meeting in Malmi, just north of Helsinki when the temperature was -16C; they said “Oh, you’re lucky – it was really cold last week”. Yet the climate change scientists talk about an increase in global temperatures of only +2C as being potentially catastrophic. That is because they are talking about world average temperatures, not individual weather events; the two are only tenuously related.
It is alarming that when I took the latter screenshot, three days after it was posted, it had been “liked” by well over 100,000 more idiots. Perhaps they were liking it for its comedic value.
The problem we have is that ignorant bigots generally are incapable of acknowledging or often even of understanding the fallacy of inferences like these, often because they are just too lazy to think things through.
Back to “the obesity crisis”
So how does all this relate to “the obesity crisis” (which I put in quotation marks because that is the term that is now widely used to refer to it)?
First, let’s be very clear: “the obesity crisis” is about a population level phenomenon, not individuals. There are many people whose weight is well above the average who are very fit and will probably live a long life, just as there are many much slimmer people who will die of cancer or heart attacks or develop diabetes. That variation is like the normal variations in temperature that come with weather and is absolutely not a problem. Indeed, I think such diversity is to be celebrated, as we do every year in the World Naked Bike Ride: male, female, fat, thin … every shape and size, can be seen to be universally beautiful once all the social baggage is stripped away. However, to use those normal variations in weight to deny that there is an obesity crisis is exactly analogous to using the normal, wide variations in temperature that come with weather to deny the existence of global warming, as Trump did in those tweets.
At the population level, there is a clear, very significant correlation between average body weight and the incidence of a whole range of diseases. The amount of research on this is huge, and is best looked into using a Google search (other search engines are available), but this review of the evidence is a good starting point. There is also clear evidence that that overall, at a population level, the average weight of people in the UK has been rising significantly over the last couple of decades. Again, it’s not necessary to produce loads of links here to support that; there’s plenty of it. This BBC article, based on an Oxford University study, puts it at 7.7kg (16.9lb) increase for men over a 15 year period, and this extremely well-referenced review article looks at international trends in body weight and the related health consequences.
Unlike the case of climate change versus weather, a change of 7.7kg is actually comparable to the natural variation in weight between individuals, but it is still that population level change that is the main concern, not the individual variations. Just like temperatures in relation to weather and climate change, BMI (Body Mass Index) is quite a blunt instrument when applied at the level of an individual but is very significant when applied at a population level. Quite apart from the suffering those diseases cause, the change and its effect on the overall health of the population is costing the National Health Service large amounts of its precious resources, and we need to address this, because of both the human cost and the financial cost.
The relationship to cycling and cycle campaigning
There is also good evidence that cycling can have a significant impact on body weight. Again, this is not necessarily the case for every individual as there are many other factors such as diet and genetics, but at a population level there is good evidence that commuter cycling is associated with reduced body weight, for example in this article reporting an Australian study. The association between commuter cycling and weight loss is shown to be much clearer than, for example, between walking and weight loss.
Of course, there is an argument that we should just refer to the health benefits of cycling without saying anything about weight or body shape. For example, this very good review of research on the health benefits of cycling, shows that there are undoubtedly many health benefits from cycling that are not primarily associated with weight loss, and I would certainly support augmenting our existing arguments to emphasize those other benefits more strongly. However, I do not think that necessarily implies that we should abandon all mention of the obesity crisis which, as we have seen in the previous section is a very real issue that can be addressed, at least in part, by enabling people to cycle where they would currently drive.
Even if we do believe that the nature of the discourse should change to downplay the role of body weight, that can only be done from within the context in which the problem is framed. That context is not cycle campaigning, which is just one part of a much bigger picture. I believe a change that needs to be addressed through education of people who mistakenly feel that public health campaigns are blaming them, and by pulling up bigots who misuse population level studies and public health campaigns, to make individuals feel bad. That is where the problem lies and that is where the solution ought to be found.
In fact, when we do mention the obesity crisis in our campaigning, the message generally coming across is that people are not to blame because they are prevented by the current environment from doing the things that might help them improve their health. That includes the possibility of reducing their weight without resorting to extreme diets and joining clubs where they will probably lose far more in pounds sterling than they will in pounds avoirdupois.
In the end, the campaign for investment in cycling (and walking) infrastructure is a political campaign. It is the fact “the obesity crisis” is currently a big political issue that makes it a very effective way to justify the spending of what should be a significant amount of investment on cycle infrastructure. By all means try to change the way the health crisis is framed more generally, but we should think very carefully before pre-emptively abandoning that element of our campaigning, despite the “fat shaming” issue.
Thanks for this, Grahame. I think the biggest health message we can use as cycle campaigners relates to the grotesque consequences of air pollution, which is increasingly linked to a whole range of conditions beyond the classic respiratory diseases – there is increasing evidence of links between pollution spikes and heart attacks, strikes etc. The problem with the reference to obesity is that it’s such a blunt tool – based solely on your height/ratio – and says very little about your underlying health, as you yourself rightly say. So referring to obesity at all is by the very definition labelling people as unhealthy purely by their body shape without controlling for any other factors. Plus: the causes are much more complex than the mere access to bicycles – poverty, mental health issues etc. can also have a significant negative impact on people’s habits and health, and building a bike lane through their neighbourhood won’t solve those on its own. So the claim that cycling can solve obesity can’t be sustained, and even with all the caveats, we’re on shaky ground, especially given that the type of cycling we promote is far from the high heart-rate stuff you’d need to have a structured programme of exercise to take you from a “high” BMI to a “normal” one. It’s a promise we can’t keep, so why make it?
If we are going to talk about the population level at all, then “inactivity” is a better term as it can apply to people across the BMI range, which is a more accurate approach. But even there, as Jenny says, there are fit and active people who drive everywhere, who wouldn’t feel addressed by that argument, so our focus must be on reducing the number of car journeys as opposed to reducing the number of fat people – many of whom already cycle and have very mixed experiences of its potential for weight loss, or indeed whether that’s even a consideration for them at all. It really is a can of worms!
Hi Nick. Thanks for this response.
I think I failed to get across properly the distinction between population level stuff and individual level stuff. (For example, pointing out that increasing the rate of cycling across a population can result in a reduction of the average BMI is not the same as promising that a particular individual’s BMI will go down if they cycle.) Although your second paragraph does highlight the difference and the associated fallacy.
However, your response is, as ever, thought provoking and has caused me to rewrite significantly the last section (now two sections) of the article, as well as including more evidence to back up my arguments (which I really should have done in the first place).
I think the can of worms isn’t so much in the apparent contradictions between populations and individuals, which clearly disappear if we look at the logical fallacies that underlie them. It is more in the transition from rational scientific analysis into the irrational world of politics; a place where I (and probably you) feel very uncomfortable but are obliged to reside for pragmatic reasons.