Hasta La Gadget!

New York State’s highest court ruled on June 26 against New York City’s proposal to limit the size of servings of sugary sodas. It’s a ruling that raises real concerns about limiting the ability of municipal health departments to tackle 21st-century public health challenges. It also underscores the importance of creating a public climate in which those health challenges — and the most effective approaches to disease prevention — are better understood and appreciated.

What was so remarkable about the city’s proposal is that it was only to limit the size of individual servings — not to ban the drinks or to restrict the number of servings that could be purchased. It would simply have eliminated huge servings at restaurants, movie theaters, and stadiums. Yet that simple evidence-based proposal generated litigation over the role of health departments, and in this case, New York City’s authority to implement it.

While the opposition, led by the soft drink industry, won in court, the more important lesson is that the public will need to be increasingly aware of the threats to its health, and the costs that those threats impose. The soft drink industry has protected its profits, but the public will lose if the epidemic of obesity continues unabated.

More than one-third of U.S. adults are obese, and the cost is extraordinary, according to the Centers for Disease Control and Prevention. The estimated annual medical expense of obesity was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight. And that’s just the cost of obesity itself.

It is also clear that obesity is a cause of other diseases, conditions such as heart disease, stroke, type 2 diabetes and certain types of cancer, which are among the leading causes of preventable death. All of these take a toll on our health and productivity and add to the cost of preventable disease.

It is the responsibility of our health departments, our cities, and our states, to protect our health. New epidemics require scientifically based solutions to prevent disease effectively; some of those approaches must be designed to protect the whole population. With the courts placing constraints on our ability to take evidence-based, population-level approaches, the burden will shift to individuals, who will need to be especially thoughtful in considering how to protect themselves. Unfortunately, individual will power is powerless to control an epidemic.

Measures that limit choices are typically controversial and often opposed strenuously by special interests. Look at the opposition over decades to reducing smoking. But that doesn’t mean that they aren’t in the public interest. Often it takes time for the public to adapt, and that may be true even in the case of soda sizes.

That’s why it’s so important for the public to value the ever-changing role of health departments. Traditionally, health departments have been responsible for the operation of public hospitals, for responding to and preventing outbreaks of infectious diseases, and for ensuring safe food and water, workplaces, and sanitation systems. To that we must now add, preventing chronic diseases and conditions, including obesity.

One of the central lessons of public health is that more than half of health is created by factors that are not fully in the control of the individual. If streets are not safe or sidewalks are missing, the ability to go out and walk or exercise is limited. If fresh fruits and vegetables are not readily available, the opportunity to prepare a healthy meal is reduced. By the same token, if huge soda servings are the most readily available, they will be purchased — and once purchased, they will be fully consumed.

In the 21st century, the future of health across the life course will be determined by the actions we take collectively, as societies and as a world, to create the conditions that make healthy choices the easier choices, and thus make health more likely — and in some cases even possible. This latest court ruling limits what cities can do by executive decision, so more will need to be accomplished legislatively. In that arena, of course, the influence of special interests is especially powerful.

The public will, therefore, have to make up its own mind as to who is really looking after our interests. As New York City Health Commissioner Mary T. Bassett stated on Thursday, “Today’s ruling does not change the fact that sugary drink consumption is a key driver of the obesity epidemic.”

Accepting a smaller serving of soda is a small price to pay, when the alternative is a far greater cost — and one that’s growing steadily. With this court ruling, the public is still left bearing that growing cost.

It’s been two weeks since former Secretary of State Hillary Clinton’s Hard Choices hit the shelves, and she’s already getting hit for a “disappointing” rollout. Critics say her book is “bombing” and sales are “tanking,” news outlets and conservative blogs report.

But sales figures for Hard Choices, compared with sales of books penned by potential Republican presidential hopefuls, tell a different story. According to Nielsen BookScan data, Clinton has sold almost 135,000 copies of her new memoir.

Meanwhile, Republicans who have similarly aimed to boost their profile with a book — Sen. Rand Paul (R-Ky.), Sen. Marco Rubio (Fla.), former Florida Gov. Jeb Bush, Rep. Paul Ryan (Wis.), Wisconsin Gov. Scott Walker, and former Arkansas Gov. Mike Huckabee — have paled in comparison. In fact, Clinton’s two weeks of sales top the total sales to date of books by Paul, Rubio, Bush, Ryan, Walker and Huckabee — combined.

Clinton isn’t the only one putting conservative book sales to shame. Sen. Elizabeth Warren (D-Mass.), a liberal sweetheart to whom many have dished the big 2016 question, has sold more than 65,000 copies of A Fighting Chance since its April release, almost doubling the leading seller of the Republican bunch.

Huckabee leads the GOP authors with 35,503 copies sold. Rubio is right behind him with just over 35,000 sales. None of the others has hit 20,000. Bush has sold fewer than 5,000 copies of his book, Immigration Wars.

It’s no surprise Clinton’s books aren’t hitting the same numbers as bestseller The Fault in Our Stars, but conservatives may want to consider the success of their own book sales before describing Clinton’s as “horrendous.”

There is much talk about the unique opportunity emerging from the womb of fragmented Iraq to produce qualitatively new regional and international agreements. Some are saying that the time has come for the “grand bargain.” Others call for adapting to the situation on the ground, and to officially acknowledge the idea of autonomous provinces and the need to transition from a “simple state” to a “compound state” in Iraq. However, there are also some who see Iraqi events as the beginning of collapse, partition, fragmentation, and bloody sectarian warfare in the entire Arab region. What is happening in Iraq and Syria is extremely serious, and there is no room for any errors, which would be truly devastating. It is time for a new approach at the regional level, especially with respect to Saudi-Iranian relations, and at the international level, especially with respect to U.S. involvement rather than self-dissociation. Barack Obama has started to correct his policies, though concerns remain regarding the possibility of him backing down, at least in the view of those who have been closely observing the U.S. president. The Iranian leadership is trying to take advantage of the events in Iraq to further its interests, especially in the context of Iranian-American relations. The Saudi leadership believes that U.S. vigilance regarding the layers and repercussions of Iraqi events opens the door to a new dialogue between the two countries on Iraq and Syria, and also on the requirements of mending Saudi-Iranian relations. As for Russia, it is watching with concern the developments in Iraq for fear they may impact its “victories” in Syria. For this reason, perhaps, Russia is downplaying and reducing the Iraqi event as something that solely falls under the category of terrorism, just like it had done with the events in Syria. The difference is that Russia is a direct actor with military contribution in the Syrian civil war, where Russia is in an organic alliance with the ruling regime and President Bashar al-Assad. By contrast, Russia is a marginal player in Iraq.

The common denominator among all these parties is that they are all convinced the Islamic State in Iraq and Syria (ISIS) poses a threat to all of them, being a barbaric terrorist group whose main ideology is destruction and the establishment of an Islamic “emirate” to replace any pluralistic and open form of government. The other common denominator is that all these parties are fully aware that what is happening in Iraq is also an uprising against the administration of Prime Minister Nuri al-Maliki, who was brought by the United States and Iran to power, and that ISIS is only one out of dozen groups or so that are taking part in the rebellion.

All sides agree on not allowing ISIS to achieve victories that can lead to the creation of that “emirate” it so desires. The difference is that some want to immediately defeat ISIS as a precondition for a comprehensive political process, while others believe that a military solution is not possible without an immediate political process that shuns exclusion, marginalization, and sectarianism. ISIS, in this context, can never be part of a political solution in the mind of any party. It is part of the military solution, which is being discussed to eliminate and defeat ISIS as a terror group.

The problem is that ISIS was practically the vanguard of the uprising that upended the internal balance of power in Iraq, but ultimately, it is only one among many other factions in the Sunni uprising against Maliki’s exclusion of Sunni Arabs. Realistically, ISIS broke the first ring of the siege, and created a new dynamic against Iranian hegemony over the government of Iraq through Nuri al-Maliki. But behind ISIS’s vanguard, many other factions overlap with ISIS, in spite of the differences that will inevitably surface among these groups, which have conflicting objectives and ideologies.

Thus, any talk about decisive victory against ISIS means military action that inevitably requires air strikes, in which the United States will have to have a role through drones, reconnaissance planes, and special forces, which President Obama has now dispatched to Iraq to provide assistance though not to engage directly in combat.

The Iraqi government has asked the Secretary-General of the United Nations to provide cover for international assistance – meaning U.S. assistance on the basis of previous bilateral agreements between the two countries, and given that Iraqi military capabilities are limited while Iraq lacks the kind of fighter planes needed for such a military action.

Iraqi Foreign Minister Hoshyar Zebari focused on the issue of international support as the key to the solution, and said that important developments are going to take place in the coming period. Zebari stressed that what was needed was a stand against terrorism rather than a stand with the Maliki government or with Shiites, saying that ISIS’s threat affected everyone, though he acknowledged that a military solution is not possible without a political process, and called for proceeding along both paths.

Iran, according to sources, is ready to persuade Maliki to step down, but not before things return to normal as they stood prior to the Iraqi uprising’s seizure of posts and crossings, and not before ISIS is eliminated by means of airstrikes. Tehran wants to cancel what has happened on the ground as a precondition for agreeing to Maliki stepping down. The Iranian leadership believes that there is a golden opportunity now to formulate a bilateral “grand bargain” with the United States to fight ISIS and similar groups, beginning in the Iraqi theater.

To be sure, Tehran may be prepared for Maliki to step down in a way where he can save face, and has in its pockets a replacement who is no less loyal to Iran. However, Tehran categorically rejects any calls for it to similarly abandon Bashar al-Assad in any deal – be it a small or a grand bargain. To be sure as well, Tehran does not feel itself under any U.S. pressure in that direction. In other words, it has not heard from U.S. officials anything about Assad’s fate similar to what they said about Maliki’s.

The only link between Iraq and Syria in the mind of the Iranians is the need to eliminate ISIS and similar groups in the two countries, reverse any victories on the field achieved by ISIS in Iraq and Syria, and head off any Syrian uprising similar to the Iraqi uprising – i.e. where Sunnis ally themselves with the “devil” to get out of the status quo.

Deep inside, the Iranian leadership is aware of the difficulty of achieving what it is touting as an opportunity to its advantage. The Iranian leadership, realistically and practically, is not ready for the “grand bargain” yet, because that bargain requires serious concessions by Iran and also Saudi Arabia. The only player that can push Iran and Saudi Arabia toward that grand bargain is the United States. Perhaps there is a real golden opportunity here if the Obama administration decides it is time for a comprehensive approach to find serious and permanent solutions in both Iraq and Syria, but this requires a coherent strategy and it is not clear whether Obama and his team are up to this or not.

U.S. Secretary of State John Kerry, as usual, has been touring, exploring, endeavoring, analyzing, and hoping for things. It is time for his president to boost his efforts with a clear and bold strategy with both Saudi Arabia and Iran. It is really time for a new, firm, and determined approach that would delineate and limit the Iranian roles in Iraq, Syria, and Lebanon, and defeat Salafist terrorism, something that requires partnership with the Sunnis rather than sectarian wars.

But if the U.S. priority is to seal a nuclear agreement with Iran at any cost, then the Obama administration has only itself to blame in the event of total collapse in Iraq and unchecked growth of Salafist terrorism, as this is the only alternative to the failure of the United States to confront Iran over the consequences of its policies and military intervention in two major Arab countries.

Historical responsibility also falls on Saudi Arabia at this serious and decisive stage. This is not the time to gloat. It is the time to take advantage of the favorable opportunity to advance ideas conscious to the fate of Iraq, Syria, Lebanon, Jordan, and perhaps also the Kingdom itself. Insisting on the exclusion of Iran from regional and international understandings will not do any good. Iran has become a key player in Iraq, in Syria, and in Lebanon, and any solutions in these countries requires negotiations with Tehran.

Certainly, the Saudi leadership is aware more than others that ISIS and similar groups threaten the stability of Saudi Arabia, if they emerge victorious and establish their emirate. Decisions taken by the Kingdom to prevent its citizens from joining extremist organizations and to fight terrorism are important and necessary decisions. Now, Riyadh must not leave the scene and allow Iran to claim that it is the natural partner for the United States in the fight against ISIS and its ilk, and must not allow Russia and even the United States to reduce Iraq and Syria into an issue of terrorism. It is of the utmost importance for Saudi Arabia to make every possible effort to immunize Lebanon from falling into the arms of ISIS retaliation against Hezbollah, because Lebanon’s collapse would be a strategic loss to Saudi Arabia, and not just to Hezbollah and Iran behind it.

The Islamic Republic of Iran is trying to emerge as a natural partner for the United States in the fight against terrorism, and is touting old-new ideas to the U.S. media and the American public – under the title of readiness for regional cooperation and the establishment of a new security regime that includes the GCC, Iraq, and Iran.

The GCC countries are fully aware that Iran’s tireless goal is to break and dismantle the GCC framework and replace it with a security organization dominated by Tehran, which has not forgotten that the six GCC countries once supported Iraq in its war against Iran under Saddam Hussein, along with the United States. Deep down, Iran denies that one of the GCC’s goals in supporting Iraq back then was to prevent the export of Iran’s mullahs-led revolution, and impose the Iranian system of government upon neighboring countries.

It is important for Saudi Arabia to put forward a narrative to counter that of Iran, which has a guise of logic and reconciliation. If Iran’s narrative is unacceptable, then let Riyadh come up with its own to counter it. If it is acceptable with reservations or conditions, then let Saudi Arabia clarify this comprehensively. It is important for Saudi reconciliatory proposals not to be absent and for Riyadh itself not to be absent from making initiatives.

Translated from Arabic by Karim Traboulsi

RaghidaDergham.Com

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