Jim Kenney was 15 minutes into his pitch for a 3-cent-per-ounce tax on sugar-sweetened beverages and still hadn't mentioned the word
. Philadelphia's mayor was far more focused on the city's pre-K crisis than its residents' waistlines.
"We have a 26 percent poverty rate," he told me. "We have an incarceration rate of almost 7,000 people at any given time. And if we don't change generationally, educational opportunities, training opportunities, job opportunities for people, we're never going to get that 26 percent poverty rate down. And it has to start with 3- and 4-year-old kids in a pre-K situation."
It's not that the new mayor doesn't get the health side of the debate; he just thinks it's ancillary to his bigger priority.
"It's terrific if people drink less sugary-sweetened beverage," he said. "But the point is that I got to get these kids educated. I have to get them ready for school, ready for jobs in the next generation, and I have to get some of our people to stop going to jail or to the cemetery, because they don't have the opportunities to get a good education and fall by the wayside."
A few days after our chat, the mayor's secondary consideration got a boost from seven academics who published "The Association Between Income and Life Expectancy in the United States between 2001-2014" in the Journal of the American Medical Association. This is the largest observational study of its kind, evaluating the tax and Social Security records of everyone in America with a valid Social Security number and earnings between 1999 and 2014.
Harvard's Benjamin Scuderi, one of the authors, told me there is a definite correlation between health behaviors and longevity.
"What we find is driving a lot of these differences, at least in a correlation perspective, are health behaviors," Scuderi said. "A lot of the work has been done to measure how healthy a population is in terms of the behaviors they engage in, like smoking, exercise, and obesity rates. And those three factors are our highest correlations. Interestingly, when we look at data that's been collected on health-care access and quality across different locations those variables aren't significantly associated with longer life spans."
One revelation in the data is the disparity in life span among the poor based on geography. It's far better to be poor in Santa Barbara, Calif., (81.7 years) than Detroit (77.7 years) or Philadelphia (78.7).
Scuderi sees several lessons for policymakers like Kenney.
"These findings should be a great step of encouragement for people who are interested in public-health policies that nudge people toward better health behaviors," he said. "Local leaders should absolutely be thinking about ways that they can work to change health behaviors and nudge people toward better decisions."
Kenney notes that his plan includes the renovation of parks, recreation centers, and libraries, plus community schools that will offer a range of services, from eye and dental care to counseling or English-language learning.
"A lot of our parents are single parents. They work in low-wage jobs," he said. "If they take off to take care of their kid's medical needs they often wind up being fired. So it's trying to keep the family working and keeping things together."
The mayor has rapid-fire responses to the arguments raised by opponents of the tax:
It's regressive. "They advertise in African American, Latino, and poor neighborhoods more than they do in white neighborhoods. So they're targeting those folks to begin with."
It's an unreliable source of income. "Our projections are based on a 55 percent cutback on sugary-beverage purchases."
It will send soda buyers to stores outside the city. "It's possible, but a lot of this has to do with the fact that the State of Pennsylvania and legislature won't do what they're supposed to do, and that's raise the personal income tax."
It will hurt more than "Big Soda." "I understand the Teamsters' concern . . . but if there's a falloff in sugar-sweetened beverage consumption, they may be carrying more of the other products that those companies sell."
He bristles at any insinuation that he's part of a "nanny state."
"We're a city with a large poor population that costs us money in many different ways," he said. "I mean, if you look at the cost of our prisons, the cost of prosecuting crimes, the cost of fighting crime, the unreimbursed cost of health issues like diabetes and other things, I mean, we pay in the end anyway. I'm just trying to make our kids' lives better so they become better parents and taxpayers themselves and we grow the base of taxpayers in the city as opposed to trying to put our fingers in the dike and keep it from collapsing."
When I told Scuderi that Kenney has focused his soda-tax argument on pre-K, not obesity, the economist had some advice:
"I think he should say it's about both. . . . There are lots of reasons to think universal pre-K is a good idea. But I think locally we should be using this evidence to say: 'Look, health behaviors really matter. We think they really matter for health-care outcomes and for life expectancy, and we know that drinking a lot of sugary soda leads to obesity, and that's a bad health behavior. And so any policy that we take to reduce that health behavior is going to potentially have big benefits.' "