The International Health Regulations (IHR) is the quintessential binding international public health framework. The IHR emphasizes surveillance, notification, and response systems, establishing clear obligations for countries and the World Health Organization (WHO) during public health emergencies. In a perfect world, the IHR, established in 2005, would have ushered in an age of global health cooperation. Yet, this is not the case. Five years removed from the 2020 shutdown, COVID-19 has highlighted the sheer failure that the global medical industry faced as a result of lackluster international policy and diplomacy efforts. While the IHR seeks to establish a clear baseline, it falls victim to delayed and inconsistent reporting, weak intrastate capacity for surveillance and response, and finally, significant political pressure and the weakness of the WHO’s authority. 

The case of COVID-19 seems like a distant past, but nearly half a decade later we are still reeling in its effects. Most notable is the lack of transparency states have regarding their reports. Take, for example, China’s delay in reporting initial cases to the WHO. China was criticized for delaying the disclosure of crucial information about human-to-human transmission, violating the IHR’s requirement to notify the WHO within 24 hours of identifying a potential threat. However, China faced little-to-no backlash from the WHO due to both the status the world superpower holds along with the IHR framework lacking an enforcement mechanism. Without enforcement, reporting is based on speculation and individual states’ willingness to come forward. Such expectation fails on the world stage, where states are heavily incentivized to protect their domestic information and assets. However, it is not just superpowers that have not been forthright in relaying information to the WHO, as during the 2014 Ebola crisis. Guinea, Liberia, and Sierra Leone failed to report early signs of the outbreak, contributing to its rapid spread. The IHR’s fundamental goals of surveillance and notification fail at all levels, as states have no real reprimand.

The 2014 Ebola crisis displays a rarely discussed aspect of how meaningless the IHR’s requirements are, as it concerns states that have significant intrastate difficulties. Many low-and middle-income countries (LMICs) lack the resources to meet the IHR’s core capacity requirements (the ability to detect, assess, notify and report events). This is for a multitude of reasons, from the neo-colonialist policies of states, such as China with its Belt and Road initiative, the U.S.’ strong military presence, or even just the after-effects of centuries of colonial rule. However, these effects culminate in the significant underfunding of critical national healthcare infrastructure, which was highlighted by West Africa’s Ebola outbreak. Yet, the IHR has limited resources to address this issue. The WHO itself provides no financial aid, let alone structure, for these states to begin creating robust healthcare infrastructure, choosing only to temporarily patch the leaks through initiatives such as COVAX and the African Vaccine Acquisition Trust (AVAT). COVAX failed to have an impact due to richer states hoarding vaccines in the interest of domestic national security, further exacerbating the global pandemic. Fundamentally, LMICs prioritize domestic stability, causing international cooperation and information sharing to become low priorities. 

Nothing highlights the weakness of the IHR and the WHO as a whole as the disregard states have for its authority. With the U.S. exit from the WHO earlier this year, despite being a founding member, the purpose of the WHO has been called into question. When the WHO attempted to declare a Public Health Emergency of International Concern (PHEIC) for COVID-19, there was significant political pressure from China for it to not be released. There is no real punishment for states failing to abide by the core tenets of the IHR, leading to gross negligence on the part of states. No “stick” to compel states to act means that states will simply act in their best interest, avoiding disclosing any data they deem detrimental to their image abroad or at home. On top of this, when the WHO released a PHEIC for the H1N1 pandemic (2009), it faced significant backlash from the international community for supposedly “over-exaggerating the significance of the outbreak,” which killed over half a million people globally. Even when the WHO does its job properly, states will continue to complain, leading to de-prioritization. This can have dire consequences in a context where 4.5 billion people worldwide lack access to basic health services and two billion people face financial hardship due to health costs.The best way to address the failing WHO is to take conditional aid and trade measures (soft penalties), emergency intervention protocols, and strengthen partnerships with regional bodies. Similar to the World Bank, IMF, or WTO, tying the requirements of the IHR to economic measures would ensure that states prioritize their domestic reporting infrastructure and decrease the likelihood of states failing to report to the WHO when concerns do come up. In extreme cases where a country conceals or suppresses critical public health information, the WHO could invoke emergency powers to deploy rapid response teams and work directly with states to be able to mobilize neighboring countries or regional coalitions to address the outbreak.

This framework has largely been ignored by states due to their national security concerns, but at the end of the day, human security is what should matter. Allowing for the IHR and the WHO to have a realistic, non-military enforcement mechanism is the best possible solution to its current failings. Finally, working with regional bodies such as the Africa CDC, European Centre for Disease Prevention and Control (ECDC), or ASEAN BioDiaspora Initiative would allow for a more global approach as well as a general increase in the legitimacy of the WHO’s mission and existence. On top of this, regional bodies often have better diplomatic leverage and cultural understanding. Partnering and working with them would decrease issues related to sovereignty, as well as expedite information communication between individual states and the WHO. The best way forward is to create a path in which the WHO can truly operate on the world stage. Without these changes, we risk the collapse of the only significant international framework that seeks to benefit the health of people worldwide.

The oft-repeated “America First” mantra has been a rallying point of the Trump administration, one that includes promises like bringing jobs back from overseas, rebuilding a crumbling infrastructure, and increasing military spending. As the mid-March budget proposal release signifies, a 28 percent slash in the budgets of both the U.S. Agency for International Development (USAID) and the State Department will offset the enormous cost of a $52 billion increase in military spending. These drastic cuts will have far-reaching consequences for U.S. diplomatic, economic, and security interests. Cuts to two programs in particular—the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to fight AIDS, Tuberculosis (TB), and Malaria—will wreak havoc in the developing world.

Through partnerships, PEPFAR has provided antiretroviral treatment to millions of children like this young girl in Mozambique:

Introduced by President George W. Bush to address the worldwide HIV/AIDS epidemic in 2003, PEPFAR is the largest investment by a country to fight a single disease ever. By translating scientific and public health research into sustainable action, PEPFAR’s support allowed 2 million babies to be born HIV-free and provided antiretroviral treatment to 11.5 million people. This support accounts for a reduction in both mother-to-child transmission by 70 percent globally, and adult HIV incidence between 51 percent and 76 percent in Zimbabwe, Malawi, and Zambia.

The Global Fund, while not a U.S. government program, relies heavily on assistance from donor nations, such as the United States, United Kingdom, and Sweden. Since 2002, the Global Fund treated 15.1 million tuberculosis cases, distributed antiretroviral HIV treatment to 9.2 million people, and distributed 659 million mosquito nets to prevent malaria. These efforts contribute to 22 million lives saved and a 33 percent decline in deaths from HIV, TB, and malaria.

PEPFAR and the Global Fund created laudable changes to the world health landscape. HIV/AIDS, responsible for 1.5 million deaths worldwide in 2000, killed only 1.1 million people in 2015 and is no longer a member of the world’s top ten causes of death. Tuberculosis, while still a leading cause of death worldwide, killed 1.37 million people in 2015—down from 1.67 million in 2000. Fifteen years ago, HIV was a death-sentence; through PEPFAR and the Global Fund’s continued funding, we could see the end of HIV by 2030. While Trump’s proposal seeks to maintain current funding for PEPFAR and the Global Fund, these programs will not be able to adapt to the rapidly growing adolescent population in sub-Saharan Africa. Should the United States fail to meet the standards of funding necessary to help this initiative grow, 17.6 million people will contract HIV and 10.8 million people will die of AIDS-related causes by 2030.

The United States contributes the most foreign assistance in the world, and the results are impactful and far-reaching, which is likely why most Americans erroneously believe that foreign aid accounts for 26 percent of the U.S. budget. Many Americans are mistaken: at $42 billion, foreign aid accounts for approximately 1 percent of the entire U.S. budget and a fraction of a percent of our Gross National Income (0.17 percent). This pales in comparison to defense spending, another category that the U.S. spends more on than any other country. Military spending already accounts for 16 percent of the U.S. budget, or $587 billion.

Obama’s FY 2017 budget proposal

Slashing the already fractional amount of money budgeted to the State Department is not responsible reallocation of funding. This proposal is a political demonstration—a way to show voters that America is being put first. The White House must rethink their proposed budget and make cuts that will not risk interrupting treatment for millions of patients in the developing world—the consequence of which could be drug resistance or death.

Putting America first doesn’t mean putting the lives of the sick last. Foreign aid and diplomacy, not just the armed forces, play integral roles in keeping Americans safe. If strengthening the military is truly of the utmost importance, it should not come at a cost to innocent lives. Are the millions of lives dependent on U.S. foreign aid fundamentally less valuable than ours?

I urge all American federal lawmakers to unilaterally fight for State Department and USAID funding. Together, we can end HIV and tuberculosis.

By: Andrew Peoples

What would you do if you knew you were dying? More specifically, what if you knew that your death was going to be physically and emotionally painful, and that there was virtually no hope for recovery? It is a question that few care to consider. Most people hope that this is a question they will not face until old age, and even then that their quality of life will be bearable enough until the end that they will not have to choose to die. Yet for many Americans and others around the world, the dilemma of imminent death is a reality, and preemptive, physician-assisted suicide seems a better option. With the recent headlines about Brittany Maynard, a young teacher from California who chose to end her own life rather than suffer from her terminal brain cancer, the question of Americans’ “right to die” may be entering the public’s attention in a greater way than ever before.

The “Death with Dignity” movement, a phrase coined by the activists who passed the first right-to-die law in Oregon, has been waiting a long time for Brittany Maynard. Previously, the face most often associated with physician-assisted suicide was Dr. Jack Kevorkian, a Michigan doctor who claimed to have helped more than 100 patients end their own lives. Kevorkian eventually went to jail for second-degree murder, raising awareness for his cause, but hardly gathering support. Most patients associated with the movement are elderly, and generally in no fit state to become spokespeople for the cause. Maynard provides a starkly different kind of figurehead. A young and attractive schoolteacher, Maynard was diagnosed with terminal brain cancer barely a year after getting married. In a column she wrote for CNN, 29-year-old Maynard explains that she was given six months to live and told that her the nature of her cancer would cause her still healthy body to outlast her deteriorating mind. A video on her website explains that the disease beset her with debilitating seizures, after which her mental functions were temporarily but seriously impaired. Maynard wrote that this slow but severe decay of her quality of life would be simply too painful for her and her family, and that this drove her to pursue “death with dignity.”

In her last months, Maynard became a vocal advocate for the movement that would allow her to choose to end her life. More prominent figures than Maynard have endorsed physician-assisted suicide, from paralyzed physicist Steven Hawking, who has firsthand knowledge of terminal illness, to the editors of the Economist. Yet the idea of a young woman choosing to die has proven more compelling to the American public than any previous argument. Her video explaining her decision received ten million views, and she used her CNN column to express her frustration at having to uproot what remained of her life to move to Oregon, advocating for “death with dignity” laws in other states. News coverage of her story has put physician-assisted suicide in the national media spotlight for the first time in years. The Death with Dignity center, another advocacy group, has seen a sharp increase in calls from around the country, including many from patients who want to move to Oregon.

Oregon, Vermont, and Washington are currently the only states to allow physician-assisted suicide. Two others, New Mexico and Montana, have had court rulings lay the groundwork for the practice, but have not codified it in law. The procedure involves doctors prescribing the terminally ill patient a lethal dose of barbiturates, which the patient can choose to take or not to take at his or her discretion. Patients must be at least 18 years old and have less than six months left to live. Since Oregon’s law was passed 17 years ago, 1,200 patients have obtained lethal medication, and only 750 have taken it.

Despite the scarcity of states with physician-assisted suicide laws on the books, a majority of Americans actually supports them. Gallup polls have found that seven in ten Americans support doctors who cause a painless death “if the patient and his or her family request it.” In spite of this widespread approval, ballot measures to legalize the practice generally fail, due in part to opposition from pro-life groups and from the Catholic Church. A 2012 referendum on the issue in Massachusetts failed to pass despite polls showing 60 percent support before the election. Campaign spending records reveal that 80 percent of the money spent to defeat the measure came either from the Catholic Church or individuals connected to it. The Church equates the issue with abortion and the death penalty, both of which it also opposes, and it uses its significant resources to combat right-to-die laws. With these laws pending in seven states, observers will soon see if Maynard’s publicity has given any edge to supporters of physician-assisted suicide.

Maynard took her prescription and passed away on November 2, after deciding against her original deadline of the first of the month. That even a strong advocate of “death with dignity” would choose not to initially follow through with ending her life demonstrates that no one makes this decision lightly. Terminally ill patients rarely want to die, but those who take advantage of these laws find it better to die on their own terms. Maynard’s impact long-term impact on the right-to-die movement is not yet clear, but it is clear already that with her death, she has brought to life an important debate.

By: Michael Land

The Human Genome Project, funded by the government of the United States, was begun in 1990 and completed in 2003. A little more than a decade since, there are genetic tests for diseases as diverse as breast cancer and Huntington’s disease. As with any technological advancement, the law is often slow to keep pace with the rapidly changing developments in the field of genetics. For example, until 2012’s landmark case Association for Molecular Pathology v. Myriad Genetics, it was possible for a single corporation to patent a human gene and thus monopolize all genetic tests for a particular illness. The associated increase in cost prevented many people from obtaining information vital to their own health and the health of their family members.

In 2008, the Genetic Information Nondiscrimination Act (GINA) was signed into law. It attempted to remedy some concerns about genetic testing by prohibiting certain types of discrimination based on an individual’s genetic information. Under the terms of the law, employers and health insurance providers may not discriminate against healthy people simply because of a predisposition to develop an illness. The Patient Protection and Affordable Care Acts further limit discrimination based on pre-existing conditions. Nonetheless, these laws apply mostly to adults; legal controversies still surround genetic testing, particularly in cases of fetuses or children.

Huntington’s disease is a genetic disorder that causes progressive neurological degeneration and death. Anyone who carries the mutant gene will develop the disease, and there is currently no cure. Women with children at risk for Huntington’s disease may undergo prenatal genetic testing to determine whether the fetus carries the mutant gene. Some choose to undergo selective abortion if the test reveals that the fetus will develop Huntington’s.

This brings up a moral dilemma. The disease is late-onset, generally presenting when the patient is about age 40. Women who find out that their children will be affected by such a disease must make a difficult decision. Is it better to live with a shortened lifespan or to never live at all? Perhaps moreimportantly, is it within the purview of the government to make that decision, or should it be left to individual choice?

In the United States, sex-selective abortion is illegal in some states. If we accept the belief that a government may ban both genetic discrimination and sex-selective abortion, may it also ban abortions based on the genetic makeup of the fetus? Does the potential for a false positive or false negative change the underlying ethics of the situation?

Finally, we cannot discount the fact that genetic disabilities are not a monolithic disease. They range in severity from mild to devastating. When laws regarding prenatal testing are considered, it is imperative that they take these differences into consideration. For example, one might argue that there is a distinction between banning abortions based on the potential to develop Huntington’s disease, in which symptoms appear during middle-age, and Tay-Sachs disease, in which symptoms occur soon after birth.

Differences in disease pathology, family history, and personal beliefs may influence a person’s desire to undergo genetic testing. Megan Smith is a teenager with a family history of Huntington’s disease. She has a 50 percent chance of developing the disorder within her lifetime. Megan is choosing not to be tested for Huntington’s, underscoring the deeply personal and possibly traumatic nature of the information revealed by the test. While Megan has the chance to live a normal life, some families are not so lucky. Emily Rapp is the mother of a son with Tay-Sachs disease. Her story highlights the harsh reality of having a child with a debilitating illness. With no reason to suspect that she carried the Tay-Sachs mutation, Emily chose not to have the genetic test performed on her unborn son; he was born with the condition that would later end his life. She explained her dilemma this way: “I’m so grateful that Ronan is my child. I also wish he’d never been born; no person should suffer in this way—daily seizures, blindness, lack of movement, inability to swallow, a devastated brain—with no hope for a cure.”

Emily’s story offers a more nuanced alternative to the black-and-white worldview of pro-life politicians such as Rick Santorum. In 2012, Santorum claimed that prenatal genetic testing was a recipe for more abortions, designed to “cull the ranks of the disabled from our society.” Santorum’s daughter Bella suffers from Trisomy 18, a rare and often fatal disorder that is easily detected via prenatal testing. Some studies have shown that up to 90 percent of fetuses with genetic abnormalities are aborted, making prenatal testing a new battleground for pro-life activists.

Last April, a federal judge heard the case of North Dakota’s most recent anti-abortion law, considered by many to be the toughest in the country. The law’s restriction on abortions later than six weeks was overturned. However, the parts of the law banning sex-selective abortions and abortions based on genetic disabilities remained unchallenged. As these tests become more affordable and widely available, more states will question whether or not to ban abortions based on the results of genetic testing. While such laws may result in fewer abortions, they will also be associated with an increase in the number of children born with genetic disabilities.

In the past decades, we have seen a revolution in the field of medicine. Society is struggling to move forward at the same rate. While efforts have been made to combat discrimination because of genetic predispositions, there are still ethical dilemmas posed by genetic tests. Are prenatal tests ethical? Is there a moral dilemma surrounding the association between these tests and selective abortions? As society evolves and science continues its relentless march towards progress, we must make a conscious effort to examine the implications of traditional medical ethics in light of these new discoveries.

Actor and comedian Robin Williams took his life on August 11, 2014 due to his prolonged battle with depression. His death sparked an unprecedented nationwide debate about the state of mental health within the United States.

The National Alliance on Mental Illness published a survey in 2013 that found that about 25 percent of the adult American population has experienced mental illness in any given year. In addition, 20 percent of youth aged 13-18 experience mental disorders. Of the 25 percent of adults affected by mental health problems, 60 percent received no mental health services. 50 percent of the youth surveyed received no treatment as well. These staggering statistics reveal that mental illness is a common occurrence and it is likely that we interact with people affected by mental illness on a daily basis.

Among the adult and youth that fail to receive treatment, there are often negative reactions and connotations when mental health is mentioned, resulting in a societal stigma when speaking about mental health. The stigma in turn contributes to a lack of medical care due to a fear of not wanting to disclose the state of personal mental health. Stigma from peers occurs as well as self-stigmatization, resulting in feelings of self-shame and worthlessness when a person discovers their mental health issues. A public poll in the UK revealed that 80 percent of people surveyed supported the statement “most people are embarrassed by mentally ill people” and 30 percent agreed that they felt “embarrassed by mentally ill persons.” As a result of the societal stigma, the affected person may keep the issue a secret, and mental illnesses go untreated or sometimes punished.

This problem is even more acute among college students as is shown in the case of a college student at Princeton University, after overdosing on his anti-depressant medicine and subsequently admitting himself to the hospital, he was barred from attending his classes or even going on campus after the administration heard of the situation. Princeton even demanded that the student withdraw from the school. Upon hiring lawyers to defend himself, the student was readmitted to Princeton for the following school year. When institutions react to mental illness and a student’s desire for self-help in this manner, it is hard for students to disclose possible mental health issues especially during college years.

However, it is precisely during the formative years of college when students need to speak up. Statistics reveal a staggeringly high number of college students deal with mental illness. A 2010 survey by the American College Health Association reports that 45.6 percent of students felt hopeless and 30.7 percent said they felt so depressed that it was hard to function. These statistics refer to depression and anxiety, but counselors are reporting that eating disorders, substance abuse and self-inflicted injury are joining the ranks as well. Some college campuses may deal with the issue as Princeton did, yet others may ignore the issue altogether.

Should colleges and universities be the sole caregiver for students with mental health problems? The Americans with Disabilities Act prohibits discrimination against students whose psychiatric disabilities limit a major life activity and mandates colleges and universities to provide reasonable accommodations. For example a lighter course loads and extended deadlines are possibilities provided students can meet nondiscriminatory academic and behavior standards and provided that their disability does not pose a significant risk of substantial harm. Problems with mental health qualify under the Americans with Disabilities Act, so universities do have a responsibility to help their students who struggle with mental health.

However, universities should not have to bear all of the responsibility for treating mental health issues, especially if those ailments are preexisting. When matriculating, it should be made apparent if a student has problems with mental health and the extent of that student’s treatment with private family doctors. While counselors and professors have an obligation to assist students, they also have the responsibility to refer the student to outside doctors and therapists when necessary and to create an environment in which students are comfortable asking for help without fear of being expelled.  In the case of the student at Princeton, a previous ailment was worsened when he started college. Although Princeton’s manner of dealing with that particular student seems extreme, universities have a reputation, to uphold and being labeled as a “suicide school” harms the school. A lot of universities view students who struggle with mental health as liabilities and find it easier to expel students from the institution.  When situations such as the one involving this Princeton student occur, universities may feel caught between a rock and a hard place.

What causes this surprisingly high rate of mental illness among college students? Most college students are more susceptible to struggling with mental health freshmen year, but that doesn’t discount that problems can arise at any time. Stress factors that college students deal with on a daily basis contribute to the creation of various mental health issues. For example, being unorganized can increase our sense of helplessness as we attempt to adjust to new classwork loads, extracurricular activities, and social activities. Bad eating habits also contribute to our stress levels when we get so overwhelmed we forget to eat healthy meals resulting in poor physical health that can affect our mental health. Pressure about our uncertain future and career path stemming from internal pressure cause increased levels of stress as we plan for the future. Issues stemming from social situations such as going to parties or social gatherings involving alcohol require self-control especially on weeknights. Lastly, time management is a common theme dealing with organization, social endeavors, eating habits, and classwork.

These are just a few common stress factors that can potentially cause and worsen mood and anxiety disorders as well as depression. Recent studies at Berkeley have shown that stress can weaken the maturation process of neurons and prevents effective communication between synapses.  While every person’s reaction to stress and external pressures differs, stress causing mental health issues has a strong correlation that gains even more strength during college years.

It is important to be aware of resources on college campuses when you’re feeling overwhelmed by school, work, or life in general. At the University of Georgia, the University Health Clinic provides students with a listening, objective ear as well as confidentiality if you feel scared to express your feelings to your peers for fear of judgment. Online resources also include tips for parents and friends when a loved one is fighting with mental health. Throughout the nation both students and institutions of higher learning share the responsibility of dealing effectively with mental health issues within the student body. Students should be more outspoken and self-motivating when issues arise or feelings of helplessness occur. Similarly, universities need to understand that students are more susceptible to mental health instability during college years and make an effort to be more accommodating to the student body at this pivotal point in our lives.

By: Kathleen Wilson

According to Section 4205 of the Affordable Care Act, restaurants with 20 or more locations must provide on their menus the number of calories in each menu item. These regulatory measures largely affect regional and national fast food chains that have many different locations. Furthermore, the number of calories must also be listed for self-service foods such as food sold through salad bars, cafeteria lines, or buffets. Additionally, vending machines must also display the caloric amount of each article of food in a clear and conspicuous manner. A date for enactment of this policy has not been set; however, once enacted, these regulations will be monitored by the U.S. Food and Drug Administration. The goal of this provision of the Affordable Care Act is to prevent obesity by making consumers more aware of their caloric intakes. But is putting calorie counts on menus a feasible way to attack this modern day pandemic, and will it change consumer behavior?

The act’s provision fails to take into account the feasibility of listing calories alongside every menu item in restaurants and fast-food enterprises. For instance, Domino’s Pizza claims that when factoring in all of the different crust and toppings combinations, it offers more than 34 million different pizza combinations. An online calculator could allow customers to customize their pizza and receive an overall caloric estimate, but this would not satisfy the demand that caloric values be printed directly on menus. The FDA has suggested that restaurants’ menus offer a calorie range for different pizza options, but has not given guidance on specific calorie range values. As another alternative, pizza restaurants could include the calorie count per one serving of each possible topping on their menus, allowing customers to calculate their individual calorie estimates. However, would the average consumer take the time to actually perform these calculations?

The American Pizza Community has become a prominent voice in opposition to Section 4205; however, this argument extends beyond just pizzas. For example, Chick-fil-A lists its Cobb Salad as containing 430 calories. This calculation, however, does not include the caloric estimate for a serving of the salad’s suggested Avocado Lime Ranch Dressing: 310 calories. So, if someone buys this salad and uses all of the dressing in the packet provided, the total caloric amount of the salad is 740 calories. What if only half of the dressing is used? What if a customer decides to order the salad without the cheese; how many calories does that subtract? Chick-fil-A could list a range of caloric amounts for its salad (430-740), but this would take up more space on an already cramped menu. Section 4205 does not require that menus include calorie amounts with such a degree of specification, but its goal is to make consumers more aware of their calorie intakes and thus prevent obesity, how effective is it to simply list the information about a basic salad? If anything, this exclusion of the salad dressing in this case gives consumers a false, underestimated calorie count.

Furthermore, the question remains: will any of this actually change consumer behavior? A study conducted by the New York University Lagnone Medical Center found that calorie counts on menus are often ignored by consumers and do not have a significant impact on the healthiness of the orders placed. In a survey of more than 2,000 patrons of Burger King and McDonald’s in Philadelphia, only 49 percent of Burger King patrons and 34 percent of McDonald’s patrons noticed the calorie labeling. The study also found that only 10 percent of study participants responded that the calorie labels influenced their food choice. This study is important because fast-food is eaten disproportionately by low-income people who are also the part of the population most likely to be overweight. If the focus of Section 4205 is to prevent obesity, the NYU study suggests that calorie count labels will not have a sizable impact on changing the behavior of those consumers most prone to being overweight.

Individuals with low incomes who frequent fast food establishments may be more responsive to price than to calorie labeling. The American Journal of Public Health reported that a 10 percent increase in fast-food prices yielded an 8.1 percent reduction in consumption. Thus, one under budget constraints would be more likely to buy the $2 Bacon McDouble (460 calories) than the $5 Southwest Salad with Grilled Chicken (290 calories)because even though a salad may be healthier, its high price would make it prohibitive to purchase. Moreover, low-income individuals with poor math skills would be more likely to simply buy something with a lower price than to examine calorie counts and calculate how much the calories in one food would contribute to the daily recommended value of calories.

The mandate that menus contain calorie counts is unfeasible for small businesses and largely ineffective in changing consumer behavior. If the goal of the FDA is to prevent obesity by increasing labeling on menus, a color-coding system could be a more feasible solution. An Oklahoma State University study found that a traffic light labeling system—green lights for foods fewer than 400 calories, yellow lights for 401-800 calories, and red lights for foods over 800 calories—has a much greater effect on encouraging consumers to choose lower-calorie options than menus with calorie counts. A similar study done as Massachusetts General Hospital found that after six months, the number of red, unhealthy items purchased decreased by 20 percent, while green purchases rose by 12 percent. Furthermore, the United Kingdom Department of Health has decided to implement a national color-coding on food labels by December 2014; this system will color-code not only calories but also fats, saturates, sugars, and sodium. Such color-coding systems allow for consumers to make quick, visual decisions without making mathematical calculations. Furthermore, they benefit businesses by being cheaper to use and easier for including ranges instead of exact numbers. A color-coding system in combination with a comprehensive online calculator that provides both caloric information and other nutritional information (fats, carbohydrates, sodium), has the potential to be most beneficial for the FDA, producers, and consumers.