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On Election Day, voters in Berkeley, California, made their city the first in the country to adopt a tax on sugary drinks, including sodas. The 1-cent per ounce tax was approved by more than three-quarters of voters, showing solid support despite a multimillion-dollar beverage industry campaign against it.

Gov. Neil Abercrombie had proposed a much larger soda tax soon after he took office at the end of 2010, but the Legislature has soundly rejected several different forms of his proposal over the past four years.

Proponents say the soda tax is a way to combat the epidemic of obesity. They hope the Berkeley vote repesents a tipping point, and that more jurisdictions will follow its lead.

But industry representatives argue it’s more likely a dead end in light of Berkeley’s rather unique political culture, and the defeat of similar measures in dozens of other cities and states, including Hawaii and, most recently, San Francisco.

Opponents tend to view the soda tax as a simple issue of personal choice versus government control. People can simply choose not to drink sugar sweetened drinks if they object to them. Issue closed.

But the issue just isn’t that simple.

“Before focusing on lifestyle choices, we have to give people those choices,” Dr. Keaweʻaimoku Kaholokula, chair of the Department of Native Hawaiian Health at the UH Medical School, said in a recent presentation.

“People don’t choose to be unhealthy and die early,” Kaholokula said. “They are forced into early death by economic and environmental circumstances.”

Kaholokula said Hawaiians, Samoans and other Pacific islanders suffer more from obesity and diabetes, and have the shortest life spans. For example, 23 percent of all adults in Hawaii in 2010 were obese, but the obesity rate among Native Hawaiians was 44 percent, compared to just 14 percent for Japanese adults.�� He said the data points to larger societal issues beyond biology and personal choice.

In the medical and public health community, these social broader determinants of health are referred to as “obesogenic” factors.

In the medical and public health community, these social broader determinants of health are referred to as “obesogenic” factors.

Obesogenic factors are elements of our environments, whether our neighborhoods, work places or schools, which encourage the consumption of unhealthy foods and reduce opportunities for exercise. I was suprised to see that there is a strong medical consensus supporting the importance of obesogenic environments, along with biological factors, in causing widespread obesity.

Some factors are straight forward, according to .

“If a community has no safe places to walk or play, lacks food outlets offering affordable healthy foods, and is bombarded by advertisements for unhealthy foods and beverages, its residents will have less opportunity to engage in physical activity and eating behaviors that allow them to achieve and maintain a healthy weight,” the report found. “Successful obesity prevention thus involves reducing negative and increasing positive influences on a societal level.”

And those negative influences, and the resulting health consequences like obesity, aren’t spread evenly through our neighborhoods. They are both more prevalent and relatively more important, because of the smaller number of positive alternatives, in some neighborhoods — and among certain ethnic groups — rather than others.

It’s great to have a word that captures the concept that health isn’t just an individual issue or a reflection of individual choices. The word itself is empowering, pointing to collective responses that must be addressed through public policies. We need to stop blaming individuals for unhealthy choices, and instead look toward our public officials for policies to reduce obesogenic environments.

A in Hawaii looked at three Oahu neighborhoods with varying number of Native Hawaiian residents, who overall have among the highest rates of obesity.�� The neighborhoods ranged from 55 percent Native Hawaiians in the first area down to just 13 percent in the third area.

Overall, the researchers found the higher the proportion of Hawaiians, the higher the area’s rate of obesity. The question, though, was why this was the case. The study compared the areas in terms of the availabilty and access to different types of food resources, ranging from fast food outlets to restaurants, supermarkets, and specialty or convenience stores, as well as access to and use of exercise facilities.

The area with the lowest percentage of Native Hawaiians had a significantly lower number of fast food businesses, while the neighborhood with the highest proportion of Hawaiians had the highest usage of fast foods, and fast food outlets represented a higher proportion of total food sources than in the other neighborhoods. All three areas were found to have similar usage of exercise facilities, but conditions of the facilities were poorest in the neighborhood with the most Hawaiians.

According to the authors of the study, published in 2008, it was “the first to provide confirmatory evidence that increased obesogenic environmental factors are more frequent in communities with a higher proportion of Native Hawaiians and that there is a trend of increasing environmental factors associated with increasing obesity prevalence.”

Although the Legislature killed Abercrombie’s proposed soda tax, it did create a�� Childhood Obesity Prevention Task Force, which . The report provides an excellent background on the issue of obesity, but its recommendations are somewhat timid.

Overall, the researchers found the higher the proportion of Hawaiians, the higher the area’s rate of obesity.

The task force supported the soda tax, recommended exempting fresh fruits and vegetables from the general excise tax, urged the state to be a leader in promoting good nutrition in its facilities and work places, and identified a variety of ways to monitor and improve the health of young people.

But shouldn’t we be doing more? The city and state could be upgrading recreational and park facilities in underserved neighborhoods to eliminate ethnic and income differentials. And how about safer sidewalks and streets to make walking more inviting? Could zoning regulations prohibit fast food outlets from opening near schools, just as we regulate other kinds of businesses? How about tax breaks for grocery stores that operate in neighborhoods that otherwise lack access to fresh fruits and vegetables? Do schools in your neighborhood offer an hour of physical activity to students daily, as called for by the Institute of Medicine, or are those programs victims of budget cuts?

The med school’s Native Hawaiian Health program has been experimenting with culturally grounded community health interventions with some significant success, and these need to be extended into other communities.

Obesity costs all of us. The soda tax movement should get credit for pushing the issue of obescity into the headlines, but there are lots of other things public officials could be doing even if they continue to reject the tax idea. It’s up to us to push them along.