'Public health' and the aura of truth

Not enough is written about the ethics of 'public health' (spoiler: it's unethical) so it is always nice to see a new critique. This article by Ronald W. Dworkin is an absolute belter.

As I argued in Killjoys, the public health movement turned pernicious when it went beyond it's remit of tackling contagious disease and decided to use coercive measures against anything that could conceivably have an effect on an individual's health, including - in fact especially - self-regarding choices made by the individuals. It is now an authoritarian political movement masquerading as a branch of medicine.

Dworkin writes: 

... lack of humility has emboldened public health to insert itself into practically every conceivable public policy debate. Along with its traditional menu of concerns, including sanitation and immunization, the public health field now voices opinions on such issues as gun control, mental health, drug abuse, domestic violence, social justice, gender equality, sustainability, wealth redistribution, children’s day care, and foreign policy.

This is arrogance of the long-sighted kind. Public health activists drape themselves with the scientific method, declaring, “Why should not a method of investigation that has succeeded so well in solving problems in medicine be used to improve people’s well-being in a social, ethical, and political sense?” Because public health has a bona fide link to science, through medicine, which no social scientist can lay claim to, it has transformed itself into science’s emissary to policy debates once thought far removed from science. The fact that almost every life problem spills over into the public realm eventually, while also touching on somebody’s physical or mental health, makes public health’s portfolio potentially limitless. Not even social science claims such a range.

Dworkin considers 'public health' in its modern form to be arrogant, ideological and ultimately ineffective:

Arrogant because public health experts do not watch their science fail on a daily basis. Because they work with large populations rather than with individual cases, public health experts often think with words—for example, the American Public Health Association’s (APHA) goals to “reduce global childhood mortality” and “support global food security.” Goals like these are easy for the thinker with words; the delay between error and the serious consequences of error—a very short timespan for an anesthesiologist—is too long for the public health expert to learn humility or even responsibility. After articulating a principle, the public health expert sees nothing go right or wrong for years, if ever, and so the value of the words can only be judged by their good intentions.

.. Public health is ideological because all ideologies contain an element of hope and aspiration that can only be dampened by contact with reality. An ideology is a big set of ideas, a sweeping philosophy relevant on a large scale and for a long period of time. It thrives by ignoring details; it is so simple in its explanations that a single slogan can sum it up. Individual cases with particular details detract from the smoothness of an ideological system. Because public health experts do not manage individual cases, reality is less likely to quash their ideological enthusiasm.

I could quote much more from this article, but I will leave you with a few one liners and urge you to read the whole thing.

Doctors respect science, and most of what they do is anchored in science; but they will ignore science if the situation demands it.

Because many Americans think science is the last word on the art of thinking, public health’s historical connection gives the field cachet.

Public health activists are clever enough to understand the scientific method, but they are not clever enough to understand its limits.

The scientific method gives them an agility that others lack, but it also gives them the bad habit of believing that all is accomplished when they have indulged in a process of reasoning that has the aura of truth.

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Farewell then, UK Health Forum

Despite years of alleged austerity, various pressure groups continue to get money from the state. The nanny state industry has done particularly well from the unwitting taxpayer over the years, so it is always nice to see the government pull the purse-strings shut...

A public health charity providing “vital” services has been forced to close this year after losing most of its government funding.

The UK Health Forum received around £300,000 in government funding last year, a fraction of the over £1m it received in 2016-17. In particular, it lost £200,000 in core funding from the Department of Health and Social Care, which the charity’s latest annual report described as a “significant” blow.

Alas, the article doesn't detail the 'vital services' that have supposedly been supplied by the UK Health Forum. In truth, it is a slush fund for 'public health' activists to lobby for the usual assortment of paternalistic anti-market interventions in lifestyle choices. In recent months, it has promoted higher tobacco taxes, food taxes, advertising bans, sugar taxes and minimum pricing. 

The UK Health Forum received £216,306 from the Department of Health in 2016/17 in addition to £680,000 from Public Health England and an unrestricted grant of £371,660 from the European Commission. Of a total budget of £1,597,619, its state funding amounted to £1,470,626 (92 per cent). A third of its staff earn more than £60,000 per annum.

The UK Health Forum is effectively an arm of the state. It says that it is having to close down in May due to “fewer opportunities to bid for funding for policy work". Good. Taxpayers' money should never be used to pay unaccountable private organisations to do 'policy work'. The sums given to this sockpuppet organisation were obscene and it is appalling that it has taken so long for the government to do something about it.

It doesn't seem to have occurred to the UK Health Forum to do what most charities do and raise money from the general public. They probably know that there is no public demand for their 'vital services' and that they would not raise a brass farthing.

Hopefully, the millions of pounds that these quangocrats would have siphoned from the taxpayer over the next decade will be used to provide healthcare rather than cushy jobs for perennial gravy train occupants like Simon 'caps lock' Capewell and Robin Ireland.

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The cost of banning BOGOFs

The UK's banny state government is currently consulting on how it should raise the cost of living and dictate to shopkeepers where they display their stock. Specifically, it wants to hear from 'stakeholders' about the following:

• restricting volume-based price promotions of HFSS [high fat, sugar and salt, but not actually that high if you look at the definition - CJS] food and drink that encourage people to buy more than they need, for example, ‘buy one, get one free’ and free refills of sugary soft drinks
  

• restricting the placement of HFSS food and drink at main selling locations in stores, such as checkouts, aisle ends and store entrances
  

Let's leave the unspeakably meddlesome proposal for state control of shop layouts to one side and look at the proposed ban on discounts. This is going to hit consumers in the pocket and will have the worst impact on people on low incomes looking for bargains. A Public Health England document let slip back in 2015 that...

There is also evidence that during the high inflationary period of 2008-2010, promotions were a useful coping strategy for shoppers to manage the worst effects of food and drink inflation.

Naturally, the government is keen to close that little loophole! How much will it cost? Public Health England commissioned some modelling from Kantar and found...

Promotions at this level do of course play a role in helping shoppers reduce the cost of the items that they choose to buy. Based on the breadth and depth of promotions we can calculate a “giveaway” figure which equates to a 16% or approximately £634 reduction on a typical household’s annual, take home food and drink bill. 

£634 a year! And the government is seriously considering this?!

To be fair, this is an estimate of how much extra people would need to spend if they carried on buying the same quantities of the same products. Presumably, the price effect would make the real figure somewhat lower. Kantar didn't estimate what the real figure would be, but their report suggests that discounting leads to a 22 per cent increase in sales. If we take off 22 per cent, we are still looking at household spending an extra £500 a year.

We can also expect shops to lower regular prices and offer temporary multi-buy deals (which won't be banned). This will cushion the effect further but the net cost to the average consumer is unlikely to be zero and for hard-pressed consumers who rely on discounts, it is likely to be substantial.

Moreover, the Kantar estimate is based only on a ban on discounting sugary products. Back in 2015, Public Health England were still pretending that the war on food would start and end with the battle against sugar. Things have moved pretty swiftly since then and the current proposal is for a ban on all multi-buys for all HFSS food (or all HFSS food in the reformulation scheme, which is most of it) in all shops, restaurants, cafés, pubs, petrol stations etc.

As defined by the puritanical Nutrient Profiling Model, HFSS includes pretty much everything that isn't a raw ingredient or a health food and Public Health England is in the process of raising the bar even higher. HFSS food already includes such 'junk food' as dried fruit, hummus, pesto, ham, olive bread, cheese and margarine. It will soon include freshly squeezed orange juice and most high-fibre breakfast cereals.

If a ban on the promotion of sugary products is going to clobber consumers, a ban on all HFSS promotion is going to cost them a lot more.

So what is the putative health benefit of this grand financial imposition? The answer is tucked away in the Impact Assessment. The expected reduction in calorie intake for children from the government's preferred option ranges from er, seven to nine calories a day.

If this sounds utterly negligible to you, you are right. The Impact Assessment notes that 'overweight and obese children consume between 140 and 500 excess calories per day for boys and between 160 and 290 for girls'.

How can any government think it's fair or reasonable to force ordinary households to spend hundreds of pounds a year to reduce their children's calorie intake by this pitiful amount, especially when the vast majority of children are not overweight or obese?

But don't worry because the Impact Assessment has run the numbers and concludes, contrary to Kantar, that the policy will not cost consumers a penny. Its authors happen to use exactly the right assumptions and price elasticities for it to leave consumers no worth off and no better off than they were before. Meanwhile, the tiny reduction in predicted calorie intake will save billions of fictitious pounds over a 25 year period. Seems legit!

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Why aren't alcohol-related deaths falling?

At the Spectator, I ask why alcohol-related deaths haven't been falling despite alcohol consumption falling sharply since 2005.

This poses a problem for the modern ‘public health’ lobby for whom it is axiomatic that a decline in overall consumption must lead to a decline in alcohol-related deaths. This axiom was first proposed by the French mathematician Sully Ledermann in the 1950s and was endorsed by the epidemiologist Geoffrey Rose in the 1980s when he developed his ‘single distribution theory’. In his 1992 book The Strategy of Preventive Medicine, Rose claimed that ‘from the average alcohol intake of a population one can predict precisely the number of heavy drinkers’.

It is difficult to exaggerate the influence of Rose’s ideas on the public health movement. Put simply, the single distribution theory asserts that the amount of excessive or dangerous consumption in a society is directly linked to the level of average consumption. The behaviour of those at the extreme end (or tail) of the distribution is dictated by the behaviour of those in the middle. Successful prevention therefore calls for a whole population approach in which the entire distribution (or bell curve) is shifted to the left. There is little point in focusing efforts on the minority of consumers who are at high risk. What is needed, wrote Rose, is to ‘change the majority, which means redefining what is to be regarded as normal.’

Do read the rest.

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Raise the smoking age to 100!

This really is the stuff of satire....

Hawaii may increase legal smoking age to 100

Hawaii could raise the legal smoking age to 100, effectively banning cigarettes for the vast majority of people in the state.

.. The new bill, HB 1509, suggests that the smoking age should go up to 30 in 2020, 40 in 2021, 50 in 2022, and 60 in 2023 - until finally, in 2024, people would need to be 100 years old to buy cigarettes.

Even if they do this - and it will probably happen eventually - anti-smoking campaigners will still insist that they are not prohibitionists.

"Prohibitionists? Us?! You're free to smoke when you're 100. No one's going to stop you. Besides, you can always grow your own tobacco if you want. This isn't prohibition, it's just regulation."

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Drain the swamp

Remember Heart of Mersey? Probably not, but you may be familiar one of their many offshoots - the Health Equalities Group, Food Active, Give Up Loving Pop (GULP) the European Health Stadia Network (AKA Healthy Stadia) - or its vape-hating frontman Robin Ireland. 

Heart of Mersey is the umbrella group and a registered charity which describes itself as 'primarily an advocacy organisation'. As the name implies, its official objective is to tackle heart disease, but in practice this involved campaigning against vaping, fizzy drinks and outdoor smoking.

As I mentioned last year, its financial accounts make for interesting reading. In the heyday of New Labour sockpuppet funding, Heart of Mersey got a lot of money from the NHS but this dried up in 2013. They have been burning through their bank reserves ever since.

Really burning through them. As their income dwindled to almost nothing, they spent vastly more than they were taking in.

In 2012/13, they had twelve employees, nine trustees, including Simon 'Caps Lock' Capewell, and an income of £848,888.

By 2016/17, most of the trustees had disappeared and it was employing just two people, albeit at a cost of £166,632. Robin Ireland, the former chief executive, has buggered off to Glasgow to do a PhD, presumably in 'public health', and in 2017/18, it had so little income that it wasn't even required to file financial accounts.

As an organisation that was overwhelmingly funded by the taxpayer in its glory years, it is not obvious why it was allowed to squirrel so much money away rather than spend it on whatever it was supposed to be spent on. After running down the bank account, it now seems to be a shell.

And yet its spirit lives on through the various front groups it set up. Food Active campaigns for the Coca-Cola truck tour to be banned and is funded by local authorities in the North West. Give Up Loving Pop is funded by Food Active.

And then there is Healthy Stadia, whose existence I was reminded of this morning when I saw this news from the sixth division of English football:

Southport Football Club are proud to announce that as of Saturday 9 February 2019, the Merseyrail Community Stadium will become a ‘Healthy Stadia’.

With the help of the Community Foundation the club will launch three key initiatives within the stadium on match-days.

The two main covered stands – The Jack Carr and The Pure Business Group Main Stand will become a fully non-smoking zone (this includes the use of vapes), where fans instead are encouraged to smoke within the ground on open terraces such as the Popular side.

The club, in the future, will also be looking to incorporate that the whole ground is a non-smoking zone to further promote a positive healthy experience for all who attend [except smokers - CJS].

In partnership with Willow Catering, the second initiative, will offer supporters something healthier as an alternative option to the traditional match-day food on sale. This includes salad snack pots, fruit and vegetables and low sugar drinks. Healthy options will be available at the counter.

Both of the above initiatives will be in effect for the Vanarama National League North fixture against Chorley at the weekend.

The third way the club would like to promote the healthy lifestyles movement is to ask fans to look at how they travel to the ground on the day.

Can groups of friends or families car share, use the Arriva bus services or even better walk, cycle or run to make the planet greener? For those who cycle a place to store your bike will be made available.

The club will be expanding its Healthy Stadia plan over the course of the rest of the season in readiness for the 2019/20 campaign where further improvements will be made and are asking for regular attendees to help the club in its social responsibility to show the benefits of a healthy and active lifestyle.

As one fan of Stockport County says below the line, 'many of us attend football to get away from this perpetual hectoring'. 

Another replied:

Can supporting port get any better? We can now walk to the ground then stand freezing our balls off whilst eating an Apple and watching mid table hoof ball football whilst hoping teams below us don't win so we can avoid a second successive relegation battle into an even shitter Sunday league.

And who is to thank for this 'perpetual hectoring'? Look no further than our old friends at the European Commission who are always happy to step up to the plate when every other source of taxpayers' money has been exhausted.

 
Bring on Brexit. Drain the swamp.

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In denial about the black market

As covered by City AM (and no one else, as far as I can see), the World Bank has produced a report about the illicit tobacco trade.

If you thought a UN agency would ask a disinterested economist to investigate this topic, you'd be sadly mistaken. Instead, they got Sheila Dutta, a 'public health' professional, to put the document together and so the top line is that the rise of black market tobacco has got next-to-nothing to do with economic incentives, ie. high tobacco taxes... 

The tobacco industry commonly argues that higher taxes and prices (as well as other tobacco control measures), will motivate customers to buy illegal products rather than smoking less or quittin, and that this will impact tax revenue without a decline in tobacco use. Numerous empirical analyses, across a diversity of countries - including the case studies presented in this report - refute this argument.

This bald (and bold) assertion is watered down slightly a few pages later when she says:

Tobacco taxes play only a minor role in illicit trade

The suggestion that increasing tobacco duty does not lead to more black market activity does not reflect bitter, real world experience and is not even borne out by the report itself. It is fitting that the first chapter looks at Australia which had a negligible illicit trade in tobacco ten years ago but now has an endemic problem thanks to exceptionally high taxes. Contrary to the top line of the report, the authors of that chapter acknowledge that tobacco tax rises may 'heighten incentives for criminals to expand the illicit tobacco market’ and ‘can work to stimulate the trade in illicit tobacco products by decreasing the affordability of tax-paid tobacco and increasing profitability for those undertaking illegal activities.’ This should be obvious.

Similarly, in the chapter on Ireland, it says: ‘A high rate of tobacco excise, and the consequent high price of tobacco products, make Ireland attractive to those involved in the illicit tobacco trade.’No kidding.

The chapter on the UK notes that: ‘Following a series of tax rises, the illicit tobacco trade increased rapidly in the 1990s.’ The authors go on to claim that the illicit trade was brought under control in the first decade of this century by increased enforcement. Whilst enforcement doubtless played a part, a more likely explanation is that tobacco duty was frozen in real terms from 2001 until 2008.

In recent years, however, there have been large, above-inflation tax rises and, unsurprisingly, the share of the illicit market has grown. What a coincidence.

Incredibly, the authors portray Britain as a success story because the size of its black market declined after the boom year for booze cruises of 1999 (the impact on legal cigarette sales of that little splurge can be clearly seen below).

According to HMRC, the UK government lost between £1.7 billion and £3.2 billion of tax revenue in 2016/17 thanks to black and grey market tobacco sales. This is considerably more than was lost in 2010/11 and is only slightly less than was lost in 2005/06, despite there being far fewer smokers around today. If this is a success, I’d hate to see what failure looks like.

Nevertheless, the report says:

The UK experience underlines that eradicating smuggling is an issue of enforcement. Cutting tobacco taxes is not an effective method of reducing the illicit trade.

The idea that the UK has any lessons to teach about 'eradicating (!) smuggling' is genuinely laughable. It has one of the biggest - if not the biggest - problems with illicit tobacco in Europe.

As for the notion that cutting taxes would not reduce the illicit trade, imagine if cigarettes in the UK cost the same as they do in, say, Spain (around £4). Would British smokers still go to Spain to buy their cigarettes? Would they still buy cigarettes from a man down the pub for £5? Obviously not. The idea is ludicrous.

It is delusional to deny the relationship between price (driven by tax) and illicit activity. Money is literally the only incentive for buying and selling illicit cigarettes.

This is not to say that there are not things governments can do to alleviate the problem, but the problem wouldn't exist at all without sin taxes. There is a strong and consistent relationship between the magnitude of tobacco taxation and the size of the illicit market. In the EU, countries such as Britain and France, which have the most punitive taxes, have the biggest black markets. In New York, which has the US’s highest tobacco taxes, more than half of the cigarettes smoked are bought out of state.

You already know this, of course, because you are not an idiot. Who does Ms Dutta think she's kidding?

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