Sunday 21 July 2013

Economics, politics, democracy and plain packs

The wailing and conspiracy theories that have followed the coalition government's decision to wait-and-see on plain packaging has been incredible and unprecedented. 'Public health' campaigners are not good losers, perhaps because they are not used to losing. Carl Phillips writes about The Lancet's tear-stained lament for this ridiculous policy, in which the once-great journal complains that economics has been put before health in the UK. As Carl points out, The Lancet doesn't know what economics is.

Preferences — not some contrived conspiracy — is why tobacco control continues to fail. The most charitable interpretation of the dismissal of real preferences (and there are many others that are rather less flattering still) is that they think health concerns should trump all other human wants: anything that might benefit health, no matter how trivially, should be done, no matter how great the costs it imposes on people.

This is an utterly absurd position. Those who exercise police powers to force such absurd priorities on others certainly do not behave that way in their own lives. Do you think that they never eat anything unhealthy and avoid leisure travel, to name just a couple of activities that create risk? You do not have to view yourself as a libertarian to believe that government should pay attention to economics (i.e., to what people want and to the actual costs and benefits of a policy) before acting.

But when this happens, and health concerns are not allowed to trump everything else, and the “public health” types whine that they are being trumped. They are not, of course. They are just being forced to put their personal preferences into the marketplace of ideas and political process, where it just might be that others’ personal preferences win the day.

Indeed. It is all very similar to the whining that ensued when Denmark ditched its fat tax. On that occasion, 'politics' rather than mere 'economics' was blamed, but in the mouths of 'public health' both words are euphemisms for 'democracy'. As I wrote in The Proof of the Pudding: Denmark's Fat Tax Fiasco...

In the post-ban rhetoric of fat tax campaigners, the possibility that politicians had simply responded to public opinion was seldom entertained. For them, it is axiomatic that the interests of industry are in irreconcilable conflict with the public interest. No explanation is required for why the industry should prefer selling ‘unhealthy’ food to ‘healthy’ food, nor is it necessary to explain why, if ‘Big Food’ wields so much political power, it was unable to prevent the tax being introduced in the first place. (The term ‘Big Food’, which until recently would only ever be used satirically, is clearly intended to draw parallels with ‘Big Tobacco’ and to imply great power.)

From the perspective of self-appointed public health experts, it is only they who act on evidence while everybody else is motivated by the mysterious and unpredictable force of “politics”. Alberto Alemanno wrote that “the circumstances surrounding the withdrawal of the tax suggest that politics rather that an evidence-based policy assessment justify the decision of the Danish government.” (Alemanno, 2012)

But politics covers a multitude of interests. Evidence of widespread unpopularity is a legitimate reason to ditch a policy in a liberal democracy. The fat tax never had the support of the majority of Danes and it became even less popular as time went on. The proportion of the population who disagreed with the statement “in general it’s a good idea to tax saturated fat” rose from 43 per cent in 2009 to 50 per cent in November 2011. By October 2012, 70 per cent of Danes considered the tax to be ‘bad’ or ‘very bad’ (Gade & Klarskov, 2012) and by the time it was scrapped, newspapers were routinely describing the tax as “infamous”, “maligned” and “hated”. The liberal newspaper Politiken's editorial about the tax's abolition was headlined ‘Obituary for the hated fat tax’. Mette Gjerskov, the minister for food, agriculture and fisheries said: “The fat tax is one of the most criticised policies we have had in a long time.”

The indifference of health campaigners towards public opinion came as a surprise to Stephen Dubner, co-author of Freakonomics, who attended a public health conference in the US in November 2012 at which fat taxes were praised.

“One objection that I was surprised no one raised: the simple fact that taxpayers might hate the tax and rebel against it to the point where it becomes politically and economically impossible.”

Some in public health wear this unpopularity as a badge of honour. “The fat tax may be unfair and unpopular but it will certainly make people sit up and take notice,” Tam Fry of the National Obesity Forum told Deutsche Welle when the tax came into effect. “It’s a shock treatment but a necessary one to cure an epidemic.” But shock treatment rarely goes down well with voters, especially when the economy is on the rocks. Concerns about job losses and the cost of living may not be paramount to public health campaigners, but it is quite understandable that the government would place these considerations ahead of what is likely to be, at best, a small reduction in the population’s waist line.

There is, then, good evidence that the fat tax was widely unpopular in Denmark. There is equally good evidence that the tax encouraged cross-border shopping and put an unreasonable burden on shoppers and food producers alike. There is circumstantial evidence that the impact on consumption patterns was so limited that any benefit to public health would have been negligible even if the tax had stayed in place for years. And it is almost certain that the fat tax was, by its very nature, regressive. None of this is of interest to the health campaigners. From their perspective, the only evidence that could justify revoking the tax would be if rates of obesity had unequivocally risen. Even if that had happened, their response would likely have been to demand a more punitive tax rate across a wider range of products. As health campaigners, they are entitled to take a narrow view, but politicians are not obliged to do likewise. The wider social and economic perspective is too important to be dismissed as mere “politics”.

1 comment:

Junican said...

I didn't think that public health was indifferent to public opinion. In fact, I thought that the opposite was true - PH manipulates public opinion in every way it can.
What seems to happen is that the charlatans scare the naive public, but, after a while, the public realise that the scare stories were mere ghosts, and react against them. Thus, if the Mirror poll is to be believed, a 70% public opinion in favour of smoking bans has now become an 80% vote against them.