16 April 2018

The holes in the logic of public health campaigns


When it comes to designing public policy, it’s never good to be wrong in both strategy and tactics. But that appears to be what is happening with the various public health campaigns on sugar and diet. The problem, as some are belatedly finding out, is that we humans are an ‘ornery lot.

For example, the insistence that low alcohol versions of booze be pushed hasn’t, as far as we can tell, led to a fall in the amount of we are drinking. Instead the lighter versions are seen as something to be had at lunch, in addition to the evening’s catatonia causers.

Some time ago, the same thing started to happen when the rise of “light” cigarettes led to a change in the location of lung cancers. Puffers were drawing the weaker smoke deeper, leading to the tumours appearing in the lower lungs, not upper as before.

The tactics here are wrong because policymakers are making the same mistake that is regularly made on a larger scale about the economy and society in general.

We live in a complex system. It’s not always possible to direct it in detail to achieve a desired outcome. That people consume two small chocolate bars rather than the one hoped for by public health experts is a product of the same overweening vanity of those who would plan all for us.

Certainly, we can plan what inequality should be, try to influence what incomes are, demand that free at the point of use health care cure all ills without breaking the bank. We can demand and insist whatever we want, but we’ll be unlikely to achieve it. Complex systems just don’t work that way because, well, they’re complex.

But for a proper fiasco of modern governance to be complete, a tactical failure isn’t enough.  We need a failure in strategy as well. The broader failure is that it’s not the duty of government to tell us how to live our lives – nor, obviously, how we should die. The latter is really should be left up to us. The classical liberal argument about harm – that the freedom to swing your fist ends just where my nose begins – seems to have been lost in the modern age. But it is as true as it ever was.

The justification for regulating our habits is that we cost the NHS money. This is exactly what Hayek warned of in The Road to Serfdom: if government provides us with our healthcare then government will demand that we make not too many claims upon its beneficence. We will indeed all become serfs of the demands of the healthcare system. Many have laughed at that idea over the decades but it’s not exactly raising even a mirthless smile now, is it?

What’s much worse about this argument than the control freakery is that it’s also wrong. As Sir Richard Doll pointed out about smokers, cigarettes may cause lung cancer, but reducing the incidence of cancer won’t save the NHS money. It’s long lives and the myriad complications of them that raise healthcare costs, not early deaths from system failure.

Drinkers, smokers and sugary-drink swiggers save the NHS fortunes by missing those last decades of life in which the healthy incur high healthcare costs.

These current public health care insistences fail on a number of levels: we’re dealing with something too complex to be controlled by bureaucrats; that action involves an unjust interference in someone’s freedom; and the justification – that stopping early deaths saves the system money – isn’t right. Meaning that the basic justification they’re offering is wrong too. Not that any of this has changed the public health officials’ determination to tell us what we should or shouldn’t be eating or drinking.

Tim Worstall works at the Adam Smith Institute and Continental Telegraph.