Healthy Living… In A Nanny State

If there was one area of human existence which should be left to individual choice, you’d think it would be what we eat.

So the National Preventive Health Agency Bill, now ferreting through federal parliament, is quite a big deal. The agency is charged with preventing chronic disease caused by obesity, alcohol and tobacco through education campaigns and the mass-production of research papers.

It sounds harmless, but if it passes, it will represent the institutionalisation of the Australian nanny state.

The agency is to be a government-funded body with the specific purpose of expanding the scope of government – colonise spheres of human existence that have, until now, been left free from state interference.

We got some indication of the ambition of the new agency from the Kevin Rudd’s Preventative Health Taskforce, which, when it reported in 2009, recommended its formation. That and 121 other recommendations to tax, regulate, and impose national standards on food, beverages, and tobacco.

Julia Gillard announced last week the agency will not have the power to impose taxes on junk food. But that misses the point: the agency has no power to impose taxes on anything. It will, however, be empowered to lobby the government incessantly to do so.

In the long run, the formation of a permanent institution like this is more pernicious than any individual nanny state tax the government might decide implement.

Last year the British government spent 38 million pounds funding institutions to lobby for new laws and regulations, according to a 2009 study by the Taxpayer’s Alliance.

When that government launched a public consultation on potential methods to control tobacco use in 2008, there were a massive 96,515 responses. But a full 70 per cent of those responses were email campaigns originating from government-funded lobbyists – bureaucratic offshoots from the United Kingdom’s National Health Service, like “D-MYST”, the youth wing of SmokeFree Liverpool.

The situation is already much the same here: submissions to the Preventative Health Taskforce were dominated by government-funded entities. Councils, non-profits, health networks, and university public health departments all submitted proposals for new laws – and more funding.

One of the key tasks of the new agency is to develop a “national prevention research infrastructure”.

Usually, more research into the social problems and policy effectiveness is good. You can never have too much research.

But much preventive health research is highly politicised, value-laden, and of use only to those who share its predetermined conclusions.

We’re all familiar with the regular announcements that alcohol use, for example, costs Australia an enormous amount of money every year. These massive numbers are described as “social costs”.

As the New Zealand economists Eric Crampton and Matt Burgess have shown, the methodology which underlines almost all of these social cost studies (one endorsed by the World Health Organisation) is fundamentally flawed.

They typically mix costs borne by private individuals and firms – like workplace absenteeism – with costs borne by government – like funding the health system.

But the more critical problem is the failure of these studies to adequately account for the benefits of “harmful” behaviour.

And humans like fat and salt and ale; that’s the way we’re wired. To look at only at the negative consequences of human behaviour without mentioning the positive consequences is rigging the game.

Health paternalists who propose government intervene in individual choices never make explicit the value judgements which inform their belief. After all, not everyone has maximum health and minimum risk as their overriding goal. (If they did, the automobile industry would disappear immediately.)

The National Preventive Health Agency cannot divine everybody’s personal, highly subjective values. For instance, how much they value their current selves (the immediate sensory pleasure of hot chips right now) compared to their future selves (the potential they will get fat if they consume too many hot chips).

But the public health community assumes the most “rational” decision in any circumstance is to favour your future health by limiting your present consumption.

And if you think otherwise, then, well, you’re wrong.

Many argue, pragmatically, that we need to interfere in individual decisions because we pay for them. Our public health system means that the cost of obesity is borne not just by the obese but by every taxpayer. It’s a fair concern.

But first of all, it’s not always true: particularly in the case of tobacco, where the taxes levied on cigarettes overwhelmingly exceed the costs smokers impose on the health system.

And the medical cost of obesity and alcohol is often mitigated by the unpleasant but nonetheless true observation that alcoholic and obese people tend not to live long enough to cost taxpayers as much as the healthy elderly. If you’re going to calculate the cost of individual choices to taxpayers, you should at least include all the data.

Nevertheless, this argument proves too much. Is government provided health care really incapable of coping with free will? So should we be changed to suit the health system – as the health paternalists would seem to suggest – or should the health system be changed to suit us?

If it wants to do its job properly, the National Preventive Health Agency will tackle these heady philosophical, economic and social questions.

I wouldn’t put money on that.

Instead, it’s a fair bet the agency’s output will be drearily predictable: inflated estimates of the costs of obesity, alcohol, and tobacco use, and incessant lobbying for new laws and regulations.