Public health policies should at least improve health, Jenesa Jeram argues.
Public health policies should improve the outcomes of those they are trying to help.
This was one of the main messages in The New Zealand Initiative's latest report on public health regulations. Shocking as it is.
The Health of the State report released recently examines the effectiveness of policy goals aimed at changing our behaviour.
These regulations make assumptions about our preferences, and rely on people reacting to regulations in predictable ways.
The report was publicly dismissed by University of Otago public health professor Doug Sellman (ODT, 21.4.16) who claimed: ‘‘I'm not prepared to take this report at all seriously, and view it essentially as ideological big business propaganda.''
It is a shame Prof Sellman has dismissed the report.
On the face of it, it seems like we have an overlap in interests: we both want to see policies that work to achieve health outcomes.
Of course, it is understandable that some might be hesitant to question the wisdom behind such policies.
After all, health is a good and important thing. Public health policies that are designed to improve health must also be a good thing.
Those working in public health - especially those on the frontlines - must deal with the often devastating consequences of avoidable diseases.
They understandably would want to ease that burden, especially when the culprits seem so common and obvious.
But recognising a problem - such as obesity - and the causes does not necessarily reveal the solutions.
That is why the report examines public health policies through an economic lens.
While health studies can diagnose a problem and the causes of that problem, they do not always lend themselves to policy recommendations.
Economists often talk of the importance of trade-offs and opportunity costs.
Health is important. Few people would deny that. However, wellbeing or happiness is important too.
And while science might reveal how to improve healthiness, it cannot reveal people's individual preferences on what may improve their happiness.
Sometimes the things that make us happiest may not be all that good for our health.
Likewise, some people may be time poor and stressed, preferring to buy junk food and ready-made meals.
Sure, they may know such food is not the best for them. But they may choose to consume it anyway, as a time and effort saving option.
Policymakers cannot predict how people will react to a regulation, when we all have different wants, needs and preferences.
But even if Prof Sellman and colleagues were to disagree with the economic angle of the report, surely they must agree that policies must be proven to work. In this respect, our report makes some pretty damning observations about the quality of evidence in the field.
At the very least, those in the field could point out where our report gets the analysis wrong.
The report provides a list of common mistakes or flaws in public health studies.
These include things like failing to establish causality (proving that one thing caused the other), failing to take into account confounding variables (other variables that could explain results), and exaggerating real world significance.
Just because results are statistically significant, it does not mean they will necessarily have a large real world effect.
The New Zealand Initiative's report finds that some of the studies conducted in New Zealand and elsewhere repeat the flaws listed.
While others may be methodologically sound, but do not actually prove that a policy will work.
An example would be a study that shows when the price of a good goes up, people spend less on that good.
This does not necessarily prove that a tax on sugary drinks will reduce obesity.
First, because a household's expenditure does not reveal the quantity of sugary drinks purchased.
If they spend less, it could be that they are switching to cheaper brands, or even switching to bulk or family-sized options to get more fizz for their buck.
Likewise, reducing expenditure or even real consumption of one product does not show whether people switch to un-taxed but equally unhealthy foods, or whether obesity is attributable to poor diet or a sedentary lifestyle.
Different bodies react differently to different foods and exercise regimes. What is successful for one person, might not actually help another.
That is just one example, the report is full of many more examples of how poor studies or poor press releases make their way to public policy.
If policies cannot be proven to improve health outcomes then surely the policies are a failure, even given public health's own yardstick.
Flawed policies detract attention and resources away from more promising solutions, and could even harm vulnerable groups like the poor.
There could be more harm inflicted from pursuing such policies than doing nothing at all.
Not everyone will agree on when the government should intervene, or whether the government really can make a difference.
But surely there must be widespread agreement that policies should be proven to improve people's wellbeing, not make it worse.
● Jenesa Jeram is a policy analyst at The New Zealand Initiative, and author of The Health of the State.
