Oh not another one

UK Parliamentarians are throwing around aggregate social cost figures mostly consisting of costs borne by drinkers as representing costs to British taxpayers of harmful drinking. Nanny state Labourites? Nope. A Tory. Read the excellent Chris Snowdon for the details.*

This is the corruption that comes of social cost studies that disguise private costs as publicly borne unless you check their work more carefully than any journalist or parliamentarian ever will.

* I'll quibble with Chris on a couple minor points. Crime costs can be legitimate social costs, even if they're not a financial hit to the government. It's just that these studies utterly confound "committed a crime after having recently had a drink" with "crimes in which alcohol was causal and which would not have occurred but for the consumption of alcohol".

No slippery slopes

The case for taxing sugar builds explicitly on the work done in the anti-tobacco and anti-alcohol public health movements. Here's the latest from Nature.

HOW TO INTERVENE

How can we reduce sugar consumption? After all, sugar is natural. Sugar is a nutrient. Sugar is pleasure. So too is alcohol, but in both cases, too much of a good thing is toxic. It may be helpful to look to the many generations of international experience with alcohol and tobacco to find models that work ^8,9. So far, evidence shows that individually focused approaches, such as school-based interventions that teach children about diet and exercise, demonstrate little efficacy. Conversely, for both alcohol and tobacco, there is robust evidence that gentle ‘supply side’ control strategies which stop far short of all-out prohibition — taxation, distribution controls, age limits — lower both consumption of the product and the accompanying health harms. Successful interventions share a common end-point: curbing availability ^2,8,9.

Taxing alcohol and tobacco products — in the form of special excise duties, value-added taxes and sales taxes — are the most popular and effective ways to reduce smoking and drinking, and in turn, substance abuse and related harms ². Consequently, we propose adding taxes to processed foods that contain any form of added sugars. ...

Other successful tobacco- and alcohol-control strategies limit availability, such as reducing the hours that retailers are open, controlling the location and density of retail markets and limiting who can legally purchase the products ^2,9. A reasonable parallel for sugar would tighten licensing requirements on vending machines and snack bars that sell sugary products in schools and workplaces. Many schools have removed unhealthy fizzy drinks and candy from vending machines, but often replaced them with juice and sports drinks, which also contain added sugar. States could apply zoning ordinances to control the number of fast-food outlets and convenience stores in low-income communities, and especially around schools, while providing incentives for the establishment of grocery stores and farmer’s markets. ...

Government-imposed regulations on the marketing of alcohol to young people have been quite effective, but there is no such approach to sugar-laden products...

With enough clamour for change, tectonic shifts in policy become possible. Take, for instance, bans on smoking in public places and the use of designated drivers, not to mention airbags in cars and condom dispensers in public bathrooms. These simple measures — which have all been on the battleground of American politics — are now taken for granted as essential tools for our public health and well-being. It’s time to turn our attention to sugar.

And who's next in line after sugar? Remember that the anti-tobacco folks disarmed opposition in the 90s by insisting that there was no next in line.

"They use the 'slippery slope' argument. 'My God, if they can do this to smokers today they can do this to people who eat Haagen-Dazs ice cream or whatever."

I think it's safer to assume that there's no logical end to the line. Every behaviour has health consequences, and if there's a public health system, somebody will say regulation's warranted.

There's a good case to be made for abolishing the combination of American agricultural subsidies and sugar tariffs that together result in substitution from sugar to fructose, but the case for that would be independent of nutritional qualities of fructose and sucrose. There may be a case for changes to USDA nutritional recommendations. But let's not forget that it was the USDA's war on fat that helped prompt the shift to high-carb and higher fructose diets in the first place.

Kreskin, again

Last week I pointed to Richard Edwards' plenary address on tobacco control:

He cites increased "social smoking" among young adults - folks that might have a cigarette while out drinking, but otherwise don't smoke. I'd find it a bit surprising if that level of smoking resulted in substantial negative health effects. Says Edwards "The frequency of XS alcohol consumption, and its role in promoting uptake and maintenance of smoking and undermining quitting, suggests co-interventions may be needed and that we cannot tackle smoking in isolation." So anti-alcohol policy may be part of anti-tobacco policy...stay tuned. [emphasis added]

And today the excellent Chris Snowdon points to TV3:

"The problematic aspect is that since most smokers want to quit, and here, because of the high occurrence of hazardous drinking in the New Zealand situation, they have difficulty quitting," Associate Professor Wilson told NZ Newswire.

Smoking is estimated to cost $1.9 billion in direct costs to the health sector, but the social cost has been estimated as high as $22.5bn.

The researchers recommend lawmakers explore:

• Higher alcohol taxation, given some evidence that tobacco consumption has been found to decline with higher alcohol taxes.
• Raising the legal alcohol purchase age. US evidence shows this reduces adolescent smoking.
• Explore policies to further decouple smoking and drinking by making the outdoor seating areas around cafes and pubs smokefree.
• Consider additional funding health services to to address both heavy drinking and smoking cessation together.

Where to start. First, smoking does not cost the health system $1.9 billion. Here's the post where I summarized things. Long story short: MoH effectively assumed that smokers would live forever and never impose any end-of-life costs on the government if they weren't smokers. Surprisingly, I can no longer find the $1.9bn figure on the MoH website. The best I can now find is their 2010 submission on the proposed excise changes where they wrote:

The social costs of smoking have been estimated at 62,800 life years lost to tobacco-related premature deaths, and 19,000 quality adjusted life-years lost to tobacco-related illness [¹] . A 2007 estimate put the cost of smoking to the health system at $300 to $350 million per annum; however current work within the Ministry of Health suggests that figure may be as high as $1 to $1.6 billion per annum [²].

...

2. Please note that this analysis is work in progress and methodological issues are currently being addressed.

I'm not sure of the source on the $22.5bn figure. But there's no way you can get a number that high without including smokers' spending on tobacco and a rather long list of other costs borne by smokers, with little consideration of that at least some smokers enjoy smoking.

But last week's prediction was right. I hate being right. I hated it last time too.