Pierre Lemieux: Public Health Officials Far Too Often Ignore the Costs and Trade-Offs Involved In Policy Decisions

Public health theorists typically ignore that their proposed interventions have costs.

It is understandable that, in the current COVID-19 health emergency, nurses, physicians and other health care providers are appreciated and popular. Experts in so-called public health benefit from this popularity and trust, although the humongous failures of public health organizations such as the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), as well as the World Health Organization (WHO), should raise serious doubts about their effectiveness.

What is public health? Probably not what most people think it is. Although some of its experts and activists cloak themselves in the mantle of science, many might be surprised to learn that it is mainly a political movement with a specific ideology. This concept is recognized in one of the most popular textbooks of public health, Bernard Turnock’s Public Health: What It Is and How It Works (5th edition, Jones & Bartlett Learning, 2012), p. 22), which says, “In many respects, it is more reasonable to view public health as a movement than as a profession.”

One characteristic of this movement is to largely ignore the insights of economics. For example, economics teaches that, in the real world, every good or activity has a cost—that is, it prevents something else from being produced, consumed, or done. Things are scarce. Even if the monetary cost of doing something may occasionally seem low, the time doing it cannot be spent doing something else profitable or enjoyable.

Public health theorists typically ignore that their proposed interventions have costs. Perhaps they have an interest, if only ideological, in hiding the costs. Or, they choose not to think in these terms. Turnock (6th edition of the same textbook, 2016, p. 320) writes, “The argument that resources are limited and that there simply are not adequate resources to meet treatment, as well as prevention purposes, is uniquely American and quite inimical to the public’s health.”

This is an obviously non-sensical statement. Every individual has to make trade-offs between his health and other goods and pleasures; no individual spends all his resources on his health. There is nothing uniquely American about this. On the contrary, Americans spend more on health care than the people of any other rich country, and about half of that is spent voluntarily (outside of Medicare and Medicaid). When resources are allocated by the state, costs don’t miraculously disappear.  They are simply and forcibly transferred to certain sections of the population, who have therefore less to consume. These costs must be recognized.

More sensibly, the Stanford Encyclopedia of Philosophy notes that “[p]ublic health resources are always in short supply and priority setting in public health policy and practice is always morally challenging” (Ruth Faden and Sirine Shebaya, “Public Health Ethics”). It is also economically challenging. From all we know, markets are generally more efficient than governments in allocating resources and producing goods and services. In fighting malaria in Africa, for example, it appears that governments overdistribute insecticide-treated bed nets in big cities and under-distribute them in the countryside. Moreover, compared to other means of fighting the disease, too much money is spent on bed nets, “partly because nets are easy to count—a feature that aid programs are particularly found of” (“Malaria Infections Have Stopped Falling,” The Economist, December 5, 2019).

Perhaps we can hope that the current economic crisis will instill in the public-health movement the idea that the interventions they propose carry costs that are paid by ordinary people in taxes or reduced economic growth. But don’t count on it.

Not only do public health theorists and experts generally ignore the inconvenient discipline of economics, but they nearly always ignore its public choice component. Public choice analysis is a strand of economics, developed over the past seven decades, that analyzes how politicians, bureaucrats and voters make decisions. One would think that this sort of analysis would be crucially important for a public-health movement that typically favors public choices, that is, government decisions, over private choices.

Turnock’s textbook does not even mention public choice economics, while its topic is basically the public choices made in health matters. If he had taken this strand of economic analysis into account, he might not be so surprised by “the lost opportunities in securing and using recent tobacco settlement … to shore up a sagging public health infrastructure” (Public Health, 6th edition, p. 320).

In fact, state governments securitized future payments and often spent the money on their pet projects because such was the interest of politicians and special interest groups. This political naivety adds to the temptation of simply ignoring costs.

The ideology of the public health movement is summarized by Turnock, who writes that “[s]ocial justice is the foundation of public health” (Public Health, 6th edition, p. 19). In the public-health vision, social justice can justify government interventions in virtually any private choice. Professor Gerard Hastings of Stirling University writes in a medical journal that “lethal though tobacco is, the harm done to public health by our economic system is far greater.” Marketing, he claims, “undermines our mental as well as our physical well-being” and, when done by multinationals, presents “a major threat to public health.” (“Why Corporate Power Is a Public Health Priority,” BMJ, 2012)

Measures being taken now to fight COVID-19, such as forcing the shutdown of businesses deemed non-essential and imposing home quarantines, might be justified or not. But it is certainly not possible to appraise these measures, or even think about them, without examining their total costs.

Even in the current crisis, especially in this case, it is certainly risky to let Leviathan (the powerful state) and public health advisors loose without any restraint. The aim here is not to deny that the coronavirus pandemic is a serious one, but to point out that the natural biases of politicians, bureaucrats and public health movement have the potential to influence policies that cause damage and thus should be factored into the overall analysis of policy decisions.

Pierre Lemieux is an economist affiliated with the Department of Management Sciences at the University of Quebec in Outaouais.

This op-ed was first published by the Reason Foundation – please read the original here.

This entry was posted in Classical Liberalism, COVID-19. Bookmark the permalink.

19 Responses to Pierre Lemieux: Public Health Officials Far Too Often Ignore the Costs and Trade-Offs Involved In Policy Decisions

  1. Nob

    Like I keep saying, you listen to input from experts.

    You don’t let them run the show.

  2. David Brewer

    You don’t let them run the show.

    …especially when their “precautionary principle” supposedly dictates a remedy that has NEVER been tried before, and that involves the indefinite cessation of the free, properous life we are supposedly protecting…

  3. stackja

    So we will know what to do with the next pandemic from Red China?

  4. C.L.

    … many might be surprised to learn that [public health] is mainly a political movement with a specific ideology.

    Not me. That’s ludicrously obvious in Australia.

    Perhaps we can hope that the current economic crisis will instill in the public-health movement the idea that the interventions they propose carry costs that are paid by ordinary people in taxes or reduced economic growth. But don’t count on it.

    If anything, The Crisis will consolidate the notion that ‘public health’ is sacred and, more importantly, ‘free.’ The ‘free’ stuff that will become institutionalised following this will be gargantuan, in toto.

  5. JC

    The Crisis will consolidate the notion that ‘public health’ is sacred and, more importantly, ‘free.’

    And more, look at the ghouls who just showed up at the wedding.

    So why not ban smoking?

    If we’re prepared to trash the economy and be stuck in our homes for months to save lives, banning smoking can’t be too big an ask, say health experts.

    Public health experts have called for a ban on cigarette sales, declaring the government’s response to the coronavirus “farcical” given how many more people died annually from tobacco-related illnesses.

    There will come a day when “experts” will be executed. (H/T Artie)

  6. JC

    And this is not chump change.

    In its latest budget, update the government forecast tobacco excise receipts of $17.2 billion this financial year.

  7. Jesus Christ.

    Look at what I pay for pipe tobacco and cigarillos, let alone cigars.

    I can’t even get the cigarillos I like due to Nanny Roxon’s awful plain packaging malarkey.

    These damned neo Puritans would ban sex if they could.

    What with STIs and all these days…

  8. JC

    Give these nazis (and that’s what they are) a decent thread serve, CL.

  9. Scott Osmond

    Many moons ago my old man asked me, you know what an expert is? x is the unknown quantity and a spert is a drip under pressure. Each time an expert has mouthed off they don’t know or understand that their discipline is only one in an interconnected web of disciplines, all necessary to keep civilisation functional. We are now learning what happens when public health types are allowed to run wild. Combine that with a leadership class that is as incompetent as it is gutless and has a thirst for interfering with peoples lifes even down to the micro level and this is the result.

  10. currencylad

    Will do, JC.
    Can you post the article here, please.

  11. JC

    Coronavirus: Health experts argue for smoking ban to save more lives
    People wearing protective masks while smoking last week in New York, the epicentre of the coronavirus pandemic in the US. Picture: Getty Images.
    People wearing protective masks while smoking last week in New York, the epicentre of the coronavirus pandemic in the US. Picture: Getty Images.

    Public health experts have called for a ban on cigarette sales, declaring the government’s response to the coronavirus “farcical” given how many more people died annually from tobacco-related illnesses.

    COVID-19 would be “unlikely to ever match the relentless and growing annual toll from tobacco smoking” and its spread was an “opportune time to move towards removing cigarettes from general retail sale”, according to analysis published in the latest issue of Tobacco Control, an international health journal.

    The death toll from COVID-19, which has infected almost 6000 Australians, reached 50 in Australia on Wednesday. Around 15,000 Australians die each year from tobacco related illnesses, according to the Cancer Council.

    “If governments had acted to protect the public from tobacco with a fraction of the effort (and financial investment) they have exerted to control this coronavirus, many millions of lives could have been saved, and underlying demand on health services significantly reduced,” they said.
    NED-1524-Covid-19 control scenarios – Australia – 0

    Authors Marita Hefler and Coral Gartner, of Charles Darwin and Queensland Universities, respectively, said tobacco smoking – which kills around 8 million people annually – was “a greater, sustained strain” than the coronavirus, which has killed around 70,000 globally, mainly in Europe, China and the United States.

    “In China, there have been just over 3300 COVID-19 deaths compared with approximately 1 million each year from tobacco. In Italy, which currently has the highest deaths per million of the population, there have been nearly 14,000 deaths from COVID-19, compared with 93,300 each year from tobacco,” they said.

    The government released modelling on Tuesday that estimated 35,000 extra intensive care beds a day would have been required if 23 million Australians became infected by COVID-19, enough to overwhelm the health system’s capacity.

    The researchers’ warning came as the federal parliament met to pass the biggest single expenditure measure in the nation’s history, a $130bn wage subsidy scheme to help curb unemployment and bolster the economy amid strict social distancing rules that have caused swathes industry to shut down.

    Despite strong evidence a history of smoking worsened the effects of COVID-19, governments had done little to stem the sale of cigarettes, even in Italy and France, “where tobacco shops are still open”, the authors said.

    “The contradiction between shutting down to protect the community from a deadly virus, while minimising disruption to continue to produce the most lethal consumer product in history, is farcical,” they added.

    In its latest budget, update the government forecast tobacco excise receipts of $17.2 billion this financial year.

    “Given the role of social cues in relapse during quit attempts, self-isolation may make quitting easier for some, although there is a need to provide support for people to manage stress and mitigate mental health risks,” the article said.
    Adam Creighton
    Economics Editor

  12. Tim Neilson

    “The contradiction between shutting down to protect the community from a deadly virus, while minimising disruption to continue to produce the most lethal consumer product in history, is farcical,” they added.

    Fine.

    Re-open society and the contradiction will be removed.

    FFS, you just knew every monomanic loon on the planet was going to try to hitch a ride on the Wuhan virus, didn’t you.

    They don’t seem to notice that the thing about smoking is that it’s voluntary, unlike getting a virus.
    Even if there’s some justification for the suspension of human liberty to fight a virus, that doesn’t justify the suspension of human liberty to stop people doing something to themselves that they can refrain from doing to themselves if they want to.

  13. Professor Fred Lenin

    Smokers are heroic they lay downtheir lives to give the government lots of excise money to waste.

  14. Nighthawk the Elder

    Never let a crisis go to waste.
    A
    s well as JC’s post about banning tobacco, in the MSM over the last couple of weeks have been spivs extolling the virtues of giving up drinking or giving up meat.

    And let’s not forget good old climate change.

  15. Nighthawk the Elder

    Curse the cursor and his old mate the enter key. Second line should have started “As well as…”

  16. candy

    Our economy is going to be based around free health care, health care jobs with huge salaries, premiers and PM’s whose jobs rely on providing everything free in regard to health care and also education and aged care.

    Never ending and when everything is free, no-one appreciates anything and so quality drops. Human nature.

  17. egg_

    Public Health Officials…

    are obviously immune from their own decisions!

  18. David Brewer

    If we’re prepared to trash the economy and be stuck in our homes for months to save lives, banning smoking can’t be too big an ask, say health experts.

    …which only goes to prove that we should NOT have been prepared to trash the economy.

    Banning smoking IS too big of an ask, as is banning alcohol, motorbikes, bicycles, cars, surfing, hang-gliding, skydiving, rock- and mountain-climbing, caving, Aussie Rules, Thugby, cricket, martial arts, or any of myriad other activities that are inherently dangerous to various degrees, and cause death or injury to many citizens every year.

    We don’t ban them for a reason – namely, that it’s a free country – or it was. The same reason should have made the scale and viciousness of the present lockdown unthinkable.

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