IPN Health Blog

Salt and Shake Spin

“UK experts” warn that the government target for cutting the salt you put on a baked potato isn’t strict enough.

That’s according to the BBC, whose coverage gives the impression the only dispute among our benign dietary overlords is between whether they should terrify us into near total salt avoidance, or just plain scare us into a slightly less tasty diet.

But there’s plenty of evidence that the whole statist plan to regulate the nation’s scrambled eggs needs to be taken with, well, a pinch of salt. When new anti-salt ads were unveiled in October, The Times quoted Catherine Collins, chief dietician at St George’s Hospital in London: “Advice to cut back on salt really is the poorest of all the dietary messages around.”

So who are the “experts” recommending that the government’s action against pork scratchings must go futher? As so often in these cases, fakecharities.org can help. Here we find that "Consensus Action on Salt and Health" receives substantial donations from the Food Standards Agency, the government agency it is supposedly lobbying for more regulation. Somehow the BBC fails to mention this.

Perhaps we need  a new study into whether state-funded charities and state-funded news websites might just have a bias towards deeper state involvement in our choice of crisps.

Marc Sidwell

A strong gust of hot air from the Lancet

The Lancet seems to be accelerating its mutation from respected medical journal to lefty campaigning rag.

A few months ago it was trumpteting the publication of the WHO's execrable report on the Social Determinants of Health.

This week it turns its humourless gaze onto climate change, which it alarmingly describes as "the biggest threat to health of the 21st century".

Its major new report, written in association with University College London, makes the usual tired claims about killer heatwaves, malaria moving into highland and northern areas, and increased hurricanes and other weather mayhem - unless, of course, governments intervene massively at the local and global levels.

I've written at length on the climate change / health nexus before, so I'm not going to rehearse the old arguments.  But the facts remain:

• Climate has little to do with the range of the malarial parasite, which is more down to sociological and economic factors
• Deaths from 'extreme weather events' have actually decreased by 95% since the 1920s
• Cold is far worse for health than heat, as any shivering pensioner will tell you.

Check out my article for a longer exposition on these themes.

I understand that the Lancet see itself as a catalyst of change or something equally grandiose, but it really needs to start tempering its hyperbole if it wants to continue being taken seriously by anyone outside the global public health bubble.

Swine Flu not an excuse for blocking trade

Undoubtedly today's main health story concerns the outbreak of swine flu, suspected to have killed over a hundred people in Mexico.

Sadly this serious health concern is already being used to block perfectly legitimate trade.

News agency Bloomberg report that the Russian government has blocked all imports of meat from Mexico and some US states, while pork from other countries in the region (Guatemala, Honduras, the Dominican Republic, Columbia, Costa Rica, Cuba, Nicaragua, Panama, Salvador) is now also banned.

While this might seem reasonable at first, note that the World Health Organization clearly states that the virus cannot be transmitted through well-prepared food.

This document from the WHO confirms that the virus dies at 70 degrees celsius.

The Russian government's reactionary measures are the kind that imbed people in poverty throughout the world, furthering the spread of diseases like swine-flu.

As explained by Indur Goklany, free trade is crucial for economic growth and technological development, both of which combine to improve prosperity and health outcomes.

Oxfam's 1950s ideology

Oxfam, a state-funded pro-aid lobby group, released a major report yesterday slamming the World Bank for supporting private sector healthcare in less developed countries. (Blind Optimism: challenging the myths about private health provision in poor countries)

Its objections, according to Andrew Jack's report in the FT, are that private care boosts inequality of access, costs more and contributed to a brain drawn of trained health workers.

The study might have more credibility if it wasn't so wilfully selective of evidence.

To determine the level of private coverage, it cited World Bank Demographic Surveys, but then selects only 15 of the 21 countries they cover.  Oxfam only counts visits to private doctors, ignoring visits to private clinics and hospitals. It also ignores the private drug shops where the poor get most their care.  This is how Oxfam arrives at a figure for private health coverage that is ten times less than the reality.

Oxfam seems to be arguing that donors should place all their eggs in the public sector basket.  But we know public sector health does not produce better quality care.  A 2006 study of 278,000 children in 45 countries found "no evidence that nations . . . with relatively large public health systems perform better or worse than those with larger private systems”. 

We also know that that "free" public sector health tends to be captured by more affluent, urban dwellers, at the expense of the poor in rural areas.

It is strange that in this day and age Oxfam should be advocating monolithic state health provision, when this approach has failed to deliver after many decades of trying and plenty of money. This is hardly surprising - monopolies rarely benefit consumers, whether they be in supermarkets or mobile phones. 

Surely the answer to the healthcare problems of the developing world lies in diversity of provision, with as many players as possible brought to the table? Even countries that are deeply concerned with 'social solidarity' favour this approach (the Netherlands, Germany, France etc).

Fortunately, most journalists have seen this paper for the bit of ideological advocacy that it is, and have not covered it (except the FT).  Obviously Oxfam's massive press office needs to be working a bit harder!

April Harding over at the Center for Global Development has more.

Vaccinations and the Danger of Scare Stories

A story this week from the UK starkly warns of the dangers to health that come from shunning vital vaccinations.

The Sunday Telegraph reports that over a million children in the UK are now unprotected from measles, leading to concerns of an imminent epidemic.

These children should have been protected by the MMR vaccine, yet media-driven scare-stories earlier this decade saw uptake drop considerably. At the peak of the political controversy, then-Prime Minister Tony Blair was hounded by journalists asking if his son Leo would be vaccinated with the MMR jab.

The controversy began due to a report suggesting the vaccine could be linked to incidents of autism. The report was later revealed as receiving finance from solicitors seeking a case against vaccine manufacturers.

There is now wide consensus on the safety and benefits of the vaccine: yet harm has already been done, with cases of measles increasing.

The World Health Organization estimates that every year 1.4 million children die from diseases that are preventable by vaccination, with over a third being from measles.

Vaccinations are vital to improving public health and should not be taken for granted in wealthy countries, nor fall prey to unsubstantiated scare stories.

Making poverty perpetual

According to the sages at the Chronic Poverty Research Centre - an international partnership of universities, research institutes, and non-governmental organisations - the UN’s Millennium Development Goals are not ambitious enough.  Even if they are met, there will remain 800 million ‘chronically’ poor people around the world.

In order to lift these marginalised people from poverty, their report advocates a massive scaling up of state welfare in developing countries, ranging from cash benefits to ‘minimum income guarantees.’

Later this year, the World Health Organization is also likely to recommend expanded social protection – including minimum wages -- as an essential means of improving the health of the poor.

These kinds of interventions are likely to make the problem of ‘chronic’ poverty worse.

Take minimum wages. In richer economies, they don’t cause too much economic damage during times of rising prosperity. The problems start when an economy begins to slow down.

When things get tough, employers will dispense with those they regard as the most marginal workers first, such as unskilled people, part-timers, women, and so on.

But in fragile African economies, asking the private sector to provide ‘minimum income guarantees’ is tantamount to telling them not to bother employing anyone at all. As the World Bank has shown, there are enough bureaucratic hurdles to starting a business in the poorest countries, without this costly extra burden. 

And without a strong private sector creating wealth, there will be no juicy tax revenues to fund state welfare – unless, of course, western governments are prepared to underwrite African welfare systems indefinitely.

Countries like Britain have had enough experience with welfarism to know that it is not the way to eradicate poverty.  As the light shone on Glasgow East during the by-election has amply demonstrated, it entrenches it.

Making Poverty History? Making Poverty Perpetual would be more accurate.

A prize turnip of an idea

After years of campaigning, activists have narrowed the debate about health care in poor countries to a single premise: Patents drive up the cost of medicines, so patents are bad.

As part of this campaign, activist groups such as Medecins sans Frontieres and Knowledge Ecology International regularly cite the fact that few drugs have been developed for several tropical diseases. On the basis of this, they claim that markets are incapable of providing drugs that people need.

It takes quite a distortion of the evidence to support this claim.  Nevertheless, the NGOs argue that the current market-based system through which drugs are developed needs to be dismantled, and replaced with a system where government experts decide what needs to be researched.  They would then allocate 'prizes' to drug developers who are able to develop efficacious medicines that meet the terms of the prize.

Without breaking into much of a sweat, I can think of three immediate objections:

• This would result in the immediate politicisation of drug research, with research being allocated to political rather than clinical priorities.  I can't see how this would be an improvement on the current system.
• the value of the prize will never be a true reflection of the market value of the invention, no matter how clever the prize awarding committee.  If the prize is too low, companies will be reluctant to compete for future prizes, leading to fewer new drugs. If the prize is too high, the new system will squander taxpayers' money and divert effort from other areas of research.
• Prizes were widely used in the Soviet Union to stimulate research.  Not only did the USSR produce very few novel drugs, but many scientists risked life and limb trying to escape to the West where their talents would be properly rewarded.

Can any readers think of any more objections, or even reasons why I'm wrong? The comments are open.