Heath-Care

This is an opinion piece and I do not claim to have performed financial analysis. Hopefully it inspires some debate and original thought, even if it’s only in your own head. It is likely to offend some people, hopefully the ones who need it.

I read this article on radionz a few weeks ago and listened to the radio interview linked on the website. I think it was shared on facebook somewhere and Nikki picked it up. The basic message is this: New Zealanders consume too much sugar, so should we implement a ‘sugar tax’ on sugar sweetened beverages in the aim of changing consumers behaviour? Gareth Morgan’s political party proposes to do just that.

Several questions immediately arise:

  1. How much sugar are we consuming?
  2. How would the proposed tax be implemented?
  3. Will it work? Ie. Will it reduce our sugar consumption and by extension, make us healthier?
  4. Is there another solution?

Another possible question could slot in at number two, is the current rate of sugar consumption unhealthy? Unless you work for the DAA or have been living under a rock for the past 20 years I think we can all agree that excess sugar consumption is undesirable and hence we will leave this aspect of the discussion out of this piece aside from a brief touch on NZ obesity levels.

So let’s look at question one. How much sugar are we consuming? According to Prof Mike Berridge, that figure is over six times the WHO’s recommended amount. SIX TIMES! That equates to 37 teaspoons of added sugar per day. Are you kidding me?! This is a phenomenal amount of sugar and most people don’t realise they are consuming it. There are clues though, quoting Berridge:

“The amount of sugar in virtually everything we eat, including bread, crackers, biscuits, and it all adds up.”

Clues? None of the above mentioned are actually foods.

Quoting the radio nz article:

“He said just 100ml of yogurt contained as much sugar as Coca-Cola.”

Not any yoghurt that I’m prepared to eat, or let children near. In fact I had some yoghurt today, 4.8g sugar per 125g serve. And none of that is added sugar. Clearly there is an issue of food choice affecting sugar consumption. A lot of people here will cry that this is due to affordability and I do not disagree. 2015/16 statistics show that 32% of adults are obese and a further 35% are overweight (ref 1). Let’s not mince words, 67% of New Zealand adults are fat. This figure is 32% for children (under 15) and quickly rising. Backing up the affordability claim:

“children living in the most deprived areas were three times as likely to be obese as children living in the least deprived areas.” (Annual Update of Key Results 2015/16: New Zealand Health Survey).

It would appear from these stats, and only if we can make the very broad assumption that cheap sources of sugar (Sugary drinks and yoghurt as examples) are responsible for the obesity, that those with less income to spend are getting more overweight, supposedly from consuming too much sugar. That relationship is certainly not causal, but is a correlation nonetheless. In its current form, it is suggested that a tax on sugary drinks (What qualifies as sugary?) would be the first step to try and break this pattern and change consumer purchasing behaviour.

But how much tax? Lisa Marriott, Victoria University:

“The literature is very clear. A tax will change behaviour, but what you need to consider within that is the size of the tax, because in order to get a significant behavioural change you do have to have a significant tax, and those types of levels, 40 or 50 percent, are going to be politically unacceptable. And even at the lower end, 10 percent, you will still see some behavioural change, but there are a number of factors that will then also impact on the level of that change. For example, you’ll expect to see a much stronger behavioural change in people who are heavy users of sugar products, and a much lower change in people who are not.”

If a 1.5L bottle of Coke costs $0.99, a 10% tax is not going to add a significant amount to that purchase price. A 50% tax maybe, if we can put aside the “politically unacceptable” consequences. But is it enough to change behaviour?

If your kids are nagging you for Coke but the price has just gone up (10-50%) what do you do? Insist on the milk at 2-3 times the price? Hold strong and give them water? Or fold and buy the Coke (it’s only an extra 50 cents….)?

I believe this tax has the ability to slowly create change in habits but only if implemented in an aggressive manner, ie. A high tax rate. This may force consumers to change spending habits, perhaps halve the sugary drinks they purchase, ease up on the fake yoghurt (it would have to apply to food also), and maybe even lose a kilo or two. But for this to change our country, most need to lose more than a few kilos. And as we have seen above, this tax rate would be considered “politically unacceptable” and just that comment alone should make you question who is controlling these decisions. It’s not about your health.

But the consumer has to buy something right? And I believe that for the proposed tax to work effectively we need to provide an alternative, healthy option. This would come in the form of tax breaks on healthy food and drinks, all we have to do is ignore the health star rating system and ensure that the right products are chosen…. Yeah right. The tax break would be funded from the sugar tax, although if the sugar tax worked we would see decreased expenditure. There are many problems here.

These sorts of interventions are what I call soft-intervention. In concept it sounds great, but they fail to address the real issue. I’m not saying it won’t work, just that it’s not a silver bullet. But nobody wants to talk about real paradigm-changing change. At least nobody in a public position due to the immense hatred and abuse that is thrown at them by the keepers of the current paradigm. Just look at the ridiculous and unfounded flak that Pete Evans is getting for his documentary, how dare he suggest people eat real food and eliminate bread and dairy?! Right there is why government food recommendations will always be wrong.

Self Responsibility.

Until it is considered cruel to feed children soft drink and lollies our population will always suck. Without taking ownership of your own health you will always be sick and fat. And you will always blame someone or something else, McDonalds, tobacco companies, Coke. We all know an obese man who consumes a 400ml can of energy drink for breakfast, chips, yoghurt and sandwich for lunch, uses a screen all evening, and takes no ownership whatsoever. Soft-interventions are not going to fix that. Hell, maybe nothing will fix that! But hard-intervention may get us closer.

Enter Heath-Care. A bit like health-care, a bit like Obama-care, or maybe I just liked the name.

New Zealand has a fantastic sick-care system. We call it healthcare but it’s not. We are absolutely privileged to have access to an almost free medical system our entire lives, it’s that handy even foreigners take advantage of it! But it is an ambulance at the bottom of the cliff and every citizen who takes no responsibility for themselves is milking it dry. And all tax payers are paying for it. Look at the above obesity stats and soft-interventions, do you think this is heading towards lower sick-care costs or higher?

Never one to complain without offering a solution:

  1. Offer free medical care (Including physio, dentist etc) to everyone who meets certain conditions:
    a. Waste circumference under X
    b. Non smoker
  2. All those excluded by a. and b. above must pay or have insurance

We currently offer free medical care to everyone, regardless of the level of self responsibility demonstrated by the patient. There are exceptions of course, token exceptions. For instance, a person may be required to quit smoking before being allowed a surgery, but this does nothing in the way of prevention. This in my mind is madness. Why are we not encouraging better health? “We are” you say? It is not working.

From the Report on New Zealand Cost-of-Illness Studies on Long-Term Conditions (2009) (ref 2): the New Zealand Government study in 2007 showed the direct costs of obesity in New Zealand to be $460 million in 2004. Indirect costs were estimated at $340 million but were restricted to lost productivity. Tobacco use is estimated to cost NZ $300-350 million annually in direct health care costs, from a 2007 Otago University study. Alcohol related problems are estimated at $700 million. The issue here is that the NZ Government is well and truly covering these costs with tax income, could this be the same situation with the proposed sugar tax? Is the government committed to a healthy population or to the bottom line only?

I have suggested two conditions that must be met to qualify for free healthcare. A maximum waist measurement and absence of smoking. Why? Correlation to overall health and ease of measurement. The waist circumference condition alone would deny 67% of adult kiwis free healthcare. Radical and extremely politically incorrect. But is what we are currently doing working?

Other conditions could be added of course. Blood glucose levels, VO2 max etc. But the key is that the qualifying tests are easy to administer (any Dr can administer them, even self-checks can be carried out) and that they have proven correlation to improved health outcomes. Actual values for the waist measurement for instance would be gleaned from available statistical data and vary by sex. Don’t get me wrong, lean people have heart attacks and diabetes too and I’d venture the blood glucose would catch them out, but the trend is certainly in the other direction.

So what happens if you don’t qualify? Either pay, have insurance, or take some responsibility and make some changes.

Insurance companies will be loaded with applications for health insurance, only all of these applicants will be in ‘at risk’ categories. Premiums will skyrocket. Meanwhile, the cost to public healthcare will drop as the system will only be covering those at low risk of health issues in the first place. The obese/smokers (remember that these are major risk factors for nearly every chronic disease known to modern man) will therefore be required to make some decisions. If you have the option of health insurance at $50/week, or lose 20kgs, which option do you take?

Self Responsibility.

Most of you will have close relatives who are obese and this will seem cruel or unfair. But I believe they can change. I also guarantee you will know unmotivated people, who are unwilling to change, some who make no effort to care for themselves but demand all the healthcare privileges that the government is offering. And you are paying for it. I believe an implementation timeframe of 3-5 years would allow ample opportunity for those who want to change to be able to do so. And those who don’t, I know who you are.

I am fully aware that there are many flaws in this logic. With competing insurance companies we would require legislation around minimum costs for health insurance for example. What if nobody could afford insurance and 67% of adults decided to lose weight instead, what about the burden on the public system? Well, we carry that burden now don’t we, at least they would all have improved health. Imagine, what if New Zealand’s obesity rate was under 5%? What if we saved $460 million per annum? What I am suggesting is politically unacceptable in our current society, but our current society is a failure, and hey, it’s election time.

Get off your slightly larger than regulation gluteal area.

 

References:

  1. http://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/obesity-statistics
  2. https://www.health.govt.nz/system/files/documents/publications/nz-cost-of-illness-jul09.pdf
By | 2017-09-13T16:05:16+00:00 September 13th, 2017|Blog|0 Comments

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