State Health Ministers LOVE the idea of prevention for two reasons:
1. It means they have an excuse to divert funds from hospitals.
2. Much, much better they can blame the person with the disease and demonise them. “They are clogging up my hospital because of their lifestyle; it’s their fault and the taxpayer is propping them up. There is no personal responsibility, etc etc”

Obesity is the latest hysteria. Most overweight people live just as long as everyone else with almost no extra diseases. The morbidly obese is a different matter and have very high mortality rates; of course the response of hospitals is to limit the numbers who have bariatric surgery.

PS I am skinny, don’t smoke and don’t drink alcohol. And I’m definitely not a conservative.

Conservative Mark Steyn commenting today on the health debate in the US:

“the “health care” debate is not primarily about health, which chugs along regardless of how the debate goes: Life expectancy in the European Union 78.7 years; life expectancy in the United States 78.06 years; life expectancy in Albania 77.6 years; life expectancy in Libya, 76.88 years; life expectancy in Bosnia & Herzegovina, 78.17 years. Once you get on top of childhood mortality and basic hygiene, everything else is peripheral – margin-of-error territory.”

Whatever your political slant he is correct.

Effective public education relating to the prevention of smoking probably saves money in health care costs but the benefit in other areas of health is extremely dubious.

Quality of life is the prime advantage of advanced health care. But the potential costs show no limits. Once universal government health care is introduced subsequent elections depend on how much the sides are willing to bid for the electorates vote. Labor always bid more but eventually you end up with deficits, Soviet health care or the NHS where lives really are lost through health care inadequcy.

We’re nowhere near that stage yet but as Nicola Roxon said last night:

“We have to acknowledge that there are, one: difficult choices to be made about how we spend the existing resources that we have. Two: how do we set up the system to make sure it’s sustainable into the future? And three: have a discussion about what governments should contribute and what individuals should contribute.”

Surpisingly mature remark from this minister. I hope Rudd’s ‘prevention’ nonsense is not used as a deflection from sober decisions.

Heavy investment in bike infrastructure, which does have a cost, may not translate into long-term rises in bicycling because transport choices are driven by other factors like family and work commitments.

You knew this would draw out the bike nuts, didn’t you?

I take your point that it’s very important to make sure that investments in bike infrastructure, like everything else, are value for money.

But there are plenty of places elsewhere in the world where cycling does work as a mainstream transport choice. And, these days, parts of inner Melbourne are getting very close to that. Back in 2006, in several inner-northern suburbs of Melbourne, over 10% of people cycled to work. Since then, cycling traffic counts have gone up by over 40%. That’s suggesting that the rates are approaching 15%.

The further point to make is that there has never been a ‘vast investment’ in cycling infrastructure, or calls for it. The kind of money generally talked about is chicken feed - a couple of hundred million bucks a year across the country is about as ambitious as it gets. Roughly the equivalent of a couple of kilometres of freeway.

To translate, we are getting better at prolonging the life of people with artherosclerosis and getting better at treating people after their first, second etc. myocardial infarctions. The actual cases of CVD (expressed as a percentage of the population in each age cohort) are actually slightly on the rise.

And, it is not the case that the causes of CVD are a complete mystery; it is that they are contestable. That is to say, the low-fat and diet proponents who have held sway in terms of public health for the last three decades will continue to preach their mantra despite the mountains of controlled studies that demonstrate that it does not work. But, despite this, the power of conventional wisdom and cognitive dissonance is such that every disconfirmation is merely dismissed as an ‘outlier’ (remember Ancel Keys’ notorious Seven Nations Study - whatever happened to the other 14 nations?!) or is a result of ‘unknown variables’ (e.g. red wine consumption is put up as the variable that explains the low rates of CVD in high saturated-fat-eating France, despite the fact that Italians drink just as much of it, and die of CVD in droves!).

The take-home message is; the public health “authorities” pass off as knowledge what is their best guess (and, if one is to be cynical, what serves their interets - there is big, big money in preventative health - note the Heart Foundation’s tick of approval!). At best, preventative health measures based on these contestable theories are wasteful, at worst they could be catastrophic.

BTW, I’m not a doctor of medicine.

This will no doubt come as a shock to many people, who understandably trust that the “authorities” by virtue of their qualifications, letters after their name, and carefully crafted gravitas, have all the answers. Nothing could be further from the truth.

Take, for instance, the biggest killer of Australians - cardiovascular disease (CVD). Surely, the authorities know what causes it, and therefore, how to prevent it? Hardly.

Time after time, studies show that the preventative measures preached by the mainstream (i.e. avoiding saturated fats, eating a diet high in carbohydrates, increasing exercise to up to 5 hours/week) have yielded next to zero impact in preventing CVD. At the same time, studies have shown that diets high in fats and proteins, and low in carbohydrates, help to reduce obesity, improve blood sugar profiles and decrease blood triglycerides.

Ok, so which message gets the tag as “preventative”?

If the facts are contestable (and in so many cases, they surely are), then throwing buckets of money at preventative measures that may well be useless is not only wasteful, but bloody dangerous. Until we have secured more certainty on these issues (as we have on issues such as the smoking - lung cancer link), then treating the symptom actually makes more sense (counter-intuitive as it may be).

I would be quite happy to see junk food advertising banned. I like bike paths and I use bike paths, and to call it a “heavy” investment alongside road and rail is more than a bit disingenuous. Some things are just the right thing to do, whatever libertarian wingnuts wish to preach.

But I would agree that doing these things in the name of preventive medicine ought to require some concrete evidence of benefit.

David, your response is just a rant, unless you’re willing to say where you would draw the line on free speech. Your analogy with “real estate property rights” demonstrates this very clearly. The “community harm” that is often cited as a reason for restricting real estate property rights is too often a cover for private interests (more often than not, competing real estate property rights).

The idea that McDonalds, KFC and Hungry Jacks should have untramelled speech rights seems pretty fanciful. Obviously, their abilities to impose huge amounts of their ‘speech’ on to us is a function of their massive financial muscle. If we are going to allow them untrammeled rights to dishonestly (‘misleadingly’ is too euphemistic a term) promote their products then it would be equally fair and democratic to allow real estate property owners to build whatever they damn well please on their properties.

Unlimited advertising is not free speech but unlimited property rights. We don’t allow unlimited real estate property rights, because of the community harm that would cause, so why should we allow the unlimited development of business properties (ie products and brands) regardless of the harm they cause?

In fact, why not go the whole hog and expose the complete and utter waste of Government funds across a whole range of dubious informational activities, ranging from the ad campaigns against domestic violence to the flood of glossy (and largely unread) annual reports from every government agency?