Friday, September 04, 2009

Nanny knows best

Rather than being a nudge towards a healthier society, the Preventative Health Taskforce's report is a government shove on how average Australians should live their lives.

One of the objectives of the report is to influence markets to achieve preventable health outcomes.  And it recommends doing so using measures that are popularly grouped as "nudge" policies.

American academic Cass Sunstein's nudge theory is that governments should direct people in the preferred direction without limiting their choices.  Recently Finance Minister Lindsay Tanner argued in favour of the nudge theory because it "holds enormous potential for reforming government and regulation" towards more desirable societal outcomes.

But the taskforce report's nudges are really more like shoves.  The report argues that those most vulnerable to obesity, tobacco and alcohol-related health problems are "those Australians with less money, less education and insecure working conditions".

Following the nudge brief, the taskforce recommends imposing heavy sin taxes that will increase the price of food, alcohol and cigarettes.  But these tax increases are unlikely to have any additional effect on existing taxes, advertising bans and horrific warning labels about the consequences of smoking.  They are likely to act as a regressive imposition on the least well-to-do in our community.  The only beneficiary is likely to be government coffers.  Increasing taxes as a deterrent has a poor record of success.

Since 2001 Australia has had a "fat tax" called the GST.  The GST acts as a fat tax because it applies to all cooked and processed foods but not to fresh food.  If tax increases are supposed to nudge Australians into a healthier lifestyle, then they have spectacularly failed.  Processed foods have had an additional 10 per cent tax over fruit and vegetables for the same period that the taskforce has argued obesity rates have been rising.

The argument that additional taxes need to be collected to support the consequences of an unhealthy lifestyle also go up in a puff of smoke when you look at the facts.

Traditionally governments have argued that increasing taxes on cigarettes is necessary to help offset the additional costs of those who contract cigarette-related illnesses such as lung cancer.  But according to the Cancer Council of Victoria's Tobacco in Australia report in 2004-05, total state and federal government revenue from tobacco-related products exceeded tobacco-attributable costs by more than $3.5 billion.  In other words, smokers already pay far more in tax than they cost in healthcare.

Recommending that the price of a packet of fags should be taxed until it costs $20 or more will only exacerbate the imbalance.

Another recommendation is for the government to end the act governing cigarette advertising to require that they cannot be sold "except in packaging of a shape, size, material and colour prescribed by government".  Family First senator Steve Fielding has already introduced a bill to this effect.

In the taskforce's discussion on food, it recommends that within three years there should be "standard serve-portion size(s)" in restaurants.

These measures are designed to stop us going to a fast-food restaurant and, if we do, to realise that we should not order a large combo meal when our stomachs cry upsize.

People may make decisions about what they consume and do that government does not like, and there may be legitimate measures that can be taken to stop people making the poorer choices.  But to bring Australians along, public health activists need to learn to treat us as grown-ups.

The 26 potential pieces of legislation, 18 new programs and frameworks, seven new bureaucracies and 71 other recommendations by the taskforce do not communicate respect for the individual's choices.

Australians can make rational, informed decisions and still smoke, eat fast food and binge-drink beyond the technical standard of three glasses of booze without destroying our health, as long as we are encouraged to take responsibility for our lives.

Instead of encouraging responsibility, the taskforce is trying to shove us into thinking it can make those decisions for us.

The necessity to implement the report's recommendations is being sold with predictable alarmism.  Health Minister Nicola Roxon has argued that "we are killing people by not acting" and taskforce chairman Rob Moodie has argued that "sitting on our hands is not an option".

The real decision facing the government isn't about whether to accept the report's recommendations.  It is about whether government thinks its role is to ensure consumers can take the responsibility to make informed choices or to decide for them.

Unfortunately, the taskforce's report is recommending the latter, not the former.


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