The Right – speaking monolithically, of course – is exercised, no pun intended, by the Government’s legislation for a National Preventive Health Agency. The bill has been delayed by the Senate while it awaits the provision of a related report by the Government.
And no they’re not exercised by the fact that it is bloodywell preventative not preventive, though they should be.
No, it’s the Nanny State thing. Bureaucrats – shiny-arsed pencil-pushing latte-sipping faceless Canberra bureaucrats – telling Aussies what they should and shouldn’t do about their health, about what food they eat and how much exercise they get.
Just out of pure contrarianism, I’m with them – them being those who consistently apply the Nanny State objection even on issues where they’d like to take a positively Stalinist line on behavioural regulation, and that narrows the field quite a bit - on the Nanny State thing. I object to being harangued by bureaucrats or non-bureaucrats alike about how much I drink and eat. I can look after my own health, thanks very much. Judging by the obesity I see around me whenever I go to my local shopping mall, I’m not so sure too many other Australians can look after their own health, but that’s not my lookout. In any event, if we had some price signals in our health system, people might be motivated to looked after themselves a bit better.
Though I can only maintain that idea as long as I don’t look at the American experience. So let’s not go there at this point.
But the Nanny State thing isn’t the real reason to object to the National Preventive Health Agency. In fact it’s not really a reason to object to anything, because it’s a slogan rather than a coherent argument. No, the reason to block this witless bill in its tracks is pithily summarised in the Parliamentary Library’s Bill Digest, which gives the financial impact of the Bill.
As the table shows, the bulk of the $100+m that will be spent by this agency will be directed to “social marketing campaigns”. Social marketing campaigns are those annoying ad campaigns designed to change your behaviour and make you, say, not binge drink and wind up sprung by your friends having sex with a dag.
The $30m a year will basically go to market research companies who will sit round focus grouping ad ideas, ad executives who will design the campaigns and use the money to buy more cocaine, and the media – mainly television.
In the scheme of things, $33m a year isn’t actually all that much. It certainly won’t buy you a hell of a lot of airtime. A good television-focussed social marketing campaign will cost north of $50m to research, design, make and broadcast when people will actually see it. The only virtue about the NHPA wasting money trying to change behaviour is that it won’t be wasting as much as it really should.
Still, if you’re an ad exec, or a television network desperate for more revenue, the NHPA will be just your ticket.
10 Comments
well there goes my next six posts, bernard, cheers.
You can see why “Prevent(at)ive Health” looks like a bit of a silver bullet to health economists in the system. With average unit health cost increases running between 2 and 5 times inflation, the theoretical prospect of saving eleventythousand billion dollars by getting people to stop stuffing shit down their gob, easing up on the XXXX and taking up a hobby that’s a bit safer than smoking – like say, physical exercise – certainly appears to be a public policy panacea when it comes to the allocation of scarce resources.
So saying – the road to hell is paved with bureaucratic conventions and the whole thing will inevitably achieve nothing.
I reckon the best preventative health strategy available is a series of ads called “This Is Why You Die” – filled with a creepy little story of why the shit you do every day will kill you stone cold dead, and the gritty consequences of it.
A lot cheaper.
And my heart goes out to Chris – column thief!
Get a dog, walk the dog, good couple Km a day.
I did that, dog was pulling my arm out on the walks, not comfortable for either of us so went to dog obedience club. Now I am trialling in obedience and will trial in agility.
Whole thing gets me out in the fresh air and exercises my 62yo mind and body.
Then a stubby beer or nice glass of red!
Thanks, this is the problem and I feared as much since the agency was first announced.
There is a school of health promotion based on the idea that people make rational decisions provided they are given adequate information about their suseptibility to illness, the advantages of change and the problems with not changing. This focuses on the agency of the individual and it is fine for some things – it works well for vaccination for example. But its shortcomings are well known and it is crap for difficult issues like smoking, obesity and alcohol which are the Governments own preventative health priorities.
To say that social marketing, which is just advertising healthy messages, is ‘preventative health’ indicates the government and beuracracy either don’t know better, or are just ignoring the difficult evidence from public health. I suspect the latter, because there are plenty of PH professionals who have been pointing out the issues for a long time. The evidence is that one has to address social determinant of health, and barriers to people changing their behaviour in order to bring about change. Telling people to wear seatbelts is fine, for example, but you also have to legislate them being worn and for cars to include them. Governments rarely want to hear this because it moves the game from telling people they are fat, to legislating standards for advertising, improving city infrastructure for exercise (let a thousand cycle paths bloom) etc. That annoys the donors as much as saying you can’t save the planet with a 30 second add about low wattage light globes, for example.
The point is that the ‘preventative health’, in identifying peoples behaviour as a major determinant of their health, does not equate to making everyone individually responsible for changing their behaviour in the response to slick jingle. That is a political imperative because telling people they are all individuals (we are all individuals) is popular, punative social policy is acceptable to the powerful (who are already the thin, non-smoking and healthy) and is intellectually lazy. It is also far more important to appear to be doing something, which means it has to be on the tellie, than to actually do something, which might only be noticed by those being helped if at all.
A spin class with not tangible health benefits if ever I saw one.
I’ll go back and finish this but don’t want to miss the chance of enlisting you in the cause of keeping “orientate” at bay. If you don’t like “preventative” being substituted for “preventive” (which has not been one of the bees in my bonnet hitherto but will be now) you will see the point of people reorienting themselves instead of taking the time to reorientate themselves.
preventive should be preventated?
More seriously, the “nanny state” health educational approach has been around for a long time – generally not noticed by contrarians like you – and has some impressive successes under its belt. For example, a sustained public health campaign has reduced smoking to a tiny fraction of its former level. Before people can even think about changing their habits they first have to get the message that change is necessary. It’s not just “advertising healthy messages”; there is plenty of evidence from properly collected and analysed data and from valid comparative studies to demonstrate the effectiveness of these programmes.
Your argument seems to be that because you have a healthy lifestyle, these programmes should hide themselves from your sensitive eyes. How do you do that? Small print on the government health warning “If you are not a semi-alcoholic lazy lardass then you should not read this message”?
“If we had some price signals in our health system” – the invisible hand cures all!!!
Bernard, I don’t understand why you object to price signals in food, alcohol and tobacco, but not to price signals in health. The first is preventative and the second only takes effect after a bad outcome which could have been avoided. It’s not logical. (But everyone takes out adequate insurance and considers all the risk of a bad outcome before they act, eat, smoke or drink, right? Oh).
Bernard, the term “Nanny State” sounds a bit harsh. I think it was invented by Lady Thatcher as part of her war on the welfare state. Advertisements obviously motivate people to spend their money, enriching the advertisers very effectively. So why wouldn’t responsible public health information work?. As a GP, I have seen some messages that work. The smoking ads worked. The antibiotic ads worked. Insights such as, for example, “Remember to hug your children” “Being often angry can make you ill” “Constant stress is bad for your system” “Carbs, not fat, make you fat”, could be advertised, using amusing, cheerful messages. It would certainly remove the need for a lot of GP counselling. Presenting facts, not hassling, is the way to go. Most people are very interested in their health. They just haven’t got the time to undertake the necessary research. You shouldn’t knock social marketing, Bernard.
It is a cost-effective public health strategy. Preventive, not preventative (ugh!).
I would take issue with the smoking ads having ‘worked’, or at least worked alone. The point about social marketing is that it tends to ignore the other issues which need to be addressed in changing behaviour. In smoking, there has been a continual increase in the price of cigarettes, reduced availability of these products, a ban on advertising on television and in relation to sports, and a prohibition on smoking in public spaces. Now, among the educated and well-off at least, there is a cultural view that smoking around others is just unacceptable which reinforces all of this with a new social norm. This has taken several decades.
These actions worked and there were some ads around sometimes during those decades, but people remember the nice glossy ads. These also have their place but I believe the evidence from properly collected and analysed data indicates that programs which rely on a logic of health beliefs modifying health behaviour have had limited success in changing complex behaviours compared to more ‘multi-pronged’ approaches – including smoking.
So I don’t think advertising fat over carbs or anything like it would help. It would, however, be harmless and not frighten the industries too much. Afterall the central reality of social marketing campaigns is that, no matter how good, they are always outgunned by commerical advertising budgets.
I agree for the most part with your article but if I wanted to read mindless generalist insults like “shiny-arsed pencil-pushing latte-sipping faceless Canberra bureaucrats” I would be buying the Daily Telegraph. You are supposed to be better than this.