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Economics can be good for health: need for rational
policy without the influence of vested interests
New Zealand Government’s position on climate
change—New Zealand has a proud history of leading the world in
social changes, including universal suffrage, social welfare, and nuclear-free
policies. Unfortunately, New Zealand has recently been lagging in addressing a
key global issue: climate change.1 A recent
government proposal to control greenhouse gas
emissions2 is both overdue and inadequate. In
comparison, Finland introduced a carbon tax in 1990, followed by similar moves
in other OECD countries.1,3
The overall logic of the proposed greenhouse gas emissions
trading system appears sound. However, the Government is exempting the
agricultural sector (which accounts for around half of greenhouse emissions)
until the year 2013.2 Even then it plans to
give this sector 90% of emissions credits for
free,2 rather than the fairer approach of
selling or auctioning them. Is this a rational policy or the expression of
vested interests?
The “agriculture exemption” disregards the
critical “polluter pays” principle and transfers wealth to a sector
riding high on record dairy prices. New Zealand’s emissions trading
policies should be efficient, fair, and enacted without further delay given the
threat posed by climate change to the environment and global public health.
Prompt action will also help to turn the rhetoric around New Zealand’s
“clean green” image into a reality that can be genuinely used for
promoting in-bound tourism and agricultural exports.
The systematic failure of the New Zealand Government to
develop rational policy on economic policy levers to address health issues, is
also evident in other areas, including: tobacco, alcohol, and food. Is it a
coincidence that there are powerful vested interests in these areas?
Price signals around
tobacco—Overwhelming scientific evidence supports tobacco
taxation as one of the most effective tobacco control
interventions,4,5 including in New
Zealand.6–8 The government’s
current national tobacco control plan,9
identifies price as a key policy intervention, but there has been no
above-inflation increase in tobacco tax since the year 2000. With wage growth
above inflation, and smokers switching to cheaper roll-your-own cigarettes, the
price signal is being eroded.
The government’s refusal to dedicate tobacco tax
revenue to control activities, including helping smokers to quit, is an
additional concern. This is despite the international evidence that dedicated
taxes are an effective approach to ensuring sustainable funding of tobacco
control activities and that such taxes are far more popular with the public and
hence more politically palatable.10
Price signals around alcohol—As for
tobacco, there is overwhelming scientific evidence that alcohol excise tax
policy is an effective intervention for reducing harm from
alcohol.11,12 But where is the alcohol pricing
policy that rationally attempts to reduce the enormous harm from alcohol in this
country (a net 26,000 disability-adjusted life years lost per
year13) while still allowing moderate patterns
of social consumption?
There is also no published policy work for New Zealand to
explore the impact of differential alcohol excise taxes, so that those forms of
alcoholic beverage that are the most hazardous are taxed at higher rates (e.g.
beer versus wine for binge drinking14).
Price signals for healthy food
choices—Market forces have led to the cheapest foods being the
most obesogenic,15 undermining public health
efforts to address obesity. The obvious strategy to address the obesity and
diabetes epidemics in New Zealand is to tax high-energy nutrient-poor foods and
reduce taxation and/or subsidise healthier foods.
It is not surprising that previous suggestions along these
lines have raised vociferous objections by the food industry. Could this be the
reason that a Select Committee Inquiry dismissed price signals in a brief
paragraph of its 49-page report?16 That
paragraph reflects a gross failure of policy analysis from any rational
perspective.
While there are undoubtedly some complexities with taxes on
unhealthy foods, such as trade-offs between high saturated fat and high salt
foods,17 the potential value of removing GST
on, or providing vouchers for, fruit and vegetables to low income consumers
would be an obvious area to start
exploring.18
What needs to be done?—We consider
that the lack of the rational use of economic instruments by the Government to
protect the environment and public health is at least partly explained by the
intense resistance from powerful agribusiness, processed food, tobacco, and
alcohol industries. On the other hand, ineffective measures such as education
campaigns are easy to support, and create the appearance of action, but have had
limited impacts compared to price signals.
To help the politicians and officials to use appropriate
policies we need a “system upgrade” in the current economic system
and political culture:19
As with many other developed countries, New
Zealand already has a Reserve Bank that is designed to be free from political
meddling—and operates in this way most of the time. PHARMAC has also
managed to successfully constrain the growth of the national pharmaceutical
budget with minimal political interference and the capacity to fight off
multiple legal attacks by industry.
Such organisational arrangements and the other changes we
suggest above are needed to protect public health and the environment. These
should still be accompanied by efforts to maximise (for more routine goods and
services) the successful entrepreneurial aspects of market-based economies that
are of proven efficiency.21
Competing interests: The first two
authors have previously worked for NGOs and the Ministry of Health on tobacco
control issues. Similarly, for nutrition issues for the first author (NW).
Nick Wilson, Richard Edwards
Department of Public Health University of Otago Wellington (nick.wilson@otago.ac.nz) Osman Mansoor
Public Health Physician Wellington References:
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