The Health Crisis of Our Time: Vice takes center stage in public health debate

Commentary, Healthcare, Meredith Lilly

Risky lifestyle choices face unjustified public scrutiny as healthcare costs rise.

The summer of 2011 has been a summer of mundane health crises. Free from the life-threatening pandemics of the past, we’ve shifted our focus to relatively benign unhealthy habits. The habits themselves are nothing new: smoking and tanning have been known to cause cancer since the 1940s and the 1960s, respectively, while overeating and other excesses has been condemned since Biblical times. The difference is that these once private vices are now considered public matters.

What pushed these vices into the public arena? In terms of public interest it makes little sense. With the exception of some second-hand smoke concerns, vices like obesity, tanning and smoking do not pose a threat beyond the health of the individual that engages in the risky behavior. Given the low chance of harm to others, limiting choice just to prevent informed adults from engaging in unhealthy behaviour would not only be illiberal, but also likely ineffective.

My skepticism of such policies stems from experience: North Americans are already subject to a great deal of soft paternalism, and the effectiveness of these measures remains questionable.

A 2010 study in the United States showed that soda taxes had little influence on purchases and even less effect on obesity, partially due to an existing preference for sugar-free soda among at-risk groups.

Another recent study released this year suggests that taxes on fattening foods would have to be increased to 25% to have any effect on consumption. Even if high taxes were levied, there is no guarantee that consumers would not simply shift their consumption to a more affordable high-caloric option.

The taxation of smoking has been comparatively well-received, but only recently, and only among some groups. The history of smoking bans, which dates back to the 1600s, is primarily a history of failure. A combination of price sensitivity, prevailing social stigmas and a desire to quit in the first place are all essential elements to the policy’s success, making it a very difficult phenomenon to replicate.

Tanning is just beginning to feel the bureaucratic burn. Recently classified by the World Health Organization as a Group 1 Carcinogen, tanning salons are now subject to bans and extra taxes in both Nova Scotia and British Columbia.

Predictably, these taxes and regulations on tanning beds, known as “the cigarettes of our time,” have been largely ignored by the public. More effective at diverting customers from the beds have been the increased number of spray-tan salons in the market. Apparently, customers who willingly pay for the very same UV rays to which one is exposed the moment one steps outside are not the most price-sensitive consumers.

Vice taxes and bans make even less sense in terms of reducing externalities.  The premise itself is contrary to the intended purpose of public healthcare, which quite deliberately creates external costs by stipulating that no one ought to pay directly for their own care. With a mission statement like that, the argument that policy-makers ought to regulate risky behaviour because it may impose costs on others falls rather flat. 

Even if these types of externalities were a valid concern, the economic burden of vice on the healthcare system is really very small.  Altogether, obesity-related illnesses such as hypertension, type 2 diabetes, and coronary artery disease are estimated to account for a mere 2.2% of healthcare costs in Canada.

In 2008, economists in the Netherlands found that smokers and the obese cost less to care for overtime than individuals with healthy habits. A shorter life expectancy means fewer dollars spent on medical care.  According to the Institute for Research and Public Policy, “smokers make a net overall contribution of $4.3 billion [per year] to the benefits of non-smokers.” 

These vices are not particularly dangerous to the general public, are largely undeterred by taxes and cost the healthcare system next to nothing. It is merely their prevalence that makes them a target for bureaucratic busybodies. The renewed public interest in the regulation of vice and the popularity of taxation as a recommended check on risky behavior belie the true health crisis of our time: the prohibitive cost of Canada’s inefficient healthcare system and our stubborn resistance to change.