'Preventive' has become the hottest word in healthcare. From politicians in parliament to talking heads on television, everyone seems to be saying that preventive care is the smart way to get more bang for our healthcare dollar.
The most common targets for prevention are obesity, inactivity, excessive drinking, and other such risk factors for chronic disease. Unlike the wowsers of yesteryear, today’s proponents of preventive medicine don’t just claim that discouraging these sinful behaviours is a worthwhile goal in its own right. They rest their case on the far more ambitious argument that targeting these behaviours will save money in the long term by preventing costly illness from arising in the first place.
In order to make that case, preventive care advocates need to prove two separate claims: first, that there are government programs that can successfully reduce rates of obesity, harmful drinking, and the like, and second, that those changes will lower long-term health costs.
Unfortunately, neither claim is backed by anything like slam-dunk evidence. Take the second. Will lowering rates of obesity, for example, result in reduced health-care spending? At least one study has shown that lifetime health costs are actually higher for patients of normal weight than for patients who are obese, because the reduction in obesity-related disease is more than offset by the increased health costs of longer lifespans. Obesity reduction may be a net positive for people, but it isn’t a long-term money-saver.
In the particular case of bariatric surgery, which has been touted as an anti-obesity measure worthy of greater government investment, the figures just don’t add up. Diabetics who lose weight through surgery do have fewer complications, but the money saved does not exceed the original cost of the surgery unless the patient is young enough for the benefits to accrue over many years. An American study also found that, after six years, medical costs were approximately the same for those who had had bariatric surgery and those who hadn’t.
And we shouldn’t assume people’s behaviour will remain constant if government-sponsored bariatric surgery becomes more widely available. Some might well feel less afraid to let their weight balloon if they believe the government will ‘bail them out.’
Of course, there are many reasons why bariatric surgery might be an attractive option apart from the monetary angle. As Professor Paul O’Brien of Monash University has said, ‘Bariatric surgery is not about cost-effectiveness. It’s about quality of life.’
That’s true—except when the taxpayer is being asked to foot the bill. If a preventive health service is being promoted as a money-saver, it should actually save money.
On the bright side, bariatric surgery really does prevent the problem it is meant to address, which makes it rather an exception among preventive-health policy proposals. Few anti-obesity programs can claim as much.
After 2-4 years, recipients of bariatric surgery weigh 25 to 75 kilos less. For recipients of diet and lifestyle therapy, the average 2-4 year weight loss is only 5 kilos. Anti-obesity programs aimed at schoolchildren—who, unlike adults, are a captive audience—often produce only small health gains that disappear after a few years.
The unsurprising truth is that the government just doesn’t know how to make obese people lose enough weight to put themselves out of risk. If it were a matter of the obese not knowing any better, then educating the public about the benefits of healthy eating might be a useful preventive measure. However, it is hard to argue that ignorance is responsible for the rise in obesity when 58 percent of doctors and 57 percent of nurses are overweight or obese. Medical professionals, of all people, are fully aware of the causes and risks of weight gain.
Broader, population-based interventions like ‘soft drink taxes’ and trans-fat bans have been implemented as a way to influence personal choice. These also have been shown to fall short.
People who would have bought soft drinks buy sugary juices instead. Such taxes also burden occasional indulgers while having the least effect on the ‘hard core’ of extremely unhealthy eaters, even though that hard core is precisely where health risks are most concentrated.
Obesity is not like smoking, where activists could focus their efforts on a single target. Fat, sugar, carbs, insufficient exercise—all of these can play a role in obesity, but none is a suitable target for an anti-obesity silver bullet.
Would Australia be a healthier place if we all had a body mass index (BMI) under 25? Probably. But that does not mean that preventive health proponents know how to get us closer to that goal, much less how to do so in a way that saves money in the long run.
Helen Andrews is a Policy Analyst at the Centre for Independent Studies
Home > Commentary > Opinion > Government preventive health measures don’t add up
Government preventive health measures don’t add up
'Preventive' has become the hottest word in healthcare. From politicians in parliament to talking heads on television, everyone seems to be saying that preventive care is the smart way to get more bang for our healthcare dollar.
The most common targets for prevention are obesity, inactivity, excessive drinking, and other such risk factors for chronic disease. Unlike the wowsers of yesteryear, today’s proponents of preventive medicine don’t just claim that discouraging these sinful behaviours is a worthwhile goal in its own right. They rest their case on the far more ambitious argument that targeting these behaviours will save money in the long term by preventing costly illness from arising in the first place.
In order to make that case, preventive care advocates need to prove two separate claims: first, that there are government programs that can successfully reduce rates of obesity, harmful drinking, and the like, and second, that those changes will lower long-term health costs.
Unfortunately, neither claim is backed by anything like slam-dunk evidence. Take the second. Will lowering rates of obesity, for example, result in reduced health-care spending? At least one study has shown that lifetime health costs are actually higher for patients of normal weight than for patients who are obese, because the reduction in obesity-related disease is more than offset by the increased health costs of longer lifespans. Obesity reduction may be a net positive for people, but it isn’t a long-term money-saver.
In the particular case of bariatric surgery, which has been touted as an anti-obesity measure worthy of greater government investment, the figures just don’t add up. Diabetics who lose weight through surgery do have fewer complications, but the money saved does not exceed the original cost of the surgery unless the patient is young enough for the benefits to accrue over many years. An American study also found that, after six years, medical costs were approximately the same for those who had had bariatric surgery and those who hadn’t.
And we shouldn’t assume people’s behaviour will remain constant if government-sponsored bariatric surgery becomes more widely available. Some might well feel less afraid to let their weight balloon if they believe the government will ‘bail them out.’
Of course, there are many reasons why bariatric surgery might be an attractive option apart from the monetary angle. As Professor Paul O’Brien of Monash University has said, ‘Bariatric surgery is not about cost-effectiveness. It’s about quality of life.’
That’s true—except when the taxpayer is being asked to foot the bill. If a preventive health service is being promoted as a money-saver, it should actually save money.
On the bright side, bariatric surgery really does prevent the problem it is meant to address, which makes it rather an exception among preventive-health policy proposals. Few anti-obesity programs can claim as much.
After 2-4 years, recipients of bariatric surgery weigh 25 to 75 kilos less. For recipients of diet and lifestyle therapy, the average 2-4 year weight loss is only 5 kilos. Anti-obesity programs aimed at schoolchildren—who, unlike adults, are a captive audience—often produce only small health gains that disappear after a few years.
The unsurprising truth is that the government just doesn’t know how to make obese people lose enough weight to put themselves out of risk. If it were a matter of the obese not knowing any better, then educating the public about the benefits of healthy eating might be a useful preventive measure. However, it is hard to argue that ignorance is responsible for the rise in obesity when 58 percent of doctors and 57 percent of nurses are overweight or obese. Medical professionals, of all people, are fully aware of the causes and risks of weight gain.
Broader, population-based interventions like ‘soft drink taxes’ and trans-fat bans have been implemented as a way to influence personal choice. These also have been shown to fall short.
People who would have bought soft drinks buy sugary juices instead. Such taxes also burden occasional indulgers while having the least effect on the ‘hard core’ of extremely unhealthy eaters, even though that hard core is precisely where health risks are most concentrated.
Obesity is not like smoking, where activists could focus their efforts on a single target. Fat, sugar, carbs, insufficient exercise—all of these can play a role in obesity, but none is a suitable target for an anti-obesity silver bullet.
Would Australia be a healthier place if we all had a body mass index (BMI) under 25? Probably. But that does not mean that preventive health proponents know how to get us closer to that goal, much less how to do so in a way that saves money in the long run.
Helen Andrews is a Policy Analyst at the Centre for Independent Studies
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