Map of life expectancy at birth from Global Education Project.

Thursday, January 21, 2010

Return of the public health paradigm

You may have heard about this calculation -- not really a study, that figures "Reducing dietary salt by 3 g per day is projected to reduce the annual number of new cases of [heart disease] by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000."

This would not be a huge difference to you personally -- while they come up with a wide range of estimates for various effects, the average is around 4 fewer deaths per year per 10,000 people. It's more important to buckle your seat belt. On the other hand, it's a much bigger impact than preventing guys from blowing up their underwear on airplanes. The point is, when you have a small effect over the entire population, it adds up, and many of these measures cost little or nothing. Reducing average salt intake by 3 grams a day doesn't really cost anything, since this could be achieved by reducing the amount of salt in processed foods, including bread. It has a benefit similar to treating people at moderate risk with statins, but that's expensive. In fact, the authors claim it would have the same effect on coronary heart disease rates as a 50% reduction in smoking. Smoking creates much higher individual risk, but most people don't smoke. (Of course smoking also causes cancer and other diseases, not to mention house fires, so the total benefit of reducing smoking prevalence is greater.)

There are many examples of interventions like this that cost little and have a big impact because they affect lots of people. Workplace smoking bans are another excellent example, as is removing trans-fats from the food supply. Eliminating agricultural subsidies -- which make meat and corn syrup artificially cheap -- would be another. (Not going to war is a good one too, although that's in a category by itself.) The reason we don't do all these simple things is mostly because of the political power of concentrated corporate interests, and the idiotic yammerings of libertarians who insist on their God-given right to be poisoned even though they aren't actually choosing it in the first place.

These aren't the most dramatic issues confronting us but they illustrate the distorted priorities in the political culture and the political establishment that it spawns.


kathy a. said...

they are all important issues.

reducing salt is somewhat like requiring seat belts or helmets, in that it reduces overall risks, but with the additional benefit of making the product cost less instead of adding another cost.

it is hard to find low salt or no-salt-added processed foods, and i cannot figure out why. similar for those trying to weed out bad fats or corn syrup -- food can taste good without all that. also similar to trying to find refill containers of hand soap that are NOT "antibacterial," quite a good many years since those soaps and excess rx's of antibiotics were implicated in MRSA, still a growing problem.

the US supreme court decision unfettering corporate speech from restrictions on political spending is pretty horrible, because we can anticipate even worse barrages of corporate-interested advertising that is against our individual interests, and the public interest.

Chiropractic Care said...

A new health paradigm is emerging one with increased focus on health prerequisites such as housing minimum decent income , food , education and good social and physical environment.