Assume a spherical frictionless population

So, we've got the government sponsoring a review of sick leave, that essentially recommends that we treat people with acute health conditions in the same way that we now deal with chronic and terminal health conditions.

Latentexistence at Where's the Benefit? has more on the particular problems with this proposal, which I won't try to duplicate here. I want to focus on the last sentence of the article for what it says about government overall:

The DWP spokesman said: "The economy loses £15bn in lost economic output each year due to sickness absence and we cannot continue to foot this bill."

Interesting claim... After quite a bit of searching, I can't find a source for this. I have found:

• Several other unsourced repetitions of the figure, sometimes accompanied by a claim that there are 150 million working days lost annually in the UK due to sickness absence.
• One claim that £12bn (instead) in economic output is lost, but 200 million working days are lost
• Claims in the original press release for the review that the total cost of sickness absence (which is not the same as lost output) is £100bn, £60bn of which is paid by the government.

However, it does seem fairly clear that the main assumption for losses and costs is as compared with an economy where no-one was ever ill.

On that measure, we "waste" about £70 million annually on street lighting, compared with an idealised country which flies around the world on jet engines so that the sun never sets on it, or a country populated entirely by people genetically modified to have sonar.

People are people. They get ill. I'm all in favour of reducing the amount that people get ill through advances in medical science, good¹ public health initiatives, improved safety measures, more efficient treatments, and so on. But anyone seriously basing their government policy essentially on the assumption that people should never be seriously ill has such a bizarre idea² of what humans are that they shouldn't be in charge of the country.

And it leads to policies like this where the sickness absence itself, and by extension the person who is ill, gets treated as the problem - when actually it's a symptom of the facts that we don't have sci-fi medical technology now, that we have unsafe and unhealthy working environments (especially for mental health), that we place toxins into the environment far more than we should be, and so on.

That's what's "costing" us the £15bn in "lost output", not people being ill. Not getting that distinction - and so making a policy based on the belief that people shouldn't be ill (which is not unique to our current central government) - means policies like this, which are likely to make the situation worse, not better, and so cost the economy even more overall - and a lot of ill people a great deal personally.

Footnote

¹ i.e. non-dehumanising

² Admittedly, the ablist idea that "not ill" is normal and "ill" is deviant is so common that finding a member of government who doesn't believe that may take some work - but as with many discriminatory assumptions they just sound silly if you say them explicitly.

Statistical dehumanisation

[trigger warning]

Dorset, Leeds, and now Nottinghamshire. Yet again, applying a century-old statistical population measure to individuals gives an utterly meaningless result.

I've already said what I want to say about the science behind this, so I'll just link to that and summarise below. I still have more to say about the attitudes, though.

[Director of Public Health Chris Kenny] said: "Obesity is on the rise in this country and what this weight management programme is designed to do is to raise the issue with parents.

"I wouldn't want this one particular case to undermine the whole programme."

Nor, I suppose, would he want the fact that the "science" he's using is not actually supported by the evidence to undermine his programme.

Or the fact that it's counter-productive and bullying of children who really should be considered too young¹ to be given My First Body Issues sets.

The problem isn't really the horribly flawed science. That's bad - and there's a serious group-think problem within the "obesity research" field that stops this getting much time.

The problem is the attitude to people that current "public health" schemes seem to regularly get sucked into.

"Public health" is not an easy job. Done well, it can save lives, improve health, and free up valuable funds that are no longer needed to deal with preventable diseases. However, it's something that only really works at a population level.

The infamous bacon cancer study found that the risk of a particular group of cancers increased from 5% to 6% through increased consumption of processed meats. Now, as was pointed out at the time, this means that for 99% of people, whether or not they eat bacon will make basically no difference to their risk of cancer. For many of those people, bacon is a tasty food, and giving it up or cutting back will make them unhappy.

From an individual perspective it's highly unlikely to be a good deal - permanently give up bacon now, to marginally decrease your chances of getting cancer thirty years later? Most of the people who would take that deal probably didn't like bacon that much in the first place, and so probably didn't eat enough for cutting it out to make a difference.

From a public health perspective the calcuation is completely different. If everyone stopped eating bacon, rates of this group of cancers would drop about 20%, saving millions of pounds a year, and saving thousands of lives. Who wouldn't want that?²

The conflict comes between the individual view and the population-statistics view of public health policy. It's very easy to forget that those statistics are made of individuals, all of which - even if they're identical on the measured statistics - have their own very different lives.

Population statistics is the "easy" way to do "public health". It's also - because it reduces people to a few broad numbers - inherently dehumanising. With that, it becomes easy to see why they won't be dissuaded from this course: they're saving [abstract] lives, so if a few [real] lives are harmed as a result, it's still worth it.

Because the underlying attitude is itself dehumanising, some bad science that reduces health to a couple of convenient numbers is very attractive. Rather than looking at individual health, fixing the numbers becomes the goal - and if your numbers are "wrong", that makes you a problem. For people who are already dehumanised regularly on an individual level, the effects combine very strongly

The "hard" way to do public health does also happen, and there are professionals working very hard towards it - providing green spaces, looking at food availability, considering safety issues, and so on - rather than blaming individuals for making the "wrong" choices. An approach that humanises rather than dehumanises is not only more compassionate, it's also more effective.

Not surprisingly, those public health professionals don't make the news for things like this.

Also not surprisingly, the government is quite happy to, for instance, cut funding to local councils and so force them to close leisure centres (something that is certainly bad for public health), but continues paying for schemes like this to shame people with non-approved bodies.

Footnote

¹ No, there isn't an appropriate age. The product failed safety tests.

² Given the current high unemployment, anyone whose job depends on people eating bacon, for a start.

Recycling austerity

The local council has announced that from April it will be charging £24 to replace lost or damaged recycling bins or bags, except where they were damaged by the collection staff.

These things do get lost fairly often - ours have gone missing twice this year already - we put them out for collection in the morning; come back in the afternoon and they're gone - and no-one else on the street seems to have more than they should, either, so where they went is a mystery.

Which is most likely when someone's recycling bin goes missing?

1. Pay £24 for a replacement (expensive, especially if it keeps happening)
2. Drive waste to the local tip instead (inconvenient, and not an option for many)
3. Use disposable rubbish bags to put waste out instead (wasteful, and dangerous for recycling glass)
4. Throw everything in the non-recycling bin instead (easy, but defeats the point)
5. Steal someone else's bin (criminal)

Most people are honest enough not to go for option 5. But they probably won't pick option 1 either, given the choice. Still, I suppose the council saves money whichever option is chosen, and they need to do a lot of that right now, given the central funding cuts they've been given.

But it's yet another case where budget cuts are going to end up costing more in the long run as waste that could be recycled goes into landfill instead.

Buses, and the point of public services

The local County Council has had a major budget cut from central government. Part of dealing with this involves reducing or removing the subsidy they provide for certain services which would not be commercially viable.

While they say that this does not necessarily mean the service will be withdrawn, both of the major bus operators have said that they cannot afford to continue more than a few of the services without a subsidy.

Sunday services and evening services are facing the majority of the cuts, mainly in rural parts of the county.

There are two things related to this that I want to draw attention to, and they apply to all sorts of cuts that the government is making or requiring local councils to make.

Firstly, as reported in the local free paper:

About a fifth of all bus services in the county are not commercially viable. But the council believes more than 95% of bus passenger journeys would be largely or entirely unaffected by the cuts.

Obviously most passenger journeys are not going to be affected. Most journeys are made on busy routes, which don't need a subsidy. The point of public subsidy of bus routes - and indeed public funding of many things - is to make affordable services that would not be possible on a pure market model, but which are necessary to many people. To say that most journeys will be unaffected is true, but not relevant.

Lots of people who rely on the bus services to get about are going to find their movement restricted, and that leads on to the second point: cuts to public services have a knock-on effect on the private economy.

We're told by the government that public spending is preventing private spending. Well, in this case that's clearly not true - it's not as if there would be private operators on these routes without the public subsidy: the private operators have said so themselves.

But furthermore, this public subsidy helps private spending. Cut the evening services, and people won't be able to get into the urban centres of the county then - or won't be able to get out later without spending several times the cost of a bus ticket on taxi fares.

So people going into towns in the evening for the nightlife are a bit stuck, as are people who go into town to work in the pubs and clubs providing that nightlife, or in other evening shift jobs in shops where they clock off after 8pm when many services are being withdrawn or cut back. The local private economy takes a dip as a result.

They could get a car and travel that way, but that's a large cost to themselves so won't be practical for a lot of people who were relying on the buses before, and it also increases congestion and exacerbates the lack of parking in town centres, which makes things worse for everyone. And, of course, having got the car, they then don't need the bus to get around on weekday mornings and afternoons either, so that's fewer bus passengers, and perhaps some of the more borderline unsubsidised bus routes start to slip out of profit too.

Reduced private expenditure leads to reduced tax revenue, so the whole cycle starts again.

By supporting necessary but not commercially viable services, public funding helps both the public and private sector, both of which are likely to take severe damage in the next few years.