Academic hype

Is there anything that the healthists at Otago get up to that doesn't call for a press release? This time, Tony Blakely wrote an op-ed for the New Zealand Medical Journal. Press release! An op-ed!

I'm going to have to talk to Canterbury's publicity folks. I've had a couple op-eds in the NZMJ and another short piece but Canterbury's never reckoned an op-ed in the NZMJ warranted a presser. I don't think I've seen Canterbury media releases on anybody else's op-eds either though. The bar here's just a tad higher than that. Good thing too, or I'd be pushing the press guys for a media release for every blog post.

Blakely's on about health inequalities again. I'm with Tony on caring a lot about bad health outcomes for folks in the lower income deciles. But I've never cared about health inequalities per se; if I did, forcing healthy higher income folks to donate kidneys to poor folks on dialysis might start sounding like reasonable policy.

I'm also nervous about ascribing too many of the measured health differences across income cohorts to income differences. The same factors that give rise to income differences may themselves cause differences in health outcomes. Linda Gottfredson points to general intelligence as a fundamental underlying confound in the health-income literature: effects of income on health status are strongly attenuated when we correct for intelligence. That gives strong reason for differential targeting of health interventions for lower decile populations but also, as I've noted before, ought to make us reluctant to draw strong conclusions about the potential for reducing health inequalities through measures like heavy income redistribution. But that's Blakely's first recommended policy:

Ten next most important actions to reduce health inequities in Aotearoa New Zealand

1. Equitable and fair fiscal and social welfare policy, including progressive taxation, comprehensive and fair social policy, and ensuring that everyone has a minimum income for healthy living. Policy needs to be proportionate to need – what is termed proportionate universalism in the Marmot Review 9, or a balance of targeting and universalism.

As for the rest of the list, I'm a bit worried that Blakely's proposed  policies may work at cross-purposes. I'm not sure that "Aligning climate change, sustainability and pro-equity policies" ought be anywhere near a top-ten priority list for dealing with poor health outcomes among low-decile Kiwis. And country-wide bans on smoking and regulation of food salt content (priority 6!) probably are a bit broad, especially since the Cochrane Review's finding that reduced salt intake doesn't really help anything. If Blakely's push for higher incomes among lower deciles may be inconsistent with his preference for lower unemployment, depending on the specific policy proposed. Higher minimum wages won't do it, but wage subsidies might. It's not unreasonable to conclude that the Top 10 list (in the press release) reflects a few goals other than just improving health outcomes among low income folks.

But there's stuff to like too in Blakely's op-ed. We'd probably do well to shift resources by increasing the age of superannuation eligibility and redirect the resources towards interventions targeting low-decile child health. I could be convinced to push the button for that. The Ministry of Health's recent push to increase vaccination rates among Maori (here too) is probably one of the most cost-effective things it's done lately.

HT: Ed.co.nz, who always finds a way of getting me angry in the morning.