Misuse of land use planning

If you thought McDonald's was some kind of public health hazard, using processes under the Resource Management Act to try to block one from opening in Wanaka would be among the stupidest possible ways of dealing with it. 

The country already has food safety regulations. If you thought that (in fact delicious and fine) McDonald's food were actually toxic waste, food safety regs would address the problem across all existing 170+ outlets across the country. 

Objecting to a single restaurant would just be dumb. 

The land use planning system doesn't even work this way. The consent in Wanaka was to operate a restaurant type activity. 

If some other restaurant got a consent to open there, a McDonald's could buy the site and flip it to being a McDonald's without much land use consenting hassle unless they needed different transport links for a drive-through. 

If you wanted to handle this kind of thing through the land use planning system, every time a restaurant turned over it would have to go through a new consenting processes checking that the characteristics of the restaurant were substantially equivalent. 

It would be insane. 

So even if the National Public Health Service's submission against a McDonald's consent application in Wanaka hadn't been a steaming pile of anti-corporate buzzwords fresh out of a 1990s anti-globalisation rally (I mean, just look at the darned thing), it still would have been a terrible idea. 

The submission really was mad though. Here are a couple of snippets.

...there is no evidence supporting the fact that transnational (TNC) or multinational (MTC) create a prosperous, resilient, and equitable economy in the District"

...We are not aware that a holistic assessment of the value that this proposed new corporate business will add to the social, economic, and cultural wellbeing and physical health of the people and the community of Wānaka has been undertaken.

...To summarise, NPHS Te Waipounamu:

• strongly encourages further meaningful engagement with the community.
• reminds council of its Te Tiriti obligations to Kāi Tahu as mana whenua.
• is concerned about the impacts of MNC and TNC, such as McDonalds, on planetary health and the health of current and future generations.
• recommends a comprehensive HIA (including cultural impact assessment to analyse the cultural impact for Kāi Tahu). We would like to see such an assessment demonstrating that the outcomes for the individuals and the community of Wānaka would mostly be positive before granting consent for this proposed fast-food restaurant.

NPHS Te Waipounamu wishes to be heard with respect to this submission.

[Note that the changing acronyms MTC vs MNC are in the original.]

They didn't just put in a written insane submission. They also headed on out to the hearing to be heard about it.  

It reflects an NPHS that has lost sight of what it is meant to be doing and is off pursuing other objectives, in a time of tightly constrained resources. They were even intervening in the nutritional aspects of food carts in Invercargill. 

I'd covered it in my column in Thursday's New Zealand Herald, ungated here. 

A snippet:

The submission urges further measures that seem aimed at increasing McDonald’s legal costs – like demanding a comprehensive health impact assessment and a cultural impact assessment. The NPHS also weighs in on other matters about which it has no competence – like the visual amenity of the proposed restaurant.

And it provides a remarkable chart asserting that “GDP as a measure of economic growth” contributes to ill-health and health inequalities.

This is not a one-off. This is how the NPHS sees its role. This is its baked-in ideology.  

Mr Barry had previously inserted himself into discussions of whether Invercargill’s food trucks’ offerings have sufficient nutritional merit.

The letter from Health in All Policies Advisor Monica Theriault, which concludes the submission, notes, “We are eager to enhance how the concepts of health promotion can be effectively applied within the RMA framework.”

They want to do more of this.

The NPHS has revealed what it considers a priority in a time of restraint.

I draw a few conclusions.

First, the government’s coming reforms to the land use planning system must prevent the weaponisation of consenting processes.

Second, the Commerce Commission needs to pay a lot more attention to the anticompetitive effects of the land use planning system.

Finally, Minister Reti has not gone far enough with proposed budget cuts. He might consider razing the NPHS to the ground and starting over with an agency sharply focused on infectious disease. It is hard to see what else could fix it.

I also chatted with Sean Plunkett about it yesterday morning. 

Today, Minister Reti published a serve back to Health New Zealand, reminding them to focus on their core business. 

A snippet of that:

Minister of Health Dr Shane Reti says the National Public Health Service should concentrate its focus on prioritising serious public health issues facing New Zealanders.

“Earlier this week I was informed about an 8-page submission by the southern arm of the NPHS regarding a proposed fast food outlet in Wanaka,” Dr Reti says.

“I have raised my ongoing concerns about the content of submissions like these with the Chief Executive of Health New Zealand.

“Content within the submission, including observations about planetary health, landscape values, traffic and Te Tiriti do not match my over-arching view of what the NPHS should be spending its time on.

“Whooping cough, measles and raising immunisation rates are among the most pressing issues facing health today.

The serve was needed. And is welcome. 

I think Bob Edlin over at Point of Order missed the point here. 

A public health service focused far from main business, and using exceptionally stupid methods for achieving ends outside of their main business, has to be steered back, and hard. It will be hard for it to get anything else right without that direction, or without my alternative (and still preferred) solution of razing it and starting over. 

As David Farrar pointed out over at Kiwiblog:

Around half the public health staff (those who deal with infectious diseases) do amazing work, but around half seem to be taxpayer funded lobbyists who lobby the Government that employs them, or local governments.

I have an OIA in with Health NZ asking for the resourcing that went into that submission process, and for the decision-making process around it. And one in with the Ministry of Health just ruling out that they'd ever given Health NZ advice about this kind of thing. Will be interested to see what I hear back, eventually. 

And really, a better land use planning system ought to take this NPHS submission as a benchmark for "This is the kind of vexatious submission that should not only be dismissed summarily, but also result in a fine assessed against the submitter."

Monkeypox and Medsafe

In a sane world, medicines and vaccines already approved by trustworthy overseas regulators would automatically be able to be used in New Zealand as well.

New Zealand is not sane. But neither is anywhere else really on that standard. Other places are just faster than NZ in getting things approved, with more practicable pathways for expedited review. 

If a medicine is unapproved, it can still be accessed under restrictive provisions of the Medicines Act. Medsafe summarises it here. 

Those restrictions include bans on advertising and marketing. 

Monkeypox has been an obvious risk for some time. Jynneos was approved by the EMA in 2013 for smallpox and was recommended for monkeypox in 2022. It was approved by the FDA in 2019, and given emergency use authorisation for monkeypox in 2022. The "Emergency" in the EUA was the monkeypox outbreak. 

Nobody applied for Medsafe authorisation until 2023.

Medsafe took over a year to approve it, despite its already having been approved in Canada, the US and Europe at the point at which application was made.

It was available in New Zealand through Section 29. However, you can't advertise unapproved medicines. 

The Post noted the difficulties in letting at-risk communities know about the vaccine, because of s29 restrictions. 

 

Radio New Zealand notes that greatest transmission risk is concentrated among men who have sex with men, and those who have sex with men who have sex with men. 

The outbreak from the Queenstown Pride Festival now counts five in total. 

It sure would have been great if it hadn't been illegal to advertise the vaccine earlier and to make it real easy for folks to get the vaccine.   

Or if Medsafe had been required to automatically approve medicines already approved by two others - which would have had it authorised in New Zealand in 2022.

We are ruled by Vogons.

The alcohol levy review - an ongoing OIA saga

I keep a bit of a watching brief on the old BERL social cost of alcohol figure. It turns up in weird places. 

As aide memoire, BERL produced the number as commissioned work in the late 2000s that was meant to follow the method set by Collins & Lapsley in Australia. 

The Collins and Lapsley method has a few problems. But BERL compounded those problems with choices that seemed designed to generate a larger number for the tallied social costs. 

For example, Collins & Lapsley had aetiological tables that tried to attribute the fraction of different disorders that might be attributed to alcohol use. Their tables had a few disorders where the aetiological fraction was negative because drinking reduces the incidence of that disorder. BERL decided that, because they were only looking at harmful drinking, it was ok to just set all those cells in the table to zero rather than maintain a number showing benefits (and consequent reductions in net harm). 

Matt Burgess and I went through the BERL report, seeing what the number would look like if more standard method were followed. For example, BERL counted as social cost to the country every dollar spent on alcohol, including every dollar spent on excise, by those drinking more than about 2 pints of beer a day. Drinkers' spending on beer is a social cost only in the sense that private costs are part of social costs. And since benefits enjoyed by drinkers would need to be netted for any sensible net cost figure, the whole thing was a bit suspect. 

BERL responded to the critique by updating the figure to no longer count as a social cost drinkers' spending on alcohol excise, but let the rest stand. 

Brad Taylor joined Matt and me for an update to the review in 2011, when we went through the underlying Collins & Lapsley work. We adjusted upward the revised BERL figure, but the majority of the BERL-tallied costs were either double-counting or costs far better considered private than external and social. 

BERL provided an updated figure in 2018, but it turned out just to be the old figure multiplied by GDP growth over the period. Which could be fine if the initial number were sound (it wasn't) or if alcohol social costs scaled with GDP (they don't necessarily, and especially where alcohol consumption was declining over the relevant period). 

And the whole thing is a bit silly where the measured social cost really doesn't matter. The policy question is always whether any intervention, whether excise or otherwise, provides net benefits. Interventions can fail to do so despite very high measured social cost; they can also provide benefits even if social costs are low. The only reason for generating large social cost numbers is to motivate "something must be done" responses. 

Anyway. 

The number turned up again in last year's "Independent Review of the Alcohol Levy Stage 1: Rapid Review". The work for the Public Health Agency was undertaken by NZIER and Allen + Clarke. 

The work included this section:

90. The cost of alcohol-related harm to New Zealand society is significant. This section provides a summary of existing estimates of the cost of alcohol-related harm in Aotearoa New Zealand. 

91. The most recent study to quantify the social cost of alcohol in Aotearoa New Zealand was conducted by BERL in 2009. Commissioned by ACC and the Ministry of Heath, the report aimed to quantify the social cost of alcohol and drug related harm looking at the personal, economic, and social impacts. While the estimate of the social cost of alcohol-related harm in Aotearoa New Zealand published by BERL in 2009 and updated in 2018, or rather the methods used to generate it, have been criticised by some commentators, it has been widely cited in the alcohol-harm research and policy space in New Zealand over the last 14 years (BERL, 2009; Nana, 2018). The Law Commission’s 2010 report on the review of the regulatory framework for the sale and supply of liquor also cited the BERL 2009 report. 

92. In 2018, the updated estimate of the social cost of alcohol, based on the BERL methodology, was calculated to be $7.85 billion per year (Nana, 2018). This estimate included costs resulting from justice, health, ACC, social services, unemployment, and lost productivity. Intangible costs such as years of life lost from premature death, lost quality of life, child abuse, sexual abuse, and impacts on victims of alcohol-caused crime are also relevant to assessing the overall impact of alcohol-related harm on society. The 2018 update did not include intangible costs. A recent Australian Study found that in Australia $48.6 billion AUD of intangible costs could be attributable to alcohol (National Drug Research Institute, Curtin University, 2021). 

This section seemed particularly poorly undertaken. Citing the 2018 figure seemed particularly odd where the thing was just the old number multiplied by cumulative GDP growth. 

It's also incorrect to say that the 2018 update didn't include intangible costs. Intangible costs of lost life and lost quality of life were included in the 2009 figure, and the 2018 figure just inflated the old number by GDP growth.  

Paragraph 91 alludes to that 'some commentators' have criticised it, but said nothing about the nature of those critiques or who made them. Were the concerns trivial or notable?

Meanwhile, the bibliography included these two relevant references that weren't included in Para 91:

Crampton, E. (2018). The alcohol cost ‘zombie’ has returned. 

Crampton, E., & Burgess, M. (2009). The Price of Everything, The Value of Nothing: A (Truly) External Review Of BERL’s Study Of Harmful Alcohol and Drug Use (Working Paper No. 10/2009).

The 2009 piece was my original critique of the BERL figure with Matt; I'd have preferred the updated critique from 2011. The 2018 column had my initial guess that the updated BERL figure was just an inflation and population growth adjustment; my 2019 column had Ganesh Nana's confirmation that the new figure was the old figure inflated by cumulative GDP growth. So I'd have pointed to the 2019 column instead. 

But the authors clearly knew about my critiques. That they were in the bibliography suggested that there might have been more fulsome discussion of those critiques in earlier drafts. 

On 6 September 2023, I sent an OIA request to the Ministry of Health asking for all early and working drafts produced by NZIER [Paragraph 14 of the report said that NZIER undertook the analysis of existing data and evidence]; for correspondence between and notes from conversations between MoH, HPA, Allen + Clarke and NZIER regarding NZIER's analysis; and, for any peer review of the report. 

On 15 September, MoH replied saying that the correspondence would be extensive and that I needed to refine the request if I wanted to get anywhere. 

I replied immediately asking them to prioritise delivery of early and working drafts, and any peer review. I also suggested prioritising correspondence and relevant notes from meetings between and among MoH, HPA, and Allen + Clarke regarding the NZIER report. 

On 6 October, I reminded MoH that the refinement of my request only asked that they prioritise two parts of the request, and should not have triggered a clock reset; the requested information was due.

On 17 October, I had a reply from the Public Health Agency's Ross Bell. He noted that they'd considered the refinement as having triggered a time extension. But more substantively, they refused early and working drafts, as well as peer reviews, under 9(2)(g)(i) to protect free and frank expression of opinions. 

I proceeded immediately with the Ombudsman. 

On 16 November, the Ombudsman's Office commenced investigation. 

On 13 December, the Ombudsman's Office advised that the Ministry was prepared to reconsider its decision with respect to final drafts and asked whether that would be sufficient. I wouldn't know until I'd seen any released documents - if the released drafts let me see what had happened in the relevant section, that would be fine. If they didn't, I'd need to see more. I'd have to wait. 

On 2 February, a Senior Investigator at the Office of the Ombudsman noted that the Ministry had advised it would be providing a partial release, and asked whether I wished that they review the withholding of the earlier drafts; I noted that I couldn't know until I'd seen what they would release.

On 4 March, the Office reported that they were still chasing the Ministry about the later drafts. 

On 11 March, the Ombudsman advised that he had sent a letter to the Ministry recommending that the documents be released immediately and apologise for the delay.

At close of business on 14 March, the Ministry of Health released the later drafts. Ross Bell, Group Manager, Public Health Strategy & Engagement at the Public Health Agency, apologised for the delay and any related inconvenience.  

While those drafts did include some annotations from "KT" and Te Whatu Ora, they did not provide much light on what had happened with the section on alcohol social cost. The earliest draft was substantially similar to the final. 

So I still cannot really tell what happened. 

The bibliography references to the critiques suggest that, at minimum, those references were included as a citation in an earlier draft of Para 92. It's possible that an earlier version included more substantive discussion of those critiques, but it's hard to say.

I've asked the Ombudsman to form a determination around those earlier drafts' discussions of the costs of alcohol-related harm.

I suspected that the first draft from NZIER included substantive discussion of the relevant arguments. NZIER aren't idiots; they know this stuff. It's in the bibliography, so it was there at some point. 

If there had been more substantive discussion, was it excised at request of Allen + Clarke, or at request of the Public Health Agency?

In either case, the effect is a document sent to the Minister, advising on the alcohol health levy, that provides a fairly one-sided view on alcohol social costs. 

I yesterday received an additional bit from the Ministry, which might speak to the Public Health Agency's views on things:

Kia ora Eric,

Further to the below email sent to you containing the reconsidered documents of your OIA (ref. H2023031477), the Ministry has identified a paragraph pertaining to yourself in one of the early draft documents. While the Ministry is maintaining its position on withholding the early draft documents under 9(2)(g)(i) of the Act, the following excerpt is being released to you under section 16(1)(e) of the Act: 

So it seems that early drafts did include substantive discussion of my critique of the BERL figure, and that someone caused it to be erased.

I'd also note that I was discussant at the NZAE meetings on the BERL paper in 2009. It was standing room only, because my critique of the BERL paper had already been released. The Ministry could consider asking any economist in the room whether my critique was just a me-thing, or whether the profession broadly shared my concerns.

I did that work as an academic in the Department of Economics at Canterbury, five years before I joined the Initiative, and two years before doing any industry-funded work. The funded 2011 work [funded by NABIC] discovered an error in the earlier unfunded work that had us revise upward the earlier estimate of alcohol social cost. 

I note that Ross Bell, now relevant Group Manager at the Public Health Agency, was Executive Director of the Drug Foundation when the BERL figure was originally being critiqued. 

Here is the issue of the Drug Foundation's "Matters of Substance" newsletter that included discussion of the controversy around BERL's number. It would be surprising if Bell were not aware of the difficulties with BERL's figure. He had the masthead editorial on the issue of their newsletter in which my critique of the BERL figure was discussed. 

I'll look forward to seeing whether I can get any further with this via the Ombudsman. 

In the meantime, it looks pretty obvious that the Public Health Agency was very happy to put a biased document up to the Minister as advice - whether they requested that outcome directly, or had Allen + Clarke do it.

A provisional health warning on advice from the Public Health Agency may be in order. At least until we can figure out what the heck is going on over there. 

And a reminder that government-commissioned reports face censorship regimes. If the Ministry doesn't like what it says, well, the offending bit gets disappeared. As an offending bit here seems to have been disappeared. 

More black market scaremongering

None of this can really be happening. It has to be fake news. Or somehow generated by the tobacco industry. Remember? Janet Hoek told us. Black markets are just tobacco-funded scaremongering. 

So there's nothing to see here.

A dramatic influx of illegal vapes into Australia is distracting border force officials from stopping guns and illicit drugs from entering the country.

And the inundation of vapes has led the Australian Border Force to call out for more workers to fulfil the Federal Government’s demands of detecting, storing and disposing of every illegal e-cigarette.

The West Australian understands the high volume of vapes being imported has taken up border force staff’s time because they are required to refer e-cigarettes without a prescription to the Therapeutic Goods Administration.

Sources aware of the process say it is time-consuming and is diverting workers away from other priorities such as seizing smuggled weapons and drugs.

Limited and costly transport and storage capacity has created further issues as the agency is required to hold the products while a decision is being made by the TGA. The products are either then destroyed or released to the owner after samples are tested.

Ok. Maybe it's happening. But there's no way that tobacco and nicotine prohibitionists are to blame. That's just tobacco industry scaremongering.  

New regulations came into place under the Morrison Government in 2021 where any nicotine product hitting Australian shores without a prescription from a local doctor is seized and referred to the TGA for laboratory analysis to see if it contains nicotine.

The Albanese Government has gone a step further — last month announcing a plan to ban imports of recreational vapes at the border, which means those that do not contain nicotine, in the hope it will stamp out the black market.

A Border Force spokesman told The West the organisation required more staff with the calls coming before the new reforms have been implemented.

“As with any legislative change, an alteration to border controls will have a significant impact to ABF frontline resources and will require an uplift in our capability and capacity to detect, store and dispose of products containing nicotine safely,” the spokesman said.

The only possible conclusion is that Australian border officials are beholden to Big Tobacco. I can't wait for the expose on it from Hoek. I'm sure The Conversation will publish it for her.  

Afternoon roundup

I cannot count the tabs. A pruning:

• Danyl Mclauchlan on the depressing kludgeocratic budget.
• I still don't like that they're subsidising videogames.
• Peter Dunne expects capital gains taxes and wealth taxes to feature in Labour's platform
• V as classic and excellent antifascism
• Officials are looking at a carbon dividend. I sure hope it's in place before the government stops auctioning NZU. 
• A few bits from me on the budget, over at Interest.co.nz
• Hooked on Phonics worked for the UK. An older piece in AEJ: Ec Policy.
• The San Francisco Doom Loop
• New report out, covered at Newsroom, on failings in freshwater management. There still are better options...
• Don Brash is appropriately scathing about housing policy.
• For a new Great Exhibition.
• One advantage of being at a think tank: I can say what I believe to be true. 
• The government still doesn't fully understand that Covid is airborne. No mention of ventilation in the winter health plan. 
• My column in last week's Insights newsletter, on government public health forgetting there's still a pandemic on and turning back to telling us what to eat and drink...

Evening roundup

The accumulated worthies:

• Dave Heatley on the publicly-provided goods that should, and should not, draw user charges - and how to tell the difference. Public transport should be charged. I'd add that, when congestion charging is finally in place, the case for subsidising public transit really goes away. Or at least the economic case for it. 
• If you think that NZ hosting FIFA matches is worth at least $11 per capita in fun and festivities, then that's fine. But there might be better uses of the money. And if you think the spending buys us anything other than a festival, you're deluding yourself. A few bits from me in this piece. 
• New Zealand's holiday pay rules are so complicated that the Ministry of Health has spent $50 million on consultants trying to deal with it. They now estimate that they owe backpay of $1.8 billion due to incorrect holiday pay calculations. 
• Otago's public health people prefer prohibitionist approaches to vaping, with restrictions ramping up as smoking rates decline. 
• Westpac argues for vertical separation of the supermarkets to encourage competition. Their report ignores regulatory restrictions against new large-scale entry, other than nodding at removal of covenants. Bizarre from a sector that's likely to be hitting its own market study soon, and ought to prefer that interventions have sound logic. 
• New Zealand has a new policy in the event that boatloads of refugees arrive: detention. UNHCR has some reasonable concerns. 
• Concentration in graduate economics education.
• Scott Sumner on Noah Smith's pessimistic vision.
• Water flows downhill and restrictions on housing supply drive housing price growth. Nathaniel Baum-Snow in the Journal of Economic Perspectives. 
• Want affordable housing? Make sure there's ample excess zoned capacity. 
• Council-owned wastewater treatment plans are often a mess. Regional councils seem to feel constrained against properly enforcing their regulatory duties. 
• An oldie but a goodie: Alex Tabarrok on The Happy Meal Fallacy
• Some cautions about the "Gas stoves cause asthma" hypothesis. A lot of the underlying research isn't that sound. 
• Remember how SCTV came up with Bob & Doug McKenzie in response to a demand for 2 minutes more Canadian-content per episode? Think about that when considering CanCon rules for pornography in Canada....
• The Spinoff has a pre-budget roundup. Six months ago I'd have put very high odds on some form of a carbon dividend showing up. Now, with some problems in the last auction, it's harder to say. Still some odds of it though. A few bits from me in this piece. 
• Peter Griffin on Rocket Lab's successes. This really was one where NZ's regulators stepped up to quickly set an enabling regulatory framework. 

How quickly they forget

So we're three and a bit years into the pandemic. We have a decent vaccine that prevents most mortality, but there were 250 Covid cases in hospital as of midnight Saturday, we're getting about 12000 cases a week, and who knows what the long-term Long-Covid cost is going to run to.

The Government has resurrected a Public Health Advisory Committee that'll get to take on one big project a year.

There are lots of great options to choose from.

• Cost-effectiveness of tighter ventilation standards in reducing the burden of transmissible disease would be great. It's possible that it's extremely cost-effective. But it might not be! And how does it compare to UV light? The latter has looked really promising. And how should that kind of cost-effectiveness evaluation weigh the insurance aspect? This kind of intervention would also reduce the transmission risk of other stuff we haven't yet hit. Even just running improved ventilation in schools to reduce run-of-the-mill sickness would reduce days out of school.
• This would be a big project. I don't think anyone in government is tracking what Covid/long-Covid has done to labour force availability. If the number is big, then potential benefits of avoiding more long-Covid could be big. If it's trivial, then they're smaller. 
• Are our regulatory standards up to spec for these kinds of emergency scenarios. Crampton keeps arguing that we should just approve anything that's been approved by two other agencies, so we can get access to drugs in a hurry in scenarios where it matters. Is he nuts? What would be the downside he's missed?
• Can we build a better MIQ plan in case we ever have to do this again? The last one kinda sucked. It was fragile and would not scale. 
• Vaccination rates have fallen off a cliff and measles is back. What does a robust and equitable vaccination programme look like? We used to have by-DHB targets for vaccination. It's all been downhill since those were abandoned. 
• Public health starts with the local GP's office, but we're very short of GPs and few are coming through the pipeline. Every part of the system blames the others. No point in scaling up in the med schools as there aren't enough registrar positions. No point allowing foreign doctors to come in; there won't be registrar positions for them and they might not even stay. Why not expand the number of registrar positions? Not enough doctors who want to supervise 'em. Great big fun problem. How about easing back requirements for doctors from places like Canada so they can easily practice here? What about expanded scope-of-practice nurse-practitioners? 

Anyway. Lots of potential options.

Here's what they're doing, as the single project they're to be doing this year.

The resurrected Public Health Advisory Committee will tackle access to healthy food and other factors that shape our eating habits as its first major project, Marc Daalder reports

Is New Zealand fulfilling people's right to healthy food?

That's one of the questions a new public health committee is striving to answer in its first major project.

...

Minutes from the committee's first meetings show it hopes to tackle big issues like climate change and rural health. However, Health Minister Ayesha Verrall asked it to investigate food environments as its first main topic of work. Under the terms of reference, the committee has to complete at least one major piece of work each year.

"This was a topic where expert advice on solutions would be beneficial. It was acknowledged that the topic was broad and complex, but there were factors in the food environment space causing harm to New Zealanders’ health. Food security issues were heightened through the Covid-19 pandemic and continue to cause pressure due to cost of living. The PHAC would need to think creatively," Verrall said, according to the minutes.

"Minister Verrall asked the PHAC to consider the food regulatory system, including food labelling and composition, acknowledging New Zealand’s regulatory system is joint with Australia through Food Standards Australia New Zealand (FSANZ)."

So I'll continue to be the only one wearing a mask at public sector events, and the Public Health Advisory Committee will be working on my right to healthy food and protecting people against the evils of ads for unhealthy foods. 

It's like the last three years didn't happen, and we're back in the spot where MoH is more interested in making sure DHBs can ban soda from the cafeteria than in ensuring there are vaccinated hospital staff during a measles outbreak. 

Refereeing in public health journals

Refereeing in public health journals always seemed a bit iffy.

A few years back I'd noted a case where the NZ Med Journal published a piece with 9 co-authors on drinking in pregnancy, none of whom noticed that 3 authors at Superu had done a better job with the same data only a few years before. None of the authors noticed. The editor of the NZ Med Journal didn't notice. The referees are supposed to be subject experts who watch their area; none of them noticed. 

The paper's authors eventually put up a note acknowledging the existence of the prior Superu work. And, ever classy, when their note (published in NZMJ as a separate piece) refers to their own prior work, they cite it; when they mention the Superu paper, it's as an inline URL that citation metrics scrapers might not catch. 

And of course they went for the "our attention has been drawn" framing rather than pointing to any of my posts on it, which might risk pointing out that some economist knew the lit in their area better than anyone who was involved in the writing or publication of their original article.  

Rehashing that now because I noticed a tweet by Clive Bates, who's expert in vaping. 

Zvi Herzig, Clive Bates, and Peter Hajek provided a post-publication review of some work on vaping harms by the Otago public health folks. They found a pile of issues that the authors, referees, and editors over at BMC Public Health missed. 

For example, you shouldn't compare the rates of some chemical's presence among smokers and users of other nicotine delivery systems without putting in a control group who don't use either.

First, the authors ignore background exposures (the ambient exposure experienced by non-users arising from the environment, food etc.), with the exception of an attempt to correct for acrolein exposures (discussed below). This is a serious error because most of the biomarkers measured are present in nonsmokers at significant levels.[7][8][9][10] Consider this illustration: if smokers have a level of a given chemical of 60 and ENDS users of 20, the authors would assert that exclusive ENDS use poses a third of risks of smoking. However, if non-smokers also have the level of 20 for the given biomarker, ENDS use poses no incremental risk at all. 

In fact, in the Jay[6] and Hatsukami[4] studies (comprising 11 of the 17 comparisons), abstinence and NRT arms show near-identical outcomes to those of their ENDS arms, yet this important finding is not reflected in the analysis.

They also note that a lot of people classed as exclusive ENDS users were in fact smokers, among other problems. There isn't carbon monoxide in vape, so if you're seeing high CO levels, you probably have somebody who's still smoking.  

Wilson, Summers, Ouakrim, Hoek, Edwards and Blakely wound up publishing a substantial correction, retracting their prior conclusion that vaping is about a third as harmful as smoking. 

Which is great and all. But while they grabbed the references that Herzig et al pointed them to in issuing their correction, they don't anywhere acknowledge Herzig et al's assistance. 

Bates, on twitter, points to the original referee reports over at BMC Public Health.

Extra 4/3. Peer review is a solemn scientific blessing that grants a paper legitimacy, right? The breezy and superficial peer reviews for this paper missed glaring errors. They are well worth a read: https://t.co/gqAnLYCS9F

My favourite: https://t.co/mk1DMyF95m pic.twitter.com/OZHCvDTd14

— Clive Bates (@Clive_Bates) September 26, 2022

Afternoon roundup

The afternoon's closing of the browser tabs:

• Tons of port workers have been avoiding getting vaccinated. In principle this should have been simple: have public health nurses drive out to the sites and administer it. But it's not been compulsory, antivax stuff has been influential among those workers, and they're probably (and rightly) pissed off with the regular nasal swab test requirements that could have been replaced by saliva testing over seven months ago - which would feed into a strong 'not gonna do whatcha told me' attitude. More results are out on the effectiveness of the Illinois protocol saliva tests - the one that the government doesn't want to use. And, just for fun, a plague ship berthed at Taranaki, where port worker vaccination rates are low. Let's hope we keep getting lucky, despite tapdancing on landmines. Looks now like only 11 of 98 border workers involved in this one had any vaccine. 


• Bernard Hickey has a chat with me and Oliver about Oliver's column last week. The prior link is to his column; the podcast is here. Our Insights newsletter column, reprinted in the Stuff papers, called on the government to extend residence to everyone who has been here with us since last year's March/April lockdowns - as a way of rectifying some of the harm that our immigration system has imposed since then. Oliver, Matt and I chatted about it here as well. 


• We'll be getting proof-of-vaccination that can work as a vaccine passport, but so far only intended for use in international travel. If Covid is ever here circulating, I will be happy to pay a premium to exclusively attend establishments requiring proof-of-vaccination for entry. 


• Damian Grant has a superb column on corporate social responsibility. 


• Union leader Matt McCarten on the merits of not banning speech. I agree with him. 


• The Taxpayers Union points to some odd-looking public health grants. This stuff wouldn't bug me so much if they were also putting appropriate funding into classical public health - contagious disease, vaccination promotion, the usual kinds of stuff that you might expect in the context of a global pandemic. But I could only see two grants in the whole set that seemed to have anything to do with the pandemic, and a third on measles. Just under $900k to try to get an assessment tool gauging barriers to vaccination and $1.2m looking at mucosal delivery for vaccines (not specifically to Covid, but in general). Both of those seem like really good ideas. They're also putting $1.16m toward waning measles immunity - good! But they're also putting $1.2m toward research on alcohol warning labels. It feels like infectious disease is still the poor cousin of whatever public health has more recently turned into. 


• Donal summarizes the Competition conference that was on in Wellington this past weekend. I missed it; these things usually cost an arm-and-a-leg, presumably due to cartel activity by conference organisers in preventing other conferences from emerging. Plus, I was in Christchurch Friday and Saturday teaching Canterbury's MBA students about the Emissions Trading Scheme. The session on three waters regulation would have been excellent.

Hard to rouse a moral panic about coffee

Swap "coffee" and "caffeine" in this piece for "vaping" and "nicotine", and imagine the outraged calls for tougher regulation.

A nationwide survey of hundreds of New Zealand tertiary students found almost every single one of them consume some level of caffeine daily, with a quarter experiencing "distressing" side effects.

But researchers found most of those students who suffered negative effects associated with caffeine such as a fast heartbeat, upset stomach or an inability to sleep had no plans to stop consuming caffeine any time soon.

The results of the Massey University study were published in the journal Nutrients this week and measured the caffeine intake of more than 300 university students.

Chocolate, coffee, tea and energy drinks contributed most to the total caffeine intake of 99 percent of students, with the median intake measured at 146.7mg a day.

But in some cases, maximum intakes of up to 1988.14mg a day were recorded - almost five times what experts consider the "safe" level of intake: 400mg a day.

One third (34.4 per cent) of caffeine consumers ingested caffeine above the adverse effect level and 14.3 percent regularly consumed more than the safe limit, according to researchers.

If it were vaping and nicotine, we'd have the Asthma Foundation saying these addicts need to be protected against Big Caffeine. But we all know that would be crazy. Vaping is newer though and can be pitched as scary, so it's easier to turn these kinds of things into scare stories.

Pandemic priorities

Prior to Covid, successive governments' approaches to public health meant that we had central government ready and able to command District Health Boards to stop the sale of soda at hospital cafeterias, but unable to tell whether hospital staff were vaccinated during a measles outbreak caused by failure to make sure everyone was getting their measles shots.

I worry that a new Public Health Agency will find itself tempted to shift back to those kinds of priorities once Covid is eventually in our rearview mirrors - and potentially even before then. 

This week's column at Newsroom argues that the proposed Public Health Agency should be split into two parts, with one party focused on contagious disease.

A snippet:

The problem was not a fragmented DHB system. Rather the problem was that public health efforts from the Ministry of Health and granting agencies focused on non-communicable disease at the expense of communicable disease.

And it is all too easy to see how that problem emerges.

Governments have a harder time dealing with things that impose longer term risk than with things imposing present costs. Hospitals must deal, all the time, with the costs associated with diabetes, with smoking, and with harmful alcohol use. While smokers pay a lot more in tobacco excise than they cost the government, the health system still bears the burden. And health professionals who deal daily with those suffering the longer-term consequences of poor diet, heavy drinking, and smoking can be powerful advocates for focusing on those problems.

So, it is always tempting, when resources are scarce, to shift focus away from workstreams dealing with longer term risks towards ones dealing with current problems. For a public health system, contagious disease is a bit like sewage network maintenance for a city council. There is always something that is a more pressing concern until suddenly there is not.

That is one reason that a dedicated agency, like Taiwan’s, can provide impressive results. Having only one job means less chance of being diverted into other tasks.

And our Ministry of Health, pre-Covid, was frequently diverted.

A rather costly failure

Lockdown wasn't a failure; it was a symptom of a failure.

From where we were at when the government shut the country down, they had to do it.

But we didn't have to be in that position at all.

The Herald's been going through the Friday afternoon document dump and caught this one.

Contact-tracing capacity has repeatedly been referred to as a weak point in New Zealand's Covid-19 response and has been ramped up in recent weeks to a point where director general of health Ashley Bloomfield now refers to it as a "gold standard" system.

But on March 17, a document proactively released by the Health Ministry put the capacity at the time as "estimated at 10 active cases".

That morning the Covid-19 case count was 11 confirmed cases and two probable cases.
The paper said that the capacity needed to be improved within a month so the contacts of 50 cases a day could be traced.

On 17 March, we had 3 new cases. On 20 March, we had 11 new cases, then 13, then 14 on the 22nd. On the 23rd we went into partial lockdown with 36 new cases; full lockdown on the 25th.

Source: Newsroom

Contact tracing for 10 active cases - there's no way it could have kept up. Even 50 cases a day wasn't going to be enough.

Had the government scaled up contact tracing capabilities from January, would we have needed lockdown? Border closures along with contact tracing and quarantine of both cases and contacts of cases could have done the job.

This wasn't the failure mode I was expecting in January or March; I just hadn't considered that the system would fail to scale up contact tracing.

Pretty pricey mistake.

Public Health Priorities

New Zealand's public health system has pivoted admirably to focus on the current pandemic. But the neglect of communicable disease for rather a long time ahead of this has had costs.

The public health system's focus on noncommunicable disease may make sense if you only look at the current burden of disease, prior to this year. But contagious and noncommunicable disease are very different things. If I decide to live an unhealthy lifestyle and have worse health as consequence, the costs of that to others are not particularly high. There is a fiscal transfer through the public health system, but that is mostly pecuniary - unless you think that people are living substantially less healthy lives because they know that the system will cover the health costs down the track. But any real, Pareto-relevant, technological externality is small. Concerns about noncommunicable disease are largely paternalistic.

Communicable disease is different. There are real and substantial external costs from it, and real public good benefits from its suppression. If I am currently risky, my staying home provides benefits to everyone with whom I'd otherwise come into contact, whether on the bus, in a restaurant, or anywhere else.

And as much as public health people hate seeing anyone enjoying a soda, a soda has never resulted in a month-long nation-wide lockdown and economic collapse.

Every time I've complained about this, the well-thinking people have told me that government can walk and chew gum at the same time. It can both focus on banning people from doing the things they enjoy doing while also keeping on top of communicable disease.

Yeah. About that.

Here's Georgina Campbell over at The Herald.

Thousands more face masks have been found with crumbling elastic and deemed unfit for purpose in the fight against Covid-19.

Earlier this month it was revealed there were 90,000 masks with corrupted elastic at Capital and Coast DHB and a further 10,000 at Hutt Valley DHB.

South Canterbury DHB has since reported there were 58,000 N95 masks in its pandemic stock, but due to their age, guidance has been sought from the Ministry of Health on whether they could be used during the Covid-19 pandemic, DHB chief executive Nigel Trainor said.

The public health system, broadly speaking (which I take to include the Ministry of Health, the DHBs, the HRC granting system, and the universities doing the research, and the cluster of government-funded NGOs), has managed to do a lot of things recently.

It has managed to ban sodas in hospital cafeterias.

It has managed to put cameras on a pile of kids to take pictures every five minutes, and to scour those pictures for evidence of evil brands that are hurting children by their presence.

It has put huge effort into blocking new bottleshops in places like Khandallah, with months-long hearings processes.

It has prioritised working out the regulations around vaping even in the middle of a pandemic, with MoH resources being put to supporting that committee.

But it has not managed to check that the DHBs are doing stock rotation on its PPE supplies for a pandemic. A public health system that protected its workers from soda did not bother to make sure its workers would have reliable access to PPE. 

This isn't a Labour government failure. It's a failure of the administrative state over the past decade in chasing after noncommunicable disease at the expense of preparedness for communicable disease.

Places like Taiwan have been able to avoid lockdowns because they've had a public health system ready for pandemics.

It is interesting to imagine a counterfactual in which public health had maintained a focus on communicable disease. Where grant money went into ensuring best-practices for scale-up of contact-tracing rather than having people watch sports matches to count alcohol brand exposure. Where central government was telling DHBs to check their PPE stocks rather demanding that they ban soda in the hospitals.

Let's hope that the system can maintain a focus on communicable disease coming out of this.

Compare and contrast: Covid-19 funding edition

On 24 February, New Zealand's Health Research Council announced that up to $3m would be available for Covid-19 research.

We're pleased to announce up to $3 million in funding will be made available for a range of research projects to address the current COVID-19 threat as well as future infectious diseases. @minhealthnz @SunnyCollings https://t.co/6wSNVyLmsD

— HRC New Zealand (@HRCNewZealand) February 24, 2020

The Spinoff reported on Friday 17 April that they've awarded $3.8 million to 13 studies.

Nearly half the funding (around $1.3m) has been allocated to studies investigating possible treatments for Covid-19.

One, the Australasian Covid-19 Trial (ASCOT) lead by Middlemore Clinical Trials, will assess how effective two antivirals (lopinavir/ritonavir and hydroxychloroquine) are in treating hospitalised patients. The study will investigate whether one or both drugs can reduce the need for ventilator support or reduce the risk of death.

...

Aside from clinical trials, several of the newly-funded studies deal with socioeconomic impacts of the virus. One, led by public health professor Michael Baker of the University of Otago, will provide the Ministry of Health with information about how individuals and their whānau experience the pandemic – not just the disease itself but isolation due to lockdown and economic effects.

“The study does almost everything,” said Baker. “New Zealand has taken a unique approach so we want to document that. New Zealand may have got by because we’ve got a nimbler society and we’ve responded with amazing leadership but those things can’t be guaranteed. We have to learn as much as possible from this so we can prepare our society for future events.”

Two other studies, one from Massey University and the other from the University of Otago, will address how people respond to quarantine and lockdown. Particularly, the researchers want to understand how ethnic and socioeconomic inequality affect people’s ability to follow lockdown rules. The Massey University study will also try to understand the social, cultural, political and racial factors that shape people’s attitudes towards pandemic diseases.

Both are vital, the researchers say, for building solidarity among New Zealanders when combatting infectious diseases.

I'd thought that international studies were now showing hydroxychloroquine to be less promising than first hoped and Remdesivir to be looking more promising, but it's a fast paced thing.

Meanwhile, here's what Tyler Cowen put together over at Emergent Ventures. Read it twice and think about what had to have gone into getting this done this quickly.

As you may recall, the goal of Fast Grants is to support biomedical research to fight back Covid-19, thus restoring prosperity and liberty.

Yesterday 40 awards were made, totaling about $7 million, and money is already going out the door with ongoing transfers today.  Winners are from MIT, Harvard, Stanford, Rockefeller University, UCSF, UC Berkeley, Yale, Oxford, and other locales of note.  The applications are of remarkably high quality.

Nearly 4000 applications have been turned down, and many others are being put in touch with other institutions for possible funding support, with that ancillary number set to top $5 million.

The project was announced April 8, 2020, only eight days ago.  And Fast Grants was conceived of only about a week before that, and with zero dedicated funding at the time.

I wish to thank everyone who has worked so hard to make this a reality, including the very generous donors to the program, those at Stripe who contributed by writing new software, the quality-conscious and conscientious referees and academic panel members (about twenty of them), and my co-workers at Mercatus at George Mason University, which is home to Emergent Ventures.

I hope soon to give you an update on some of the supported projects.

They went from concept, to finding the money, to announcing the project, to getting an evaluation panel to evaluate 4000 applications, and awarding $7 million in grants to 40 projects, in about TWO WEEKS.

One little side-project run by Tyler Cowen.

Just amazing.

Oh, and for a sense of scale on the HRC funding project, and the implied priorities, the entire amount distributed for Covid projects is about 77% of the value of a single grant made to Janet Hoek at Otago Uni for, well, for this:

Year:                      2019
Duration:               60 months
Approved budget: $4,949,736.70
Researchers:          Professor Janet Hoek
Health issue:          Alcohol/drugs of dependence
Proposal type:        Programme

Lay summary
The Whakahā o Te Pā Harakeke programme represents a collaboration that will develop and improve evidence designed to close smoking disparities, particularly for Māori and Pasifika, enhance how tobacco control evidence is used in decision making, and accelerate progress towards a Smokefree Aotearoa. We will achieve this goal by using mixed methods approaches that combine population-level analyses of existing and potential interventions with in-depth enquiries that probe how reducing tobacco’s appeal, affordability and accessibility has impacted communities and whanau. Analysing the complex tobacco control system will evaluate knowledge translation routes, consider barriers and enablers within these, and identify how evidence can more effectively accelerate reductions in smoking prevalence and reduce entrenched disparities. By partnering with Hāpai te Hauora and Kokiri marae, we will draw on community knowledge, build research capacity, and create unique opportunities to engage across the stakeholder spectrum and address the pressing health inequities caused by smoking.

Ready-up

My column in the last Insights newsletter covered some of the coming Coronavirus mess.

The government this week extended the COVID-19 (coronavirus) travel ban barring foreign nationals from arriving in New Zealand from mainland China and suggesting self-quarantine for Kiwis returning.

The continued ban feels like the right decision for a highly contagious disease with mortality rates that appear to be around twenty times higher than the seasonal flu. But feels are a poor basis for policy.

The disease has some very worrying features.

Oral swab testing can miss cases detected by a blood test. And while the virus can be detected in most people within three to seven days, it takes up to 24 days for others. Quarantine for those who have been in contact with anyone who has been infected will be long.

Where about 5% of similar patients in Singapore wind up in intensive care, Wellington’s 29 ICU beds are starting to look just a bit inadequate. The health system will very likely quickly be overwhelmed if there is any serious outbreak.

So, preventing an outbreak seems important, if it is possible.

As more cases emerge internationally, any travel-ban strategy would have to expand rapidly but would become far less effective. And, as NZIER pointed out this week, delaying COVID-19’s arrival to coincide with the local flu season could make things worse rather than better.

We need to be thinking beyond the ban.

The government is contemplating support for exporters. But that seems only the start of the problem. How many businesses depend on timely deliveries of critical parts, tools and materials from China? Inventories will be running low and China’s shutdown will not end soon. Will everyone get a bailout?

There may be a case for compensating workers and firms affected by quarantine requirements for workers who have been exposed. Not providing that compensation makes it far too tempting for firms to tell workers to come into the office regardless of quarantine requirements, as a SkyCity manager reportedly did with an employee under quarantine after returning from Wuhan.

Singapore compensates firms for quarantined workers while applying sharp penalties to firms and workers who break quarantine. It is managing to keep something of a handle on its outbreak. The government should be considering that kind of model.

Businesses should be preparing to deal with short-notice work-from-home arrangements in addition to supply chain disruption.

The travel ban has bought us a bit of time, nothing more. Use it wisely.

Italy went from 3 cases to 130 in 48 hours, including 26 in intensive care and three deaths. And Bocconi University is now closed, along with schools in Milan. There's also a ban on public events.

It looks to be not under control in South Korea, and not even close to being under control in Iran.

The government today announced another extension of the travel ban with China. It seems almost pointless. There are still far more cases in China than elsewhere, but folks could fly in from Milan, or Iran, or bring it back from a trip to Bali where nobody seems to believe the official stats that there aren't any cases.

I would be surprised if the virus were not already here.

It has a long incubation period and exhibits similarly to a cold for a lot of people after that. I am surprised that we have not yet had a confirmed case.

It doesn't seem implausible that the first case that presents here will quickly open up a pile of additional diagnoses among close contacts, and their close contacts. Numbers rising quickly consequent to knowing where to be testing will require the government to move quickly. It would be best if they had already mapped out what they plan on doing in that event.

The government does have a pandemic plan.

It isn't communicating anything from it.

Under what conditions will schools be closed?

What provisions will be in place to support those placed under quarantine, and their employers?

What penalties will apply to workers and employers who allow breaching of quarantine?

What facilities is the government putting in place for quarantine for those who are ill?

How much isolation-ward capacity do the hospitals have, and what happens if that becomes overwhelmed? Do we know whether the spread to almost all patients in the psychiatric ward in one South Korean hospital was a function of the perhaps greater difficulty of hygiene control in a psychiatric ward, or something more endemic to hospitals in places that are not Singapore?

Has the government sought assurances from providers of critical infrastructure that they are prepared for potential loss of critical workers and for breaks in supply chains?

A lot of GPs require people to show up in person for a re-up on a regular scrip, probably because that's how they get the fees. Might the government consider requiring that regular scrips be issued on request in the lead up to and during a pandemic so as to reduce the number of people showing up at the GP? Like, maybe there's some sense in having the GP check that my daughter still has asthma and that the meds are appropriate, but making people show up at the doctor's right now seems silly to dangerous.

There seems to be a lot of stuff that could be being sorted out during this brief respite in which it feels like we're just waiting for the Mask of the Red Death to make his appearance. If the government is onto it, I haven't heard about it.

Public health and vaccination

There could well be a case for having a public agency focused comprehensively on vaccination and communicable disease. 

But the proposal that the folks over at Public Health Expert isn't that. In a post framed around the recent measles outbreak and noting the risks around antimicrobial resistance and pandemics, we get this conclusion:

Business as usual is not a rational or viable option for NZ. There are almost daily reminders about the large current and impending public health challenges faced by this country. These challenges include the health consequence of persistent inequalities, the increasing burden from rising obesity and non-communicable diseases such as diabetes, and persisting problems of poor mental health and suicide. Possibly even more alarming are the rising environmental consequences of climate change and ecological collapse that take us beyond ‘planetary boundaries’, and emerging infectious diseases including rising levels of antimicrobial resistance and the emerging coronavirus pandemic. The current national measles epidemic is just another reminder that our national public health capacity and systems are no longer fit for purpose.

The good news is that the present Health and Disability System Review could map out the design for a new kind of public health agency to lead the transformative change that NZ needs to achieve its goals of improved public health and equity, and support its shift to a sustainable future.  Public Health Aotearoa could well provide the high quality sustained public health leadership needed to eliminate measles, improve our health security, and manage other long-term public health challenges.

It would be ...surprising... if this kind of agency maintained any kind of focus on pandemic prevention and vaccination promotion. It would quickly instead become an agency pushing for greater controls around lifestyle issues related to noncommunicable disease and, from the description above, social justice issues. And when that shift resulted in another great forgetting of the importance of vaccination and core public health, it would complain come the next measles outbreak that it simply hadn't had enough funding.

I could rather strongly favour there being an agency solely responsible for reducing the risk of communicable disease. That's core public health work. It would encourage research into vaccination uptake - finding ways to get folks vaccinated who are averse to vaccination. It would have targets around vaccination rates. It would make sure that public health nurses get into the schools to make vaccination routine. If it ever came to it, it could help coordinate quarantine regimes.

I really like the kinds of things that Nick Wilson writes about pandemics and preparedness. But I have no confidence that a new public health agency would pay any attention to pandemics or vaccination rates outside of a crisis.

Like, why would it be any different than the general focus of the current regime, in which it is dead simple to find millions of dollars in grants to Otago Uni to run focus groups about smoking (while Marewa does the real work out on her own) but hard to find much evidence of support for research into encouraging vaccination?

I'd put in an OIA request last year asking the Ministry of Health to list any research it's commissioned around vaccination. This is what I got back. It isn't much, despite waning vaccination rates.

Vaccination just seems to be low priority until there's a crisis. I wonder whether one tobacco researcher, by herself, has gotten more funding than the whole vaccination research agenda noted below.

Ice Cream Makes You Happy

An excellent response to a stupid complaint to the Advertising Standards Authority, a ludicrous ruling from the ASA, and a milquetoast response from the manufacturer.

First, the stupid complaint about an ad outside a dairy noting "Ice Cream Makes U Happy". 

I wonder if E Fowler has ever tasted ice cream. And wouldn't kids who've walked a kilometre from school to the dairy deserve an ice cream?

The ASA upheld the complaint. Absolutely absurd, inside-the-asylum stuff:

A majority of the Complaints Board said the advertisement could undermine the health and well-being of individuals. This is because the advertisement contains an implicit claim that there is a link between ice cream and happiness. The promotion of this link could potentially undermine the health and well-being of individuals because ice cream is a high fat, high sugar food, and the desire to be happy is universal. The majority said the large size of the advertisement and its location on the outside of the store were relevant.

A minority disagreed. The minority said ice cream is widely recognised as an occasional
food, a nice treat, and the advertisement is not making any scientific or nutritional claims.

Is the advertisement socially responsible?

A majority of the Complaints Board said the advertisement was not socially responsible
because the advertisement could undermine the health and well-being of individuals.

A minority disagreed. The minority said the advertisement was socially responsible and did not undermine the health and well-being of individuals. 

This is absolutely nuts.

No sane industry self-regulatory body could select members that would reach this decision.

The ASA takes a lot of heat from public health campaigners who'll argue that industry self-regulation is inadequate and that the state needs to do it directly. It looks like the ASA is so worried about that kind of prospect that it jumps to ban claims that ice cream makes you happy. And I fail to see the point of industry self-regulation in that case. If it were all given to the Chief Censor to manage, at least the bootprint of the State would be visible in these kinds of decisions.

Christian Bonnevie's take over at Stuff is excellent:

You would think that Unilever, the maker of Streets ice creams and the billboard at the centre of this grand conspiracy, would stand up for happiness. But alas, all we get is the usual corporate waffle about "how important it is for New Zealanders to eat a balanced diet, maintain a healthy weight and to look after their mental wellbeing".

So bland. So wet. The classic "make it go away" comment that probably passed through a dozen lawyers before being sent to media.

Where's the passion for your product, Unilever? Do you actually believe in it? You were presented with an opportunity to show some personality and stand up for the average Kiwi ice-cream lover. Instead, you quietly file an appeal and talk about being committed to promoting mental and physical health.

We don't care. We just want good ice cream. Because it makes us happy.

It's a bit unfair to pick on Unilever, as their response has become the sad and predictable default setting of big corporates in recent years. Much of this is because in an outrage-fuelled society they can only see risk, not opportunity.

It's even understandable given the penchant of faceless bureaucrats to come up with such consistently stupid rulings and not even have the stones to put their names to them.

But that's why it's even more important for businesses to stand up to authorities like the ASA, loudly. Otherwise they won't just be banned from advertising happiness, they'll be taxed even more to deliver it.

Vaccination, compulsion, and paternalism for the lower orders

The National Party has come out in support of encouraging greater vaccination uptake.

But it sure isn't the way I'd do it.

National's suggested docking the benefits of those on benefit whose kids aren't keeping up with their vaccinations. Some in National have suggested extending that to payments under Working for Families, but that appears more controversial.

We can go back to first principles and note that there's a reasonable case for government intervention to encourage vaccination - as I have done previously. There is compulsion all over the place in public health, except where there's an actual market failure case for using compulsion.

I think that case is strongest when it comes to those workers most likely to be in contact with not-yet-vaccinated youths, and with people whose immunity may otherwise be compromised. So, ECE workers and workers in the hospitals and public-facing parts of the health system.

A case for docking benefits as a way of encouraging vaccination you'd think would have to start with data showing far worse vaccination rates among beneficiaries - is there a there there?

Unfortunately, it's hard to find data on anything like that. The closest we've got are the Tier 1 immunisation stats which sort immunisation coverage by DHB area, by deprivation, and by ethnicity. They have those stats for immunisation status as of 6 months, 8 months, 12 months, 18 months, 24 months, and 5 years.

When I look at those stats, differences by DHB are huge as compared to differences by deprivation.

Take immunisation coverage at 8 months for example. Look at the gap between immunisation coverage for the least deprived quartile and the most deprived quartile. On average, the difference is 5.7 percentage points in the most recent data. In MidCentral, the gap is 13.4 percentage points - and it's 38.1 percentage points over on the West Coast, albeit with small sample issues. But in Tairawhiti, the gap is -4.6 percentage points: vaccination coverage rates there are higher for the cohort more likely to be in receipt of benefit. And similarly in Canterbury: vaccination rates among the most deprived are five percentage points higher than for the least deprived.

Why is it that vaccination rates among the most deprived quartile in Canterbury DHB is higher than the vaccination rate among the least deprived in 13 of 20 DHBs? Have they done something there that other DHBs should be replicating? Variability in immunisation rates among the most deprived, across DHBs, is larger than variability in immunisation rates among the least deprived. What on earth is going wrong over on the West Coast, where there's that 38.1 percentage point gap and only 61.9% of the most deprived quartile bother with vaccination?

The standard deviation of immunisation rates across DHBs is 4.1; the standard deviation of vaccination rates across deprivation quartiles is 1.9. There's nasty stuff in some DHBs and in particular in some DHBs for the most deprived quartiles, but it's harder to see this as a generalised poor people problem. National immunisation rates for the most deprived, at 8 months, are 88.3%; for the least deprived, it's 92.6%.

Were I suggesting policy targeting vaccination, rather than playing into other things, I'd be looking at:

• Compulsory vaccination as employment condition in the state-funded health sector, for both new and existing staff. They impose substantial direct risk. And how many antivaxxers will look at the recent reporting on low sector uptake and take it as reaffirming their beliefs? 
• Compulsory parental notification of vaccination status of employees at ECE centres, and consider making it a condition of receipt for 30-hours free. Like, the government made it compulsory that piles of workers in ECE have qualifications - even where there's no good justification for it - but we don't even know whether ECE workers are vaccinated? Come on. 
• Bring back the BPS targets around vaccination, penalise DHBs for vaccination rates less than 90%, reward them for rates above that. The DHB-level vaccination stats are hardly secret, but DHBs have no particular incentive to go and figure out what works or learn from each other. If DHBs faced financial incentives to ensure broad immunisation coverage, they might decide it's worthwhile to send somebody out to see just what Canterbury is getting right - or whatever DHB has population most comparable to theirs but higher immunisation rates. 
• There are piles of things you can imagine DHBs trying out. Catch-up vaccinations at school for those who missed them. Making sure that all schools get a visit from the nurse with the jabs. Sending a public health nurse along on Plunket visits. Sending public health nurses along to ECEs where vaccination rates are known to be low. How far can you get just by making it really really easy for folks to be vaccinated?
• Tell the Health Research Council that funding for research in public health, aimed at policy changes or behavioural interventions, should focus on the traditional remit of public health in vaccination and contagious disease rather than noncommunicable disease. I have OIA requests in now with MoH trying to get a handle on whether they've been putting any funding at all into vaccination work. We get piles of HRC grants for stuff like discouraging youth smoking and drinking and advocating for sugar taxes; it's hard to see anything like it for vaccination. It looks like they made a grant to Auckland Uni's immunisation centre. But there just hasn't been much research work there yet on encouraging vaccination uptake. They've done literature reviews, and they have an annual set of charts that come out of the Tier One vaccination stats, but nothing like the research push that HRC makes into noncontagious disease. I suspect that Janet Hoek, all on her own, gets more funding for anti-tobacco work than the government's provided for research into encouraging vaccination. But I'd like to know. 

But National's push does play into my general theory of where we get paternalistic regulation - it's generally targeted at poor people, whether or not it makes sense. And it will be fun to watch people explain why it's okay to make it a condition of benefit, but not okay to make it a condition of WFF. Maybe there's finer-grained data that would let them show that the gap is far larger when you look at beneficiaries compared to other kids in low income quartile households, but I really doubt anybody's even looked at it.