A call for a political prescription to tackle obesity

A political prescription is needed to treat obesity
Why Nudge?

Unless there is harm to others, the government cannot exercise power over people. This is the John Stuart Mill's "Harm principle", sometimes called the Liberty Principle. And governments have taken as given that individuals always take decisions in a rational way, fulfilling their preferences. As Cass Sunstein says in his last book "Why Nudge?", such a principle "raises serious doubts about many laws and regulations. Sometimes power is exercised over people in large part to promote their own good, finally people are note entirely sovereign over their body and minds". He argues in favour of paternalism in certain circumstances. We have already explained such details formerly in this blog.
Today I would like to suggest a reading to you, an excellent editorial in the Canadian Medical Association Journal. It is a call for action on obesity and specifically on food policy and taxation on sugar-sweetened beverages.

Our current approach to obesity relies on the assumption that people have choices, often fail to make the right ones, and should be educated and helped to make better choices. This view is simplistic and clearly absurd, given the continued rise in the prevalence of obesity in countries that have been tackling the problem for decades. Are millions of people really choosing to be overweight?

People are not as free to choose as we would like to believe. Neurobiological desires for sweet and high-fat foods gave humans a survival advantage in a world where food was scarce and every calorie counted. Where food is inexpensive and easily available, biological processes related to eating can mirror addiction and will lead to our destruction. We need to change our approach. We need incentives beyond educational messages. Strategies that include individual interventions,  school-based nutrition and activity interventions, incentives for active commuting and changes to the built environment should continue; however, we also need robust ways to restrict portion sizes and reduce the sale of sugar-sweetened beverages and other high-calorie, nutrient-poor food products. Our government needs to consider taxation as a tool to combat the consumption of these addictive foods and beverages, just as it regulates the sale of alcohol and tobacco products for the purposes of population health.

In USA, Berkeley is the first city that will intoduce the soda-tax after a recent ballot. Berkeley’s Measure D proposed imposing a 1-cent-per-ounce general tax on sugar-sweetened beverages and sweeteners used to flavor drinks. The measure will not dedicate funding to a specific cause and did not require only a majority of the vote.
I still remember how a similar measure was discarded some years ago in our country. The times to reconsider the introduction of a soda tax are coming.

Food and risk perception

Food and the Risk Society: The Power of Risk Perception

This is the main message of the book: Do not send generic messages on food and its risks, the time for segmentation has arrived,

A generic approach, involving the provision of vast amounts of information to the general public, stands a real risk of leading to information overload, bewilderment and lack of interest among mainstream consumers. A more effective approach to change consumer food buying and consumption behaviour, is to focus on segmenting the population according to their information needs, and developing information with high levels of personal relevance to specific groups of respondents who may be at greater risk than the rest of the population. Such information is more likely to create attitudinal change and subsequent behavioural change as the perceived personal relevance is high.

Is the government already prepared for the task?

Stop misuse of antibiotics

 Antimicrobial Resistance in the EU/EEA: A One Health Response

Misuse of antibiotics is among the main drivers underpinning the development of antimicrobial resistance (AMR). Resistance to last-line antibiotics also compromises the effectiveness of life saving medical interventions such as intensive care, cancer treatment and organ transplantation. 

Overall consumption of antibiotics in humans in the European Union/European Economic Area (EU/EEA) decreased by 23% between 2011 and 2020, especially during the Coronavirus Disease 2019 (COVID-19) pandemic (between 2019 and 2020, the mean total consumption of antibiotics dropped by almost 18%). However, relative use of broad-spectrum antibiotics has increased and significant variability across countries suggests that reductions are still possible.

Efforts to reduce unnecessary use of antibiotics in food-producing animals have resulted in a 43% decrease in use between 2011 and 2020 in 25 countries with consistent reporting.

Despite reductions in antibiotic consumption in both humans and food-producing animals, AMR in bacteria from humans in the EU/EEA has increased for many antibiotic-bacterium combinations since 2011. Particularly worrisome is the rise in resistance to critically important antibiotics used to treat common healthcare-associated infections. 

While recent trends have been encouraging, resistance to commonly used antibiotics in bacteria from food-producing animals remains high (>20% to 50%) or very high (>50% to 70%), and there is significant regional variation across the EU/EEA region. 

 

Models for population health

 Models for Population Health Improvement by Health Care Systems and Partners: Tensions and Promise on the Path Upstream

The Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine hosted a public workshop on September 19, 2019 titled Models for Population Health Improvement by Health Care Systems and Partners: Tensions and Promise on the Path Upstream. The term upstream refers to the higher levels of action to improve health. Medical services act downstream (i.e., at the patient level) in improving population health, while such activities as screening and referring to social and human services (e.g., for housing, food assistance) are situated midstream, and the work of changing laws, policies, and regulations (e.g., toward affordable housing, expanding healthy food access) to improve the community conditions for health represents upstream action.

The workshop explored the growing attention on population health, from health care delivery and health insurance organizations to the social determinants of health and their individual-level manifestation as health-related social needs, such as patients' needs. The workshop showcased collaborative population health improvement efforts, each of which included one or more health systems. This publication summarizes the presentations and discussions from the workshop.

The world is fat

 The Heavy Burden of Obesity – The Economics of Prevention

Almost a decade after the publication of the first OECD report on obesity, a new one has been released. This are the facts:

More than half the population is now overweight in 34 out of 36 OECD countries and almost one in four people is obese. Average rates of adult obesity in OECD countries have increased from 21% in 2010 to 24% in 2016, so an additional 50 million people are now obese. Despite a drive in the last decade to deal with increased obesity, more needs to be done amid sedentary lifestyles and an almost 20% increase in calorie supply – i.e. calories available for consumption – in the OECD over the past 50 years.

So what?

The OECD identifies four categories of policies to tackle the problem and gauges the effect of three promising “policy packages” to help countries achieve greater impact and coherence in tackling the obesity epidemic. Food and menu labelling, regulation of advertising of unhealthy foods to children and the promotion of exercise, including by doctors and schools, are among the measures analysed.

Most of the strategies requires a confrontation with the food industry, and governments usually try to avoid it. We'll see what happens.

Manufacturing disease

Lethal But Legal: Corporations, Consumption, and Protecting Public Health

The quest for better regulation is an open-ended learning process. In democracy, governments maximize impact during their political term and better regulation deserves a longer term commitment. The costs and benefits of inaction for society are larger than for politicians. A recent new book explains that public health regulation and specifically on food policy, needs a complete overhaul. I've said this many times, in the book you'll find the details to take into account.
The author, Nicholas Freudenberg, DrPH, is Distinguished Professor of Public Health at the City University of New York School of Public Health and Hunter College and founder and director of Corporations and Health Watch, an international network of activists and researchers that monitors the business practices of the alcohol, automobile, firearms, food and beverage, pharmaceutical, and tobacco industries.I strongly suggest a quick look at their site, you'll find many interesting information, like the one related to Berkeley and soda-tax.

Climate change and health

Enviromedics: The Impact of Climate Change on Human Health

These are tough times for the relationship between mankind and the planet. Therefore, this is a good reason to know better the relationship between climate change and health. In this book you'll find the details on each topic.
These are the key issues:

Part I. Climate Change Cascade
2 Climate Change 101: A Primer
3 Heat Waves and Heat Stress
4 Extreme Weather
5 Vector-Borne Diseases
6 Mental Health
Part II. Clear and Present Pathogens
7 Air Degradation
8 Water Security
9 Food Security
10 Allergens
11 Harmful Algal Blooms 

 Many of these modern sources of environmental hazards share a common feature—they derive from human activity as much as or more than from nonhuman sources. Radiation exists in nature, but its concentrated forms on Earth are created by humans. Industries produce the goods that support modern life, while they spin off by-products that can harm the environment and humans. We celebrate the productivity of modern agriculture, but if the runoff of pesticides and antibiotics pollutes the water supply and encourages antimicrobial resistance, we pay a higher price than we realize for food.

Balancing this tradeoff is complicated by the fact that the individuals and interests who typically stand to benefit from a polluting activity are not the same as the ones who will suffer the adverse health and other consequences.

Global externalities and how to fix them. This is one of the greatest challenges nowadays.

The apocalypse and our true fate, who knows?

THE FIVE HORSEMEN OF THE MODERN WORLD: Climate, Food, Water, Disease, and Obesity

In the book of Revelation or Apocalypse of John, you'll find the seven bowls. Seven angels are thus given seven bowls of God's wrath, each consisting of judgements full of the wrath of God poured onto Earth:

First Bowl: A "foul and malignant sore" afflicts the followers of the Beast. (16:1–2)
Second Bowl: The Sea turns to blood and everything within it dies. (16:3)
Third Bowl: All fresh water turns to blood. (16:4–7)
Fourth Bowl: The Sun scorches the Earth with intense heat and even burns some people with fire. (16:8–9)
Fifth Bowl: There is total darkness and great pain in the Beast's kingdom. (16:10–11)
Sixth Bowl: The Great River Euphrates is dried up and preparations are made for the kings of the East and the final battle at Armageddon between the forces of good and evil. (16:12–16)
Seventh Bowl: A great earthquake and heavy hailstorm: "every island fled away and the mountains were not found." (16:17–21)

As you may notice Apocalypse is just that, a book. Daniel Callahan set a title of five horsemen of the modern world as a metaphor of current evils. Global warming, food shortages, water shortages and quality, chronic illness, and obesity could be the key ingredients of our fate?.
At the end, Daniel Callahan calls for a diplomatic model:

to persuade the research, academic, and policy communities to accept what I will call the diplomatic model of relationships, typically now seen between and among nations, and to open a serious dialogue with the business community

Agree.

Tackling obesity: the toolbox

Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking

World Cancer Research Fund International NOURISHING framework 
Food policy framework for healthy diets and the prevention of obesity and diet-related non-communicable diseases. 

 Key message:

The problem of obesity must be reframed to acknowledge on one hand that individuals bear some personal responsibility for their health, but that, on the other hand, environmental factors exploit biological, psychological, social, and economic vulnerabilities that promote overconsumption of unhealthy foods. A vicious cycle is created in which the preference and demand for unhealthy products are not only shaped by the environment, but lead to environmental changes that further encourage consumption of unhealthy foods. This cycle makes it difficult for people to act in their own long-term self-interest, but it can be broken with regulatory actions from governments and joint efforts from industry and civil society to create healthier food systems.

Aturem el genocidi armeni (una altra vegada)

 The humanitarian crisis in Nagorno-Karabakh

La situació de Nagorno-Karavag és un genocidi del poble armeni. I no és la primera vegada. Aquesta és la carta publicada al Lancet i que crec rellevant de destacar a data d'avui:

We want to bring the attention of doctors to the humanitarian crisis happening in Nagorno-Karabakh. Nagorno-Karabakh, an area of 1700 square miles between Armenia and Azerbaijan, is home to about 120 000 people, including about 30 000 children. Nagorno-Karabakh, also known as Artsakh, was a region in the former Soviet Union with a predominately Armenian population that had restricted self-governance. However, since the dissolution of the Soviet Union, its status has been a contentious issue between Armenia and Azerbaijan.

Since 1991, Nagorno-Karabakh has been a de facto independent state. A 44-day war in 2020, started by Azerbaijan during the COVID-19 pandemic, resulted in thousands of deaths, more than 10 000 injuries, and the displacement of many more people.1 After the ceasefire, the only supply route for food, medicine, and fuel connecting Nagorno-Karabakh to Armenia was the Lachin corridor.2,  3

In December, 2022, Azerbaijan began a blockade of the Lachin corridor that has resulted in starvation, with inhabitants forced to wait in long queues for food and medicine. The public transportation system has collapsed and there is concern about fuel for heating homes in the winter. Local doctors report that malnutrition is causing miscarriages, people who are pregnant are unable to reach hospitals to give birth, there is no infant formula, and that the lack of adequate nutrition has impeded breastfeeding.4

People with chronic illnesses cannot access basic medicines, such as insulin. People with suspected cancers cannot have diagnostic studies and people with cancer have little access to simple anti-cancer drugs.5 Access to cancer services in Armenia is now blocked. The Red Cross, the only operational relief organisation in this area, cannot guarantee the safe transportation of people who are critically ill to Armenia. Even before the current crisis, this region had challenges in providing adequate health care to the population; the blockade has driven it to a crucial point. On Aug 7, 2023, the former chief prosecutor of the International Criminal Court stated “there is an ongoing genocide against 120 000 Armenians living in Nagorno-Karabakh”. Although most people think genocide implies mass killing, this notion is wrong. The legal definition of genocide in the 1948 Genocide Convention is “acts committed with intent to destroy, in whole or in part, a particular national, ethnical, racial or religious group”. It is obvious that the objective of the blockade is to starve the resident Armenian people so that they die or flee.

We are not alone in our assessment of the situation in Nagorno-Karabakh.6 The International Association of Genocide Scholars warned of the “risk of genocide”, the Lemkin Institute for Genocide Prevention issued an active genocide alert, and Genocide Watch has declared a genocide emergency.

We urge the global medical community to voice concern and take action that might help end the blockade of the Lachin corridor until a reasonable compromise can be reached between authorities in Nagorno-Karabakh and Azerbaijan. We need to stop this genocide.

La societat no hauria d'acceptar passivament fets com aquests. Les Nacions Unides fan el paper de la trista figura, amb un mecanisme de veto inadmisible a data d'avui.

 

Tackling obesity

Integrating Educational, Environmental, and Behavioral Economic Strategies May Improve the  Effectiveness of Obesity Interventions

On top of the priorities for the improvement of public health, obesity deserves a place. However, the tools and decisions to slice its impact on health are still dubious. A recent article may help to put together different approaches:

Obesity is a multifactorial problem impacted by access to foods (supply) and food choices (demand). Neighborhood environments constrain the food choices available to individuals, while complex dietary decisions are driven by taste, cost, nutrition, convenience, and weight concerns. The complex nature of dietary choices therefore requires informed educational approaches that are strategically combined with guided nudges, and environmental interventions that improve access to promote healthier eating. Moreover, multi-institutional  collaborations will likely be necessary to address the obesity epidemic.

Since a multi-institutional approach is needed, somebody has to lead this effort. Is the government able to do it?. If so, don't delay it.

PS. Let me suggest also this Lancet article, my key reference up to now with the OECD one and its update.

Les decisions de política sanitària que cal prendre

 La sanidad en la encrucijada post-COVID. Financiación, organización y gestión

Els que es dediquen a la política sanitària també necessiten "aliments per pensar", food for thought, o almenys així m'agradaria de creure-ho. Tinc la impressió que llegeixen poc i escolten encara menys als experts. En canvi, es basen en marcs mentals restrictius i sovint sectaris, fonamentats des de la premsa, aparells de partit i grups d'influència. No vull dir amb això que cal escoltar tots els experts i sempre, tant sols vull dir que és una veu a considerar. I tampoc vull dir que tots els polítics són iguals.

Però si hi ha una reflexió de política sanitària del moment que no pot passar per alt és la que fan Meneu-Ortún-Urbanos en aquest llibre. Cal comprendre bé com l'epidèmia ha capgirat les decisions i quines conseqüències ha tingut i pot tenir. El llibre reflexiona serenament sobre tot plegat i si només hagués d'escollir un capítol, el 3 i una secció, agafaria la "3.5. Adhesión inquebrantable a la ‘gestión directa’: mal pronóstico". Allà expliquen amb prou detall un dels aspectes que no volen parlar els que es dediquen a la política sanitària, com millorar l'organització. I aquest és precisament l'aspecte crucial que caldria al sector públic. 

Al darrer capítol es fa èmfasi en la importància d'oferir informació al públic. I jo miro ara mateix la Central de Resultats i des de fa 4 anys no hi ha dades. Algú ha apagat l'estadística. I si fos només això. I ja no dic res més.

Llegiu-lo sencer, paga la pena, recomaneu-lo a qui correspongui. I tant de bo algú escolti i tingui impacte el que proposen.

Polític sanitari exhaust fent la becaina després de tant "food for thought"

On food and public health policies

Is the food industry in the driver's seat?

The role of stakeholders in health policy requires transparency. Otherwise any potential relationship may end in conflict with general interest. The appointment of high level officials in any regulatory body has to be clean, without doubts over conflicts of interest.
Have a look at this article at EJPH. Some months ago I highlighted my concerns about this here.

Fracking, No Thanks

The Real Cost of Fracking: How America's Shale Gas Boom Is Threatening Our Families, Pets, and Food

Can you imagine a country of 7.5 million citizens that their Parliament agrees to forbid fracking and only 12 judges may decide that this agreement is illegal?. This is just what has happened again.
Last June I explained the health related damages of fracking in this post, today I would like to draw attention to this book: The Real Cost of Fracking: How America's Shale Gas Boom Is Threatening Our Families, Pets, and Food where you'll find detailed explaination of what happens in practice if the government allows such a practice in your neighbourhood. More details in Slate:

In The Real Cost of Fracking, we learn about David, a 14-year-old boy who came down with a mysterious illness shortly after the start of nearby fracking operations. David had arsenic and phenol (a metabolite of the carcinogen benzene) in his blood. When he went to live with friends, the symptoms subsided. But when he returned home to play with his animals, the symptoms came back, even sending him to the hospital again.

We also meet Claire and Jason Wasserman. One day, Jason was outside near a well that was being flared, and he got a nosebleed that stopped after a little while. But the next morning, he went into the bathroom and yelled for Claire. Blood was gushing from his nose. Claire told him to tilt his head back and pinch his nose. But then blood started coming out of his eyes. “Close your eyes! Close your eyes!” she screamed. Then blood came out of his ears.

The moment to disconnect and avoid such damaging extracting strategies for individuals and the landscape has arrived, the Parliament has to enforce its own decision.

The world (dis)order after COVID-19

 COVID-19 AND WORLD ORDER. THE FUTURE OF CONFLICT, COMPETITION, AND COOPERATION

A free book of interest:

Part I. Applied History and Future Scenarios

Chapter 1. Ends of Epidemics

Jeremy A. Greene and Dora Vargha

Chapter 2. The World after COVID: A Perspective from History

Margaret MacMillan

Chapter 3. Future Scenarios: "We are all failed states, now"

Philip Bobbitt

Part II. Global Public Health and Mitigation Strategies

Chapter 4. Make Pandemics Lose Their Power

Tom Inglesby

Chapter 5. Origins of the COVID-19 Pandemic and the Path Forward: A Global Public Health Policy Perspective

Lainie Rutkow

Chapter 6. Bioethics in a Post-COVID World: Time for Future-Facing Global Health Ethics

Jeffrey P. Kahn, Anna C. Mastroianni, and Sridhar Venkatapuram

Part III. Transnational Issues: Technology, Climate, and Food

Chapter 7. Global Climate and Energy Policy after the COVID-19 Pandemic: The Tug-of-War between Markets and Politics

Johannes Urpelainen

Chapter 8. No Food Security, No World Order

Jessica Fanzo

Chapter 9. Flat No Longer: Technology in the Post-COVID World

Christine Fox and Thayer Scott

Part IV. The Future of the Global Economy

Chapter 10. Models for a Post-COVID US Foreign Economic Policy

Benn Steil

Chapter 11. Prospects for the United States' Post-COVID-19 Policies: Strengthening the G20 Leaders Process

John Lipsky

Part V. Global Politics and Governance

Chapter 12. When the World Stumbled: COVID-19 and the Failure of the International System

Anne Applebaum

Chapter 13. Public Governance and Global Politics after COVID-19

Henry Farrell and Hahrie Han

Chapter 14. Take It Off-Site: World Order and International Institutions after COVID-19

Janice Gross Stein

Chapter 15. A "Good Enough" World Order: A Gardener's Manual

James B. Steinberg

Part VI. Grand Strategy and American Statecraft

Chapter 16. Maybe It Won't Be So Bad: A Modestly Optimistic Take on COVID and World Order

Hal Brands, Peter Feaver, and William Inboden

Chapter 17. COVID-19's Impact on Great-Power Competition

Thomas Wright

Chapter 18. Building a More Globalized Order

Kori Schake

Chapter 19. Could the Pandemic Reshape World Order, American Security, and National Defense?

Kathleen H. Hicks

Part VII. Sino-American Rivalry

Chapter 20. The United States, China, and the Great Values Game

Elizabeth Economy

Chapter 21. The US-China Relationship after Coronavirus: Clues from History

Graham Allison

Chapter 22. Building a New Technological Relationship and Rivalry: US-China Relations in the Aftermath of COVID

Eric Schmidt

Chapter 23. From COVID War to Cold War: The New Three-Body Problem

Niall Ferguson

Fragmented regulators in globalized markets

Food and Drug Regulation in an Era of Globalized Markets

The complexities of a globalized world have its impact on food and drug regulation. The options for a collaborative space between different agencies are huge, though the interest is low. Its an issue of power and fear, everybody knows that cooperating would be better, but a lack of commitment is the final result. This is not only an issue for health, of course, but I would like to highlight the fact that this should be the first issue of concern by health politicians worlwide. Meanwhile, you can read this book, though it is partial and limited but shows the current situation.

Commercialism in health and medicine

Buying Health: The Costs of Commercialism and an Alternative Philosophy

There are only three topics of health policy in the newspapers (unfortunately): waiting lists, copayments and privatization. As soon as one topic drops from the agenda, the informational cascade starts with the following one. The last one, privatization is still a concept in need of definition and measurement. I already covered this issue last year and I don't want to repeat it.
Today I would like to insist that beyond a new framing of the concept, maybe we have to change the scope and the term. The right term could be commercialism. We have to understand better how and when commercialism is undermining professionalism.
Jerome Kassirer wrote an excellent piece (US oriented) in Cambridge Quarterly of Healthcare Ethics some years ago that it is still a reference for today. His words:

Professionalism is fundamentally a pact with society. In recognition of certain behaviors and attributes, society confers professional status on us. These privileges are not bestowed, but are earned, and they must be renewed repeatedly for the status to be preserved. Professional behaviors include technical competence that is valued and that adds value, a commitment to self-improvement, a commitment to selfmonitoring and self regulation, and a commitment to use the unique knowledge and competence for the best interests of our patients. This last requirement should include a commitment to resolve conflicts of interest in our patients’ favor.

Is money trumping professionalism? Certainly the pharmaceutical money tsunami is having major adverse effects. It tends to distract faculty into emphasizing profitable research and to neglect their teaching duties. It replaces openness with secrecy, it privatizes knowledge, and it replaces part of the social commons by commercializing discovery. In many instances, it downplays knowledge as a social good. It has also created a culture within which the design of studies is sometimes jiggered to create positive results, in which unfavorable results are sometimes buried, where communication of results is sometimes hindered for commercial reasons, and where bias in publications and educational materials has gone completely unchecked

Maybe there are excessive generalizations, but take it as a general statement to be confirmed by facts and data.
Churchill and Churchill go beyond the usual scope. Their recent article abstract says:

This paper argues that commercial forces have steadily encroached into our understanding of medicine and health in modern industrial societies. The impact on the delivery of personal medical services and on common ideas about food and nutrition is profound and largely deleterious to public health. A key component of commercialization is reductionism of medical services, health products and nutritional components into small, marketable units. This reductive force makes both medical services and nutritional components more costly and is corrosive to more holistic concepts of health. We compare commercial and holistic approaches to nutrition in detail and offer an alternative philosophy. Adopting this alternative will require sound public policies that rely less on marketing as a distribution system and that enfranchise individuals to be reflective on their use of medical services, their food and nutrition choices, and their larger health needs

I deeply agree with such perspective.

Una recessió saludable?

ARE RECESSIONS GOOD FOR YOUR HEALTH BEHAVIORS? IMPACTS OFTHE ECONOMIC CRISIS IN ICELAND

Els animals s'adapten al medi, els humans també. I si el medi esdevé hostil, aleshores prenem precaucions. Si aquesta recessió ha portat a canviar els comportaments individuals cap a un estil de vida més saludable aquí aprop encara no ho sabem. A Islàndia en canvi ja ho han confirmat. Les conclusions d'un article de NBER són les següents:

The 2008 economic crisis in Iceland led to reductions in all health-compromising
behaviors examined—smoking; heavy drinking; consumption of sugared soft drinks, sweets, and fast food; and indoor tanning. It also led to reductions in certain health-promoting behaviors but increased others. Specifically, the crisis reduced consumption of fruits and vegetables but
increased consumption of fish oil and getting the recommended amount of sleep. Generally, the
effects of the crisis on health-compromising behaviors were stronger for the working-age
population than for the adult population overall.
Changes in hours of work, real household income, wealth, and mental health explained
some of the effects on health-compromising behaviors, ranging from 9% for smoking to 42% for heavy drinking. For health-promoting behaviors, these factors reduced the effects of the crisis only for fish oil and vitamins/supplements, by about one third. We inferred that broad-based factors—such as prices, which increased over 27% in Iceland between 2007 and 2009—played a large role in the effects of the crisis on health behaviors. We exploited our ability to isolate behavioral changes that are likely due, at least in large part, to price changes, to compute participation elasticities for the various goods. We found inelastic responses to price changes for alcohol and sugared soft drinks and elastic responses for smoking, sweets, indoor tanning, and fast food. Health-promoting behaviors revealed less price sensitivity overall compared to health compromising behaviors.

Així doncs semblaria que a Islàndia la recessió és força bona per la salut. En qualsevol cas, això cal agafar-ho amb pinces i no es pot generalitzar ni extendre temporalment més enllà de l'anàlisi feta. Més aviat diria que cal que ens preguntem si cal una recessió per arribar a comportaments saludables o potser ja va sent hora de fer-ho al marge de l'evolució de l'economia.
M'ha agradat això de conèixer l'elasticitat de la demanda abans i després, convindria calcular-ho per aquí aprop. Sabem que el consum retail ha caigut un 9,8% en un any i encara no sabem qué han prioritzat els ciutadans davant aquesta impressionant retallada en el consum domèstic.

Charting a new territory: health systems vulnerability

Learning from Economic Downturns How to Better Assess, Track, and Mitigate the Impact on the Health Sector

Regarding the measurement of country-specific health system vulnerability to economic crises in comparison to peers and over time, the WB new report says:

Compared to other fields, such as food security (Food Price Watch 2012; Messier et al. 2012) and environmental vulnerability (SOPAC 2010), the health system lags behind in providing standardized definitions, metrics, and applied tools that would help assess crisis-related vulnerabilities. There are no descriptive tools that would allow for retrospective comparison, let alone predictive tools that would enable early warning signals.

The vulnerability assessment that they propose sounds of interest at a first glance. Spain, Cyprus, Italy and Greece are at the top of european ranking of vulnerability (p.60). Data come from 2010, rigth now the position would be a different one, even worse than before. The problem is that variation within each country is huge, comparing countries is an easy way to forget such differences.

Public funding of succesful Pharma R&D

Contribution of NIH funding to new drug approvals 2010–2016

If we consider the 210 new molecular entities (NMEs) approved by the Food and Drug Administration from 2010–2016, then you'll find that NIH funding contributed to published research associated with every one. A PNAS article explains that:

Collectively, this research involved 200,000 years of grant funding totaling more than $100 billion. The analysis shows that 90% of this funding represents basic research related to the biological targets for drug action rather than the drugs themselves. The role of NIH funding thus complements industry research and development, which focuses predominantly on applied research. This work underscores the breath and significance
of public investment in the development of new therapeutics and the risk that reduced research funding would slow the pipeline for treating morbid disease.

This public funding is forgotten in the costs of a new molecule. Although in the price, the manufacturer surplus doesn't remunerate such contribution. Some adjustment should be applied, to be fair.

 Brassai at Mapfre Foundation in Barcelona