Looking for Health Outcomes from Health Policies

Everything is effective. Give somebody a potent drug and it will surely do something to them. Enact a health policy and it will surely have an effect. In fact, the effects will certainly be many – both desired and undesired. But for both drugs and health policies, the target is health. So we’d best be sure we’re having a positive net effect on health and well-being.

Risk/Benefit Analysis

For a new drug or a new vaccine, checking this box is pretty routine. Randomized, controlled trials give definitive answers about desired effects and adverse events (AEs). An approval comes when the data is sufficient to show that benefits outweigh the risks.

But that’s not the end of it. Postmarketing surveillance continues to look for rare, but serious AEs. When those problems pop up, regulators and experts stop to think. Is the benefit of this product sufficient to justify this risk? Will warning be good enough to deal with this risk? Or must we ban this product?

A Bigger Challenge for Health Policies

Health policies present a bigger challenge. In the case of a vaccination program, we might have controlled trials to tell us it will have a clear benefit for public health. But for non-communicable diseases (NCDs), solid evidence for health benefits is more difficult.

One of the big successes has been tobacco control. Taxes and smoking restrictions have yielded reductions in smoking. Vaping has had an effect, too. Less smoking has brought less heart disease and less lung cancer.  Though smoking cessation may add to obesity risk, most analyses show a net benefit.

Showing the net benefit for nutrition policies has been harder. Trans fats are clearly implicated in heart disease and calling them out on nutrition labels has paved the way for a ban. Most will agree that this is a good outcome.

Ironically, though, one of the factors that brought trans fats into wide use was the fear of animal fats. In the 1980s, health advocates pressed the food industry to switch from animal fat to hydrogenated vegetable oils, bringing more trans fats into the food supply.

Sugar Taxes Work!

But please forgive us for being curious and skeptical about the effects of taxes on sugar sweetened beverages. Yes, we know that taxes lead people to consume less of what gets taxed. However, history tells us that they inevitably consume more of something else.

In the U.K., folks say that the industry is responding to a sugar tax by taking sugar out of their beverages. That’s great. It provides some assurance that the net effect of that tax may be positive.

In the case of the Philadelphia sweetened beverage tax, we have no such assurance. In fact, the city is taxing low-sugar sweetened beverages, too. But they’re not taxing that latte at Starbucks with 50 grams of sugar. Nor are they taxing sugary fruit juices. And of course, people can seek pleasure in other beverages.

What will people drink instead of their Coke and Diet Coke? Water? A little more beer? Perhaps apple juice or a sugary vanilla latte? Time will tell. But until we have real data for the net effects of the soda taxes, don’t waste your breath telling us you know how well they work.

We simply don’t know that they work to improve health. It’s a great experiment. Let’s measure the real results.

Click here for perspective on prioritizing NCDs, here for experimental data on taxes and labeling, and here for PR to promote sugar taxes. For a thoughtful reflection on the unintended consequences of anti-obesity policies, click here.

Drinks, photograph © Vincent Anderlucci / flickr

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June 17, 2019