Smoking and health

Anna Gilmore of the University of Bath and her colleagues looked at how many people were admitted to hospital with a heart attack in England between 2002 and 2008. About 110,000 people are struck down each year.... Ms Gilmore and her team found that, in the 12 months after the smoking ban came into force, some 1,200 fewer people were admitted to hospital with heart attacks than even the prevailing downward trend had suggested was likely. That drop of 2.4% saved £8.4m in emergency hospital care. Breathe Easy, 'The Economist' (subscription), 10 June

There are several problems with drawing any policy conclusions from this. The most important is: what happened to physical well-being as a whole? Heart attacks might have fallen (though not by very much), but did other forms of morbidity rise? For instance (as pointed out by one of the commenters):

The prevalence of allergic asthma and allergic rhino-conjunctivitis decreased, in a dose-response manner (P = 0.03 and P = 0.004, respectively), with increasing exposure to tobacco smoke in the adult study population. ... This study demonstrates an association between current exposure to tobacco smoke and a low risk for atopic disorders in smokers themselves and a similar tendency in their children. Does tobacco smoke prevent atopic disorders? A study of two generations of Swedish residents. Hjern A, Hedberg A, Haglund B, Rosén M., 'Clinical and experimental allergy: journal of the British Society for Allergy and Clinical Immunology', June 2001

The other important qualification is that the reduction in heart attacks might have causes completely unrelated to bans on smoking: one correspondent suggests the withdrawal of hydrogenated fats from supermarket shelves.

More generally, results like this point to the need for broad indicators, not only of health, but of education, poverty, and well-being generally, including environmental well-being. Unfortunately, we are not geared up to using broad indicators for policy purposes. Or the broad indicators that do have de facto status as targets, such as Gross Domestic Product (or GDP per capita), are seriously flawed in that they bear no necessary relationship to well-being. Other indicators tend to be dictated by governmental structures, rather than the other round: policy is subordinated to the perceived need to keep public sector agencies happy, rather than to the well-being of ordinary people. (If this sounds far fetched, take a look at my piece on the New Zealand public sector reforms of the 1980s in my book.)

Social Policy Bonds would allow and encourage governments - and others - to target broad indicators of well-being; including those with a very long lead time. A new type of organization would result: one whose existence, structure and activities are totally subordinated to societal goals, rather than to current vested interests. If it comes to a choice between (say) a small number of heart attacks versus a higher incidence of asthma, then such choices, under a bond regime, would be made transparently and according to transparent criteria.