What’s better: (A) voluntarily reducing your salt intake, or (B) having the government mandate that you do so? Naturally, if you don’t opt for A, you get B, which we can call the Bloomberg option.
Why reduce salt? Well, there’s a chance—a small one, but non-zero—of exacerbating your high blood pressure, assuming you have that condition, and because of the possibility of exacerbation, you might live a slightly shorter life. Sure, this possibly shorter life you lead will be full of flavor, and the time you spend here will be more savory, but no citizen should choose quality over quantity when it comes to life. Right?
Linda Cobiac spends her days fretting about the amount of salt Australians ingest. She is so worried that she wrote the peer-reviewed paper “Cost-effectiveness of interventions to reduce dietary salt intake” in the eminent journal Heart. She and her co-authors conclude that “maybe there is an ethical justification for government to step in and legislate” the amount of salt citizens can buy in their food.
How did they come to this—nowadays, non-remarkable—conclusion? Why, with a computer model. Specifically:
We consider strategies ranging from those that aim to change individual dietary behaviour, to the current programme of incentives for voluntary changes by food manufacturers, to a more paternalistic approach with government legislation of more moderate salt levels in processed foods.
Shouldn’t that have read, in our more sensitive age, maternalistic approach? But never mind.
They began with a bag of assumptions, such as that as more salt is eaten, less life is lived. They then plugged more salt eaten into their model and were able to show that as more salt is eaten, less life is lived. They also assumed that government mandates to reduce salt will reduce salt most effectively; and they found, after modeling, government mandates reduce salt most effectively. This style of modeling will sound familiar to climatologists.
To quantify less life, they used the scientific-sounding DALY, which is to say disability-adjusted life years, a measure concocted and beloved by bureaucrats. I can think of no scale more easily abused, or more easy to abuse, than this curious number created in the laboratories of the World Health Organization.
DALY is bad; that is, high DALYs are worse than low ones. DALY is a sum of the years of life lost due to a person having an affliction and the number of years the person has lived with the malady.
This means that a 30-year old with chronic bursitis who dies at 80 has a DALY of 50, assuming that the man would have lived as long had he not had the bursitis. Another way to have a DALY of 50 is stroking out at 30. Of course, this also assumes that the man with the stroke would have certainly lived to 80—and not 81 or 79 etc.—had he not had the stroke.
When I used the word assumes in the above paragraph, I mean it in the same technical sense as our authors meant: that is, as a wild-ass, non-verifiable guess. Population DALYs are often used as replacements for individual DALYs, in the charming hope that averaging across many will reduce errors in the assumptions.
Who gets to decide what afflictions count toward the DALY? Bureaucrats. They always start with scary maladies like cancer, but they soon start tacking on less frightening illnesses like hypertension or post traumatic stress syndrome.
The consequence is that if you add on every little departure from “ideal” health, then soon a population’s average DALY will tend toward some fixed number because everybody has to die of something and everybody gets sick. Then, every time a government introduces a new program to decrease population DALY, they will fail, because DALY cannot go down. Which means more funds will be needed perpetually in the “war against high DALYs”. It becomes just like the “war against poverty” some politicians wage when they bellyache that half of all people earn less than the median income.
The real magic comes when DALY is married to money. All you have to do is to say each DALY is worth $X. Thus you can, like our authors did, say reducing salt not only saves lives, but it also saves money, which is more important. And certainly more tangible. Proposing laws to reduce spending are more palatable than laws proscribing salt.
This isn’t just Australia, friends. The authors say:
In an important step, the US Institute of Medicine, in their recent report on strategies to reduce sodium intake in the USA, recommended that voluntary strategies be considered only as an interim measure, with a primary recommendation to set mandatory national standards for salt content in both processed foods and foods prepared outside the home.
The key word is mandatory.
(And people thought this article was a joke.)