In terms of cold, hard cash, smoking is good for taxpayers. Public health campaigns aren’t

An article in the Guardian warns readers that ‘cuts to public health funding will cost the NHS dear’. This is a reference to the government’s plan to reduce local authorities’ budget for ‘public health’ by £200 million. The Guardian argues that this is short-sighted because money spent on prevention today is bound to save money on treatment in the future. Specifically, it says that a cut of £200 million will lead to at least £1 billion more having to be spent further down the road.

The source of this estimate is the Faculty of Public Health. The calculations upon which it is based do not appear to be available, but there are reasons to think that a cut of 6.7 per cent to a £3 billion budget will have no effect on taxpayers, now or tomorrow, other than saving them money.

As several local councillors have told me, the problem is that the money has to be spent on certain projects, regardless of local needs. This almost guarantees an inefficient distribution of resources. Local residents might prefer their money to be spent on the police than on ‘obesity management’, but their leaders’ hands are tied. If there is money still in the budget at the end of the financial year, it has to spent on something — and spending money because it has to be spent is unlikely to encourage prudence. Moreover, each council now has a director of public health (on a six-figure salary) urging them to spend it on the likes of ‘voluntary’ sugar taxes and outdoor smoking bans. One does not need to be an austerity hawk to see that there is fat that could be trimmed.

But there is a more fundamental reason to doubt that spending a pound on ‘public health’ today will save five pounds in a few years’ time. As the Oxford Handbook of Health Economics explains:

‘Although it is frequently argued (but not by economists) that prevention will save expenditure on future treatment, the current body of evidence demonstrates that it is more likely to generate additional health care costs.’

The simple fact is that when it comes to cold, hard cash, an ounce of prevention is not worth a pound of cure. A review of 599 studies found that 80 per cent of preventive health initiatives cost more money than they saved. Some, such as cancer screening, are inherently expensive, but even relatively cheap, population-wide health promotion projects, such as smoking cessation, cost more money in the long term by increasing demand for healthcare in old age.

There is no doubt that smoking saves the taxpayer money and there is evidence that this may also be true of obesity. The person who lives to 90 typically consumes a lot more healthcare than the person who lives to 75. Factor in the difference in pension payments and nursing home costs and the financial difference is vast. There are plenty to arguments for encouraging healthy living, but saving taxpayers’ money is not one of them.

Every special interest group likes to imagine that government spending on their pet projects is an ‘investment’ that will pay off further down the line. Sometimes it is, but often it is not (hello, London Olympics). The truth about spending on ‘public health’ initiatives is that they waste money if they don’t work and they cost even more — in the long run — if they do.


  • ChrisPrice4

    Spot on.

    The Public Health industry’s strive for longevity no matter what the cost is ridiculous both in terms of modern urban lifestyles and, more to the point, what the vast majority of people want. Indeed, it is tempting to say what everybody wants except the crackpots in the PH industry getting magnificent salaries and perks.

  • nisakiman

    The pogrom that has been unleashed on smokers by the ‘Public Health’ industry worldwide over the last few decades has indeed resulted in less people smoking. However, not only have billions been spent on the propaganda drives, but there has been no actual improvement in the public’s health to show for it. Cancer rates continue to increase, asthma affects more people than ever before, and diabetes is becoming endemic.

    The assumption that smokers have a shorter lifespan directly as a result of their smoking is also moot; not least because of the many anomalies that exist. One example of this is found in the fact that the Greeks, who have the highest per capita consumption of cigarettes in the world (about 2900 per adult per year, as opposed to UK at about 750 per adult per year) nevertheless enjoy an average lifespan the same as the British. Likewise, the Japanese, who top the league tables for longevity, are some of the heaviest smokers in the world. And the statement “Smoking causes lung cancer” also starts to look a bit moot when you have the Malaysian Semai people, who smoke from the age of two and live long and healthy lives. In a study conducted in the 1970s, of over 12,000 participants not a single case of lung cancer was found.

    The big problem with ideological agendas like anti-smoking is that the ‘health professionals’ involved are so fixated on the object of their disapproval that they completely lose sight of the original desired outcome. So instead of saying to themselves “Well, we’ve seen smoking rates decline dramatically, but there have been no improvements in health, so we must be barking up the wrong tree – let’s direct the money elsewhere”, they’ve become so obsessed with persecuting smokers that it has become an end in itself, and ‘health’ is merely used as an excuse to continue the persecution. (And of course to safeguard the comfy sinecure.)

    Tobacco Control in the USA gets more than $500,000,000 every year from the Master Settlement Agreement alone (H/T M J McFadden), not to mention all the government funding, the pharmaceutical industry funding etc etc. We’re talking HUGE sums here.

    So, has that vast annual spend resulted in concomitant improvements in health? Have there been similar or greater savings in health care? I’d wager that the answer is a resounding “NO”.

    • Zarniwoop

      Well said!!

  • dustybloke

    I can understand their concerns.

    If we abolished Public Health “Professionals” where would they go?

    Surely HR and PR departments are already stuffed to the gills with morons?

  • Nigel Shardlow

    This gives the impression that there’s a consensus amongst economists on the question of whether smoking saves the taxpayer money, where in fact there’s still a heated debate. As with most of these debates, choice of evaluation methodology makes all the difference. If we factor in economic value lost due to early morbidity and death (e.g. Rasmussen et al 2005), the picture changes; it changes again if we put an economic value on a human life (Tihonen et al, 2012).

  • gray cooper

    Unemployment for interfering Public Health professionals and the politicians who pay them.

  • Little Black Censored

    “Six-figure salary”! Why should anybody be paid that much of our money?

    • truckerlyn

      Good question – none of them deserve even a tiny fraction of that amount!