JOSEPH PRIESTLEY AND A BOTTLE OF POP
PROFESSOR STEPHEN LEEDER, EMERITUS PROFESSOR PUBLIC HEALTH, UNIVERSITY OF SYDNEY
A South African friend, passionate about finding effective ways of combatting obesity worldwide, recently sent me a clipping from The Yorkshire Evening Post of March 22, titled ‘How fizzy drinks were invented in Leeds on this day 250 years ago’.
The inventor was Joseph Priestley, the quirky theologian and polymath who had discovered oxygen years earlier.
Priestley came to live next door to a Leeds brewery, in which he took an inquisitive interest. He found that the gas given off by fermenting beer, which he called ‘fixed air’ to distinguish it from ordinary air, while toxic to mice, could be dissolved in water, giving it an agreeable flavour. He served the water to his friends, who liked it. And then, in the late eighteenth century, the Swiss J J Schweppe developed a large-scale process to carbonate water.
Today our concern with fizzy drinks is mainly with their huge sugar content and sugar’s contribution, the world over, to weight gain. With several countries introducing a sugar tax, such a tax is being considered here.
But as Linda Cobiac, King Tam, Lenner Veeman and Tony Blakely wrote in a paper in PLOS Medicine recently, ‘the cost-effectiveness of combining taxes on unhealthy foods and subsidies on healthy foods is not well understood’. Cobiac and colleagues are public health and health policy professionals in Melbourne, Brisbane, and Wellington, NZ.
They have developed a complex model of prices, relationships of salt, fat, sugar and fresh vegetables to disease states, and have used data from several countries about what could be achieved by taxing or subsidising certain foods.
Their simulations showed that ‘the combination of taxes and subsidy could avert as many as 470,000 disability-adjusted life years (that is, loss of life due to premature death and discounted years due to illness) in Australia’s 22 million people with a net saving [yes, a SAVING!] of $3.4 billion a year’.
I have a message for those who tell us that the costs of health care in Australia are unsustainable. If you want to save money, here are some approaches that could be tried – and confirmed or refuted by experimentation. This is an important caveat given that models are not the same as RCTs.
But this experimentation is surely better than trying to save health dollars by coordinating care, for patients with serious and continuing illness, between hospital and home – a demonstrably worthwhile thing to do – but which, because of the needs it uncovers, inevitably ends up costing more than standard fragmented care.
The authors draw a quiet and modest conclusion. “With potentially large health benefits for the Australian population and large benefits reducing health sector spending on the treatment of non-communicable diseases, the formulation of a tax and subsidy package should be given a more prominent role in Australia’s public health strategy.”
Their approach might seem unorthodox, but I can imagine that Priestley, the radical preacher, might be supportive. His beliefs cost him a berth as science adviser on Cook’s second voyage. He and his family, by fleeing to Pennsylvania, only just escaped death for their unorthodox theology.
He was a critical thinker and explorer. I fancy that, were he with us today, he might have encouraged us to try this out.