Tuesday 29 October 2013

One trillion dollars

"Why make trillions when we could make... billions?"

If you're serious about lifestyle regulation, you have to have a big number for the putative healthcare costs of Product X. The number mustn't account for the substitute diseases that people would get in the absence of Product X, nor should it include any savings or benefits that the product is responsible for. That would make the number lower or even negative, and the number must be big. In the US, the figure for smoking is said to be £96 billion. For obesity, it is said to be $190 billion.

And for sugar...

Sugar Linked To $1 Trillion In U.S. Healthcare Spending


Seriously?

Basically, the U.S. healthcare system spends about $1 trillion per year (and possibly more) fighting the effects of excess sugar consumption.


Yes, he's serious. So how does Dan Munro—for it is he—work that out?

He quotes from a recent Credit Suisse report...

“So 30% – 40% of healthcare expenditures in the USA go to help address issues that are closely tied to the excess consumption of sugar.” Credit Suisse Report – Sugar: Consumption At A Crossroads (PDF here)

At this level, the math clearly lacks scientific precision, but it does emphasize the huge burden associated with a single and truly ubiquitous substance – sugar. Assuming a U.S. National Healthcare Expenditure of $3 trillion per year – and further assuming we simply take 33% (the lower end of the Credit Suisse range), the calculation is easy.

Er, no. The calculation is easy if you look at the full quote from the report which gives the actual figures:

Obesity alone accounts for 20% (or USD 190 billion) of US national health expenditures and diabetes and metabolic syndrome account for a similar figure (though there might be some double-counting). So 30%–40% of healthcare expenditures in the USA go to help address issues that are closely tied to the excess consumption of sugar.

Note that the figures are given in the sentence that immediately precedes the quote Munro uses, so it is surprising that he missed them. It shows $190 billion for obesity and a "similar figure" for diabetes and metabolic syndrome. The high end estimate Credit Suisse are providing for all obesity, diabetes and metabolic syndrome is therefore $380 billion. It's impossible to say how much of this is attributable to the existence of sugar but it is clearly less than 100 per cent—nobody claims that sugar is the sole cause of obesity or diabetes.

Credit Suisse do not blame every case of these diseases on sugar—that would be silly. They merely say that these are the total costs of diseases for which excess sugar consumption is a risk factor. The sugar-related healthcare costs of obesity, diabetes and metabolic syndrome must be lower than $380 billion—probably much lower. Munro's claim that "the U.S. healthcare system spends about $1 trillion per year (and possibly more) fighting the effects of excess sugar consumption" cannot possibly be true.

It should be noted that Credit Suisse underestimate the US's total healthcare bill. $190 billion is obviously not 20 per cent of $3 trillion. Munro is right to say that healthcare costs are closer to $3 trillion than $1 trillion. That's a bit of a howler on their part (and strange, since they get it right in an earlier sentence), but Munro's decision to use their percentages while ignoring the dollars is much worse.

4 comments:

westcoast2 said...

Post Normal Science relies on Post Normal Maths, obviously.

Kj said...

The american diabetes association claims the lower end figure:
The study, Economic Costs of Diabetes in the U.S. in 2012, was commissioned by the Association and addresses the increased financial burden, health resources used and lost productivity associated with diabetes in 2012. The study includes a detailed breakdown of costs along gender, racial and ethnic lines, and also includes a breakdown of costs on a state-by-state basis.
Results

The total estimated cost of diagnosed diabetes in 2012 is $245 billion, including $176 billion in direct medical costs and $69 billion in reduced productivity.


http://www.diabetes.org/advocate/resources/cost-of-diabetes.html

I.e. 176 bn USD actual, payable medical costs.

Jonathan Bagley said...

What these claims always neglect is to subtract the health resources consumed by a "healthy" person who abstained from sugar/smoking/alcohol. These might include long term local authority and NHS resources spent on the diseases of old age, such as dementia. In the UK, at least, the cost of extra pension payments due to living longer should also be subtracted. This could be substantial. If,as claimed by ASH UK, smokers die 10 years earlier, the saving will be of the order of £60, 000. That alone buys a lot of health resources, considering that on average, each member of the population consumes £1,700 each year.

nisakiman said...

...considering that on average, each member of the population consumes £1,700 each year.

But what is the average for people over the age of, say, 65? I'd imagine that figure will be well above the £1,700 p.a. mark.