According to yesterday’s SMH,

Australia has overtaken the US to become the fattest nation in the world, with more than 9 million adults rated as obese or overweight.

But is this true? According to the most recent Australian National Health Survey, 35.4% of Australians over the age of 18 are overweight, and another 17.9% are obese, making 53.3% of us fat. That’s about 7.4 million people.

According to the American National Health and Nutrition Examination Survey, 66% of Americans are overweight or obese, with 31.4% obese.

Both surveys class people with a Body Mass Index of over 30 as obese, and those with a BMI of 25 or more but less than 30 as overweight.

So while we are a nation of fatties, on these statistics we are still a fair way from being the world’s fattest, our 53% lagging well behind the American 66%.

So where did the SMH claim come from?
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This morning’s ACNielsen poll attracted most attention for adding another week to Labor’s remarkable lead in the polls, but it also reported some interesting issue polling.

Alas, support for federalism - at least so far as it concerns hospitals - is no stronger than the Coalition primary vote. 40% think that it would be better if hospitals were run by the states, compared to 42% who think the federal government should do it.

I doubt that this is an ideological thing; federalism (as opposed to parochial concerns with ’state’s rights’) has never really been widely understood among the politically active, much less the masses. It is a pragmatic assessment of which level of government seems most competent, with 55% of those polled agreeing that the health system is ‘not very well run’, and nearly twice as many people (46%) blame the states for this as blame the federal government (24%).

Personally, I doubt the federal government would do a better job. The Canberra bureaucracy has relatively little experience of service delivery compared to their state counterparts, and with the added disadvantage of being very remote from the places they need to service. The one advantage of the otherwise poor policy on display in Mersey hospital takeover may be to provide evidence that the Commonwealth does no better at running hospitals than the states.

One much-publicised finding of the National Health Survey carried out by the ABS is that the self-reported mental health of Australians is declining. In the 1995 survey, 5.9% of the sample reported ‘mental and behavioural problems’, which increased to 9.6% in 2001 and 10.7% in 2004-05. An earlier ABS survey, carried out in 1989-90, came up with lower figures than 1995 - 3.8% reporting ‘nerves, tension, nervousness, emotional problems’ and 0.9% reporting depression. However, its question was different so comparisons should be made with caution.

The rapid increase has led to widespread concern, but also suspicion that there is something wrong with the numbers. Will Wilkinson has long argued that the depression trends (which are similar in the US) are fishy because they don’t match the happiness data. If there was a big increase in depression there should be a substantial increase in those with lower happiness ratings in subjective well-being surveys, but there is not in the US or UK.

In Australia, it’s harder to test this hypothesis because of inconsistent survey formats. In 1983 and 1984, two surveys giving very/fairly/not too happy options found 6% giving the ‘not too happy’ response. The two most recent surveys, the 2003 and 2005 Australian Survey of Social Attitudes, used 0-10 scales. If we count 0 to 4 as ‘unhappy’ we get 6.5% and 8.2% of respondents respectively as ‘unhappy’. The 2003 survey would seem to show little change in 20 years, consistent with what Will finds. The 2005 survey shows a more significant change. But both are below the mental problems reported in the National Health Survey.
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My new CIS paper (pdf) on mismatches in the graduate labour market is getting off to a rather slow media start (only the Courier-Mail so far, though a couple of other papers requested opinion pieces as well). The Australian and The Age are however running different stories on foreign doctor recruitment - and there is no better illustration than these of the problem I am talking about.

In fact, doctors provide a double tale in what goes wrong when governments intervene. This story starts in 1984, when the then Hawke government introduced the Medicare system, and in so doing ensured that the government picked up most of the tab for visits to the doctor. This in turn led to concern about escalating costs, on the (plausible) theory that if you charge people nothing or very little to go to doctor they will be more likely to do so.

In the early 1990s, the government formed the view that an over-supply of doctors was part of the problem. According to one report (no. 12 in the link)
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In the comments on my marriage and happiness post last week Andrew Leigh and I differed on the link between mental distress and well-being. It started when Andrew pointed to this paper (pdf) to argue that, as he put it, ‘divorce makes you happier’ (compared to a bad marriage, that is).

On average, I am pretty sure that’s right. But the paper he cited did not use the standard tests for well-being, which ask people to rate themselves on a scale according to how happy they feel, or how satisfied they are with their lives. Instead, it used the General Health Questionnaire (GHQ), which

is used to detect psychiatric disorder in the general population and within community or non-psychiatric clinical settings such as primary care or general medical out-patients. It assesses the respondent’s current state and asks if that differs from his or her usual state. It is therefore sensitive to short-term psychiatric disorders but not to long-standing attributes of the respondent.

When I replied that I did not think the GHQ’s measures of distress could be easily extrapolated to a measure of happiness, Andrew’s response was that

I think of them as measuring the same underlying stuff. See for example Blanchflower & Oswald’s recent paper that ‘validates’ cross-country happiness measures by showing that they correlate negatively with hypertension.

Though it seems intuitively plausible that the GHQ and subjective well-being indicators measure the same ‘underlying stuff’, as with happiness and marriage this is an area of disagreement among happiness researchers. In Understanding Happiness: A Theory of Subjective Well-being, now quite old (1992) but still one of the most interesting books on the subject, Bruce Headey and Alex Wearing note that:

a large minority give themselves scores which are surprising either because they rate high on both well-being and psychological distress, or low on both.

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“Ross Gittins is on leave” the SMH’s opinion page noted this morning, but we have not been spared a Wednesday Ross Gittins column. If anything, stand-in columnist Matt Wade’s effort this morning is lamer even than Ross’s standard debunking of economic growth.

Commenting on the fact that though the US has a per capita GDP it ranks well down the global list for life expectancy (29th, compared to 7th for Australia, according to Wikipedia), Wade says:

The figures suggest Americans have, on average, traded longevity for higher incomes over the past 50 years.

Huh? Life expectancy figures aren’t like happiness statistics, where there is an apparent paradox of stable self-reported happiness while GDP per capita has grown significantly. Life expectancy has gone up almost continually just as GDP in Western countries has increased almost continuously in the post-war period. That’s true of the US and it is true of Australia.

As Wade says, there are various idiosyncracies of the US that help explain why despite on-going improvement it ranks below other developed countries. These contribute to the stark differences between white and black life expectancy, apparent too in Australia on an even greater scale, but our Indigenous population is too small for it to have the same impact on average life expectancy.

But none of Wade’s explanations, with the possible exception of disputed theories about social structures and work conditions, suggest a trade-off between GDP and life expectancy. And to the extent that there is a trade-off, it works in life expectancy’s favour. As annual income grows so too does public and private expenditure on health. The long period of prosperity in Australia over the last decade has seen per capita federal spending on health increase by more than 35% in real terms. This has almost certainly contributed to increased life expectancy over that time.

While nobody thinks that GDP growth alone improves health (as opposed to providing some of the means for doing so), the reasonable inference from Wade’s article that we should not be so concerned about economic growth is wrong. Not only would it deprive us of resources needed to finance improved health care, it would add to the life stresses he suggests are harmful, as unemployment went up again and employed people’s jobs became less secure.