SECOND OPINION:SOMETIMES IT is hard to understand the way things are done in this country.
Policy-makers and public servants have an unfortunate habit of consulting the wrong “experts” when they try to solve public health problems. Experts who are part of the solution are ignored. A recent example is spending €35 million of taxpayers’ money developing plans for a new children’s hospital which was then refused planning permission.
We spend a vast amount of money before discovering a project cannot proceed or will not work for reasons that would have been obvious had the right people been consulted at the outset.
A new review group will consider the decision to refuse planning permission for the children’s hospital. The terms of reference include “informing itself about the planning considerations and processes affecting this project”. The good news is the group has two planners as members. It is hard to believe such a major piece of infrastructure could have got as far and cost as much as it did without considering the planning processes.
The National Obesity Taskforce published its report in 2005. Experts in the field knew obesity was strongly influenced by the built environment, food producers and public transport, yet none of the 20 members represented these sectors.
The group had seven doctors, who can do nothing about obesity other than treat the diseases that result, no local authority members, no farmers and no transport experts. Years later, obesity is an even bigger public health problem and we still have no children’s hospital. These are just two examples of the crazy way we go about things; some experts are included in great numbers and experts with an essential contribution are excluded from the decision-making processes.
The Government should have increased VAT rates on foods with high fat and sugar content in the last budget but didn’t. Instead, true to form, they consulted the food industry.
A new definition of bread was mentioned on RTÉ news when the Finance Bill 2012 was published and received no further media commentary even though it has serious health implications.
The Bill says baked products can now be defined as bread provided fats and sugars do not exceed 12 per cent of the weight of flour used in the dough. But bread can now have three times the amount of fat and sugar as previously and still have a zero tax rate. I was so sure the newsreader got it wrong I rang the Department of Finance to check the facts. There was no mistake: the definition of bread has changed and not for the better.
Forty years ago bread was assigned a zero VAT rate provided fat and sugar levels did not exceed 2 per cent respectively. Brown soda bread contained negligible amounts of sugar and fat, and yeast breads had less than 2 per cent. All other baked goods such as cakes and biscuits carried a higher rate of VAT. Since 1973 bread products have changed dramatically and now contain much higher percentages of fat and sugar.
The new definition of bread was formed following a wide-ranging consultation with the bread industry.
Baked products now defined as bread for zero VAT purposes can contain up to 12 per cent fat and sugar. The new definition means bagels, baps, blaas and pitta breads all now qualify for the zero VAT rate. This decision is bad news for obesity.
Why do policy-makers invariably fail to consult enough of the right experts when making decisions that are supposedly made for the good of society? It begs another question.
What is an expert? Mark Twain defined an expert as “an ordinary fellow from another town” which sums up the Irish approach to expertise. We still have very little confidence in the views of anyone who is not a member of an Irish elite or lobby group. We do not trust ourselves enough. People are often selected for strategic groups because of who they are, instead of what they know or what they can do.
The children’s hospital debacle shows that a brilliant paediatrician knows nothing about building.
Economists should have been consulted about VAT on bread.
The drinks industry should have no say in a ban on alcohol sponsorship.
It is simple.
Know what the problem is before deciding which experts have the solution. We are still doffing the cap.
Dr Jacky Jones is a former regional manager of health promotion with the HSE