World Bank looks at our vices BY ERROL OH

by **Cals** Mon 25 Nov 2013, 01:37

Published: Saturday November 23, 2013 MYT 12:00:00 AM
Updated: Saturday November 23, 2013 MYT 7:01:15 AM
World Bank looks at our vices

BY ERROL OH

A report on risky behaviours highlights their impact on development
ON the surface, the idea of the World Bank producing a report on our vices is incongruous.
It’s akin to the International Olympic Committee compiling rankings of the best burger joints. Why would an influential global institution work on a subject in which it has no apparent relevance and expertise?
However, let’s not forget that despite its name, the World Bank is not a typical bank. Yes, it provides some financial products and services – primarily low-interest loans, interest-free credits, and grants – but these are given to developing countries as part of its twin goals of ending extreme poverty and promoting shared prosperity.
Says the bank in its website: “The World Bank is a vital source of financial and technical assistance to developing countries around the world. We are not a bank in the ordinary sense but a unique partnership to reduce poverty and support development.”
And that explains the bank’s publication on Wednesday of a report titled Risking Your Health: Causes, Consequences and Interventions to Prevent Risky Behaviours.
The bank argues that smoking, use of illicit drugs, alcohol abuse, unhealthy eating and unsafe sex are contributing to “the burden of disease across the world”.
In the end, says the bank, society as a whole suffers because such risky behaviours push up public health spending and reduce productivity.
In the foreword to the report, World Bank chief economist for human development Ariel Fiszbein wrote: “Understanding the factors driving those behaviours, their incidence, and consequences, and the effectiveness of policies and programmes to affect them in a sustainable way, represents a priority not only from a public health perspective but from a broader development one.”
Here are some interesting points from the 200-page report:

l Malaysia ‘lights up’ the report
A few of the studies cited in the report included Malaysia. One of these worked out the opportunity costs of smoking by converting the cost of cigarettes into the working time required to earn the same amount or to the number of calories that could have been purchased.
The 2012 statistics covered eight countries: India, Kenya, Malaysia, Mexico, Peru, Romania, South Africa and Thailand.
In Malaysia, 37 minutes of labour was required to buy a pack of cigarettes. That placed Malaysia in fourth place. The highest opportunity cost was in Kenya, with 57 minutes.
In addition, the cost of a pack of cigarettes in Malaysia in 2012 was equivalent to 1.76kg of rice. Using the assumption that 100g of uncooked rice provides 350 calories, a smoker was forgoing over 6,000 calories so that he could buy that pack. In terms of calories, Malaysia had the third highest opportunity cost among the eight countries.
The report points out that because tobacco-related illnesses usually require hospitalisation, the direct costs of smoking can be high. According to figures showing total direct costs of smoking in 12 countries in 2010, Malaysia’s direct costs of US$922mil “could have funded its entire rural development programme”.

l Tax them and they may quit
If healthcare objectives remain a priority, we may see more price hikes for cigarettes and alcoholic beverages.
In the introduction to the report, Damien de Walque, senior economist in the World Bank’s research department and principal editor of the report, wrote: “Tax policies have been shown to be effective as instruments to prevent smoking and alcohol consumption, but so far they have been less effective for reducing the use of unhealthy food.
“Most of the evidence comes from developed countries, but an emerging literature from developing countries points in the same direction.
“Taxing unhealthy behaviours is an attractive policy option, since it also increases government revenue, even if it might encounter political opposition. Substitution across products and subcategories of products is a key issue to keep in mind when devising tax policies.

l The law versus awareness
A chapter of the report reviews two kinds of non-price interventions aimed at changing risky behaviours – legislation, and information, education and communication (EIC) campaigns. Not surprisingly, the conclusion was that using the law seems to be more effective, particularly when paired with strong enforcement mechanisms.
“In general, information and education campaign programmes have been found to be less effective in changing behaviour,” says the report. “Calorie labelling laws and school-based sex education programmes are effective in informing consumers about the risks associated with certain behaviours. But translating that knowledge into concrete and consistent changes in behaviour seems to be harder to achieve.”
However, the World Bank says EIC programmes can work if the messages are targeted and reinforced at regular intervals.
“It can also be the case that information and education campaigns work to influence general societal attitudes toward risk, and they are accordingly harder to measure, making it more challenging to prove effectiveness.”

l When length matters
At the same time, the bank says it can be argued that behaviour change programmes may be more effective in the long run than legislation.
“For example, if changing consumer preferences results in alterations in demand, this dynamic may have longer-lasting effects in reducing risky behaviours than by constraining supply, since demand often bounces back when supply returns,” it adds.
“As demonstrated, changing consumer behaviour over a prolonged period is challenging and may require a combination of interventions and incentives.”

Executive editor ERROL OH wishes unhealthy eating is not classified as risky behaviour.