Matt Yglesias

Needles in Haystacks

I think we might do a lot of good in the world, and even improve people’s personal decision-making, if we made everyone take a basic statistics class in high school. Certainly both the mammogram dispute and the post-Nidal Hasan resurgence of interest in “profiling” of Muslims is a reminder that most people don’t intuitively grasp the Bayes’ Law point about accurate tests for rare conditions. I’m finding it annoying to watch all these people with no relevant medical or scientific expertise sounding off about who should get checked for breast cancer, so let’s talk about terrorists instead.

Suppose I invent a magical device that can be pointed at a Muslim and say with 90% accuracy whether or not he’s an al-Qaeda operative. Well, if I start waving it around and it starts beeping on one guy, what should we conclude about him? A terrifyingly large number of people are going to say “there’s a ninety percent chance he’s with al-Qaeda! Let’s panic!” In fact, that’s not the case. There are a billion Muslims in the world. A test with 90 percent accuracy is going to mistakenly classify about 100 million of them as al-Qaeda operatives. And al-Qaeda actually has fewer than 10,000 people working for it. I’m going to get something like 10,000 false positives for every actual terrorist I find.

Meanwhile, applying the test to people is going to have severe consequences. The public doesn’t understand this correctly and is going to be put into a wholly unwarranted state of panic about the prevalence of terrorists. People will, of course, demand that those flagged by my machine be subjected to extra-heightened scrutiny. It’s easy to imagine lots of innocent people being mistakenly killed or subjected to discrimination or shunning. And that sense of beseigement and unfair treatment would ultimately heighten tensions between the world’s Muslims and the West, while wasting massive quantities of law enforcement resources chasing basically worthless leads.

Better Lunch, Better Test Scores

I think it’s pretty intuitive that better-nourished kids will do better in school, via Ezra Klein comes Tim Harford explaining that the combination of Jamie Oliver’s drive for better school lunches and the UK’s rather comprehensive testing let us put the proposition to the test:

Their answer – a provisional one, since they are still refining the research – is that feeding primary school kids less fat, sugar and salt, and more fruit and vegetables, has a surprisingly large effect. Authorised absences, the best available proxy for illness, fell by 15 per cent in Greenwich, relative to schools in similar London boroughs. And relative to other boroughs, the proportion of children reaching Level Four in English rose by four and a half percentage points (more than six per cent), while the proportion of children achieving Level Five in Science rose by six points, or almost 20 per cent.

Of course there’s a strain of liberal in the United States which holds that it’s illegitimate to use student test scores as a way of measuring the efficacy of education policies. But from where I sit this looks pretty convincing. Meanwhile on the flipside there’s an unfortunate tendency in some education policy circles to act as if we should only try to improve student performance through methods that antagonize teacher’s unions. But better lunch works too, it seems.

Obama Administration Endorses Paid Sick Leave

It’s not quite the high-profile issue that health care or climate change is, but there’s been some interesting developments recently on the quest to get paid sick leave for all of America’s workers. The fact that many American workers get no sick leave whatsoever is rarely discussed in elite circles, most likely because, as Steven Greenhouse has highlighted with this chart, the phenomenon is quite class bound:

Advocates for changing the situation have made headway in terms of linking the issue to fears about the spread of H1N1 flu. Does it really serve even the interests of prosperous professionals to live in a country where low-wage food service workers, for example, are likely to show up at work while sick and infect everyone else? This was discussed at a recent CAP panel featuring, among others, Vice President Joe Biden and Domestic Policy Council chief Melody Barnes where they seemed generally supportive. But things took another important step forward today in the somewhat obscure venue of the Senate HELP Committee’s Subcommittee on Children and Families where Seth Harris, Deputy Secretary from the Labor Department, came to offer a strong statement of support for paid sick leave:

In conclusion, it is clear that while much has been done to help prepare for a national health emergency like 2009 H1N1, more is needed to help protect the economic security of working families who must choose between a pay check and their health and the health of their families. That is why the Administration supports the Healthy Families Act and other proposals that advance workplace flexibility and protect the income and security of workers. I appreciate your time today, and I am happy to answer any questions you may have.

It’s worth observing that this bill would, among other things, be a specific boon to parents since it would allow you to take sick leave in order to take care of a sick child. You’d think that might be the kind of thing “pro-family” conservatives would be interested in along with us godless socialists.

Less Than Zero

Erin Riley tweets from Australia:

Apparently all I need to do to get my Swine Flu shot is rock up at the doctor’s tomorrow. And it’s free. #ilovesocializedmedicine

Something that tends to get obscured in the health care debate is that a number of very different kinds of activities are undertaken under the banner of “health care.” When it comes to cutting-edge medical treatments, you can see the case for a robust private sector role—it’s about innovation.

But an awful lot of medical care is extremely routine. Someone falls and breaks his leg and needs the broken bone set. Someone needs stitches. Someone needs a strep throat test. If the test is positive, he needs antibiotics. Vaccines need to be administered. In situations like these, innovation is really not at issue. And with some of this stuff, like with the H1N1 vaccines, there’s a substantial public health issue in play. You really, really, really want the people who need the vaccine to get the vaccine. It’s much cheaper to give a vulnerable person a vaccine than to treat them after they get sick. And of course getting enough people vaccinated against things like measles is crucial to preventing new epidemics from happening. This sick of basic health care should really be free—perhaps provided by a robust national public health service with a nationwide network of clinics. In fact, ideally it would be cheaper than free so that nobody goes without the appropriate level of vaccinations, blood pressure tests, etc.

States’ Rights to Deadly Car Crashes

As I wrote yesterday, legal crackdowns on distracted driving are a public health no-brainer. When you try to pilot a fast-moving and extremely heavy vehicle while also sending and receiving text messages and phone calls, you are endangering not only your own life but the life of everyone else trying to get from point A to point B. Thankfully, members of congress are considering legislative action to address the problem. Oddly, however, as Elana Schor explains it’s become a point of political contention.

Basically Jay Rockefeller and a group of three Republicans wants to offer extra money to states that tackle distracted driving. But back in July, a group of Democratic senators proposed penalizing states that fail to pass bills tackling distracted driving. Chuck Schumer, sensibly, is on board for both approaches. Kay Bailey Hutchison, less sensibly, opposes the stick approach and does so in a manner designed to analogize herself to white supremacists:

“I don’t think we ought to get into states’ rights,” Sen. Kay Bailey Hutchison (R-TX), who is campaigning for her state’s governorship next year, said. “[T]he states have addressed this in very different ways, but many of them are addressing it.”

Vernon Betkey, chairman of the Governors’ Highway Safety Association (GHSA), which represents state highway officials, echoed Hutchison’s stance in a Thursday appearance before the House transportation committee.

Hutchison’s opponent, of course, is Rick Perry who’s been making noise about secession recently. Obviously there’s something in the water down there.

As for the merits of Hutchison’s proposal, it would be interesting to see a legislator stake out a principled opposition to all federal conditional financial grants. You could do that either by opposing all federal financial grants (no money for highways, schools, etc.) or by opposing all conditionality. But to stake out the view that there’s nothing wrong with conditional grants per se but that we daren’t interfere with states’ sacred right to permit dangerous driving practices seems very strange.

Penalizing Dangerous Driving

Elisabeth Rosenthal reports on the UK’s crackdown on texting while driving:

Inside the imposing British Crown Court here, Phillipa Curtis, 22, and her parents cried as she was remanded for 21 months to a high-security women’s prison, for killing someone much like herself. The victim was Victoria McBryde, an up-and-coming university-trained fashion designer. [...] The crash might once have been written off as a tragic accident. Ms. Curtis’s alcohol level was zero. But her phone, which had flown onto the road and was handed to the police by a witness, told a story that — under new British sentencing guidelines — would send its owner to jail.

In the hour before the crash, she had exchanged nearly two dozen messages with at least five friends, most concerning her encounter with a celebrity singer she had served at the restaurant where she worked.

A few thoughts on this. One is that if Curtis had been walking down the street firing bullets into the air at random, and one fell and killed someone, I think she would have been sentenced to a lot more than 21 months. Another is that despite the cliché about car “accidents” the fact of the matter is that fatal motor vehicle collisions typically involve someone breaking the rules. This, after all, is why the rules are there. The traditional social convention in the United States (and apparently the UK as well) that the rules governing the safe operation of fast-moving incredibly heavy pieces of equipment should be routinely ignored or treated as no big deal is really crazy.

As I noted almost 100 people per day die in car wrecks in the United States. Fortunately, thanks in part to increased attention to the need for sensible, well-enforced rules, driving is becoming less fatal:

This trend is great, and we should be trying to continue it. One way to do so is to get serious about the dangers involved in cell phone use, including texting, while driving. Since these technologies are new, we know for certain that people are perfectly capable of getting along in life without using mobile phones while driving their cars. We also know that using them is very dangerous. Under the circumstances, fairly harsh, well-publicized penalties are called for. This is a situation where deterrence really ought to work extremely well.

WHO/UNICEF: Diarrhea Kills 1.5 Million Children Per Year

UN officials calculate that 1.5 million children per year die of diarrhea, often easily preventable:

Ann Veneman, the head of Unicef said this was a ‘tragedy.’

‘Inexpensive and effective treatments for diarrhea exist, but in developing countries only 39 percent of children with diarrhea receive the recommended treatment,’ Veneman said.

A new vaccine was developed for Rotavirus, an organism responsible for more than 40 percent of all diarrhea, but it remains out of reach in most of the developing world, the UN said.

That’s former Bush cabinet member Ann Veneman, so it’s not like this is special socialist math or anything. I find it endlessly frustrating that these kind of stories go unremarked in elite political commentary circles, but whenever there’s some pseudo-plausible argument that launching a bloody, multi-billion dollar invasion of Iraq or Sudan or Burma or whatnot everyone’s buzzing about it.

The GAVI Alliance funds a rotavirus program in conjunction with the CDC and the WHO that could almost certainly use more funding. This kind of issue is also an excellent example of the kind of health problem where we should be trying to rely more on prizes than on patents to finance R&D.

Light Rail Exceeding Expectations in Phoenix

Phoenix is hardly a transit-oriented metro area, but it does have a new light rail system and Mark Munro explains that it’s working out great:

Now comes Valley Metro, in one of the most apparently unpromising locations for transit of all, and it’s working, though not quite the way transit does in, say, New York, Boston, or Washington. Every day, Valley Metro attracts some 33,000 riders, way above the projected 26,000. But what’s interesting is the clientele. Unlike systems elsewhere, which are used principally by commuters, the 20 miles of rail in Phoenix running along the central spines of Phoenix and then through Tempe to Mesa are used largely by students shuttling between Arizona State University’s downtown and Tempe campuses, and people going to restaurants, bars, ball games, and cultural events downtown. Only 27 percent of the system’s riders use it for getting to work (compared to 60 percent elsewhere), which suggests that for now at least the Phoenix light rail will flourish as a sort of jitney service supporting a post-industrial metropolis’ ongoing cultivation of a classic entertainment district downtown, higher education there and in Tempe, and associated nodes of new and intensified development along Central Avenue.

Moving possibly intoxicated students around seems to me to be an underrated virtue of public transportation. Austin’s a fun town, for example, but when I was there I wished there weren’t quite so many people driving around after having so much fun. Growing up in New York then going to school in Boston and moving to DC, I’ve never really dealt with drunk driving youth culture on a consistent basis. In the parts of the country where there are no good alternatives I guess people are just accustomed to that sort of thing happening. But it’s really bad and dangerous.

Rep. Shadegg Warns of “Soviet-Style Gulag Health Care”

Not content with out of control Hitler analogies, Rep John Shadegg (R-AZ) took to the floor yesterday to demonstrate that he’s a fool. Lee Fang has the quotes:

SHADEGG: You know, it occurs to me, and I’ll go through these other scandals very quickly, but what we’re really getting here is we’re not just getting single-payer care. We’re getting full on Russian gulag, Soviet-style gulag health care [...] It appeared in last Friday’s Wall Street Journal. You can Google it. You can pick up the phone and call Kim Strassel. You can ask her about Soviet-style gulag health care in America, where powerful politicians protect their constituents.

Lee reminds us that “The Soviet gulags were a network of prisons and forced labor camps that held as many as 20 million people during Stalin’s reign of terror.” To compare a set of insurance regulations you happen not to favor to Stalin’s mass imprisonment and slaughter is ridiculous, and absurdly insensitive to the real victims.

Massive human rights violations aside, I would also note that health care was among the strong points of the Soviet economy, along with primary and secondary education, armaments, and mass transit.

What Is Preventive Medicine?

I think it’s interesting how opposition to health care reform will drive people to reject really banal elements of common sense. Here, for example, is Heather Mac Donald slamming the idea that medical professionals should do more preventive work:

We need to induce doctors to practice preventive, not just reactive, care! is a favored nostrum in the current health care debate. I’ve yet to hear an example of what this means. Prevention lies overwhelmingly within the realm of individual behavior, but our modern reflex of transferring agency from favored victim groups—in this case, millions of artery-clogged, waddling Americans—onto less-favored entities guarantees that we see the problems of Fat America as the failure of doctors to practice the right kind of medicine. Perhaps more doctors could counsel their patients to exercise and avoid over-eating, but my guess is that if they stay silent on these topics, it is from hard-won experience regarding the futility of such suggestions.

This is very strange stuff. Obviously, prevention is largely in the hands of individual behavior. At the same time, it’s much easier to guide your behavior in the direction of good health if you’re given relevant information about your health needs. Given such information by, for example, a medical professional!

For example, healthy eating is actually not equivalent to “don’t be fat.” How fat or thin someone is has very large genetic elements. But eating an unhealthy diet is still unhealthy even if it doesn’t make you fat. But many people (including Heather MacDonald it seems) aren’t aware of this. You might think you’re in fine shape, but actually have a serious cholesterol problem. Your doctor can reveal that fact and give you advice on how to improve it. As I recall, this happened to my always-svelte dad and he stopped eating peanut butter. A doctor once pointed out to me that it’s healthier, per unit of alcohol, to drink red wine than beer, which had never really occurred to me. Now arguably MDs are overqualified to be dispensing this kind of advice. But the point is that dispensing advice of this sort can be a much more cost-effective way of improving health outcomes than is doing surgery decades later after the cholesterol has done its damage.

The Snack Factor

Nacho Cheesier Doritos

Ezra Klein brings some useful social science to bear on the question of whether urging people to cook at home more would improve public health:

[Jamie] Oliver wants to change the way low-income communities approach meals. The problem is that the evidence suggests meals aren’t driving the rise in obesity — snacks are. A 2003 paper by economists David Cutler, Ed Glaeser and Jesse Shapiro looked at an array of different ways to measure caloric intake, and found that most meals aren’t getting much bigger. Dinner, in fact, might be getting a bit smaller. The big increase in caloric intake actually came between meals. In 1977, Americans reported eating about 186 calories outside of mealtimes. By 1994, that had rocketed to 346 calories. It’s likely even higher now. That difference alone is enough to explain the changes in our national waistline. And it won’t go away if we begin cooking dinners but still are purchasing 20-ounce bottles of Coke at the office.

This actually suggests that cultivating cultural taboos against prepared food—which is part of the Oliver/Pollan argument for cooking—actually could improve public health significantly. It’s just that the mechanism wouldn’t be substituting home cooked dinner for Taco Bell, the mechanism would be that if you eliminated prepared food from your diet you would almost have to cut down on your snacking substantially since you’re not going to get up from your desk and whip up some spaghetti carbonara in the middle of the afternoon.

That said, tackling the real causal mechanism seems preferable. Maybe offices should keep bowls of grapes hanging around? Evidence indicates that you could modestly improve public health and raise a nice chunk of change with a soda tax. Presumably something similar would apply to taxing chips and candy and so forth. You could fund a grapes-promotion program with the money. Or, you know, a robust national network of free clinics at which people could receive basic health care treatment and nutritional advice.

I should add that I have nothing against people who love to cook trying to share their enthusiasm with the world. Personally cooking is something I like to do, and it’s not something I learned from my family, it’s something I picked up from NYT Magazine articles about how great cooking is. But public health is still a serious issue and people shouldn’t just assume that their hobbies hold the key to saving the world.

What The World Needs From Its Celebrity Chefs

I have to say that I’m getting a bit tired of reading different versions of this article:

While he understands the allure of Home Wreckers and Big Macs alike, this British celebrity chef has made it his mission in recent years to break people’s dependence on fast food, believing that if they can learn to cook just a handful of dishes, they’ll get hooked on eating healthfully. The joy of a home-cooked meal, rudimentary as it sounds, has been at the core of his career from the start, and as he has matured, it has turned into a platform.

Grrr. I like to cook. Sometimes. I think it’s fun. And I”m certainly glad I know a few recipes. I hope to learn more. And everyone should know a few. But the idea that a large-scale increase in the proportion of home-cooked meals is the solution to the world’s public health problems really makes very little sense.

If over time people were getting poorer, but the number of hours in the day was getting longer, and gender norms were shifting toward the idea that women should get married young and drop out of the workforce in order to do unpaid domestic work, then obviously people would start cooking more. But that’s not what’s happening. Compared to people in 1959, people in 2009 have more money, less time, and less ability to call on socially sanctioned unpaid domestic labor. So obviously they’re going to cook less. Or to look at it another way, there are lots of things you can do in 2009 that you couldn’t do in 1959—read a blog, download an MP3, get a movie from Netflix on Demand. There are also a lot of things you can do in 2009 that were prohibitively expensively in 1959—fly cross-country, make a long-distance phone call to your sister. But there’s no more time in the day. Which implies that people need to spend less time doing the things that you could do in 1959. Sometimes we can get out of this box by finding technological innovations that let us do things more quickly, but you can’t really speed up cooking from scratch.

The good news is that there’s no real reason to think that food you prepare yourself is for some reason intrinsically healthier than food someone else prepares for you. Indeed, a normal “home cooked” meal is mostly eaten by people who didn’t cook it. One or two people cook, and the kids or the guests eat. And at the same time, it’s not as if the good people at Taco Bell are serving unhealthy food out of some perverse desire to clog America’s arteries. They’re just trying to make money the best way they know how. If someone—Jamie Oliver, for example—devised an appealing mass-market food product that was better than Taco Bell on the taste/price/convenience dimension but also healthier, well that would be an excellent thing for the world.

And maybe someone could do it. The world’s purveyors of processed foods have noted a real market demand for healthier products. Consequently, they’re poured a lot of time and energy into creating things that at least seem healthier. And so we really have a lot of healthy-seeming options. But they’ve never, as best I can tell, poured all that much effort into trying to create things that are actually healthier. But someone could. Jamie Oliver could do it. Mark Bittman could do it. Michael Pollan could do it. And it would be more likely to succeed than an endless procession of NYT Magazine articles hectoring people about how they should cook more.

Calorie Labeling in New York

So how’s New York City’s new law requiring chain restaurants to disclose nutritional information working out? Kevin Drum reports not so well:

The full study is here. Results are below. The researchers chose 14 fast-food outlets in low-income NYC neighborhoods (Newark was a control group) and interviewed a few hundred people both before and after the calorie labeling law went into effect, asking them if they’d noticed the calorie countsand if they’d changed their selection because of it. Then they got receipts from each respondent so they could find out what they’d actually purchased.

The results were pretty dismal: only about half the respondents even noticed the calorie counts and only 15% said they influenced their choice. But the receipts told an even more dismal story: overall, people actually purchased more calories after the law went into effect. The results aren’t statistically significant, though, so basically all the researchers can really say is that the law (so far) hasn’t had any effect. The only glimmer of good news is that among people under 35, respondents who noticed the labeling did seem to cut back a bit. No other subgroup showed any effect. So who knows? Young people probably respond to this kind of thing more quickly than older people, so maybe it’s just going to take some more time before all this stuff sinks in.

The fact that half the people don’t even notice the information is a bad sign. Obviously the point of having this stuff displayed is for people to read it. Especially given how few people so much as saw the signs, I don’t think it should be hugely surprising that the actual results here are less than stellar. When you think about it, a calorie labeling rule would probably have more impact among middle class or rich customers (yes, there are rich people eating fast food) than in a low-income neighborhood. If you introduce nutritional information to a population that’s acculturated to spending a lot of time worrying about losing weight, then you can see where the impact would come in. But if you’re talking about a low-income community where people are worrying about other things, then what difference is information going to make?

At any rate, more research required, says I.

John Ensign Makes the Case for Transportation Reform

Steve Benen observes a curious exchange at the Senate Finance Committee:

“Are you aware that if you take out gun accidents and auto accidents, that the United States actually is better than those other countries?” Ensign said. Sen. Kent Conrad (D-ND) had been citing the health care systems of France, Germany, Japan and Canada as more effective, but with lower costs.

Conrad responded that one can bend statistics in all sorts of ways.

“But that doesn’t have anything to do with health care. Auto accidents don’t have anything to do with h–,” Ensign said, cutting himself off. “I mean we’re just a much more mobile society. … We drive our cars a lot more, they do public transportation. So you have to compare health care system with health care system.”

What Ensign is saying here—that gun accidents and car accidents fully account for the life expectancy gap between the US and other countries—isn’t true. But the more modest claim that lifestyle factors play a larger role than health care in determining health outcomes is true. That said, it seems like the reasonable thing to conclude from the charitable reading of Ensign’s argument is that we ought to reform American transportation policy to take advantage of the public health benefits of a more European-style approach. But Ensign doesn’t see it that way. He’s never done anything to help move the country to a less car-dependent way of life. Even though his estimate of the public health benefits of such a switch is much larger than my estimate!

It’s very strange. Unless you think Ensign has just dredged this argument up opportunistically for the sake of a one-off political fight and he neither knows anything about the subject nor cares at all.

The Case for Alcohol Taxes

Mark Kleiman makes the case for higher alcohol taxes:

I should also offer a mea culpa for whining about high soda prices after repeatedly blogging that I think a soda tax would be a good idea. As a heavy Diet Coke drinker, such a tax would be annoying to me personally but it’s still good public policy. When you’re raising revenue, you have to worry about the incentives you’re creating. Are you creating incentives to not work? To avoid making investments? With a soda tax you’re creating an incentive to not drink tons of soda. That’s not a very problematic incentive at all, so it’s an efficient source of revenue. Higher alcohol taxes, however, are better.

Good News on HIV Vaccine

Some positive new on the test for an HIV vaccine as a human trial in Thailand shows that a new vaccine is partially effective at stopping infection. It’s not good enough to actually use, but it demonstrates that a vaccine can be made to work in principle and should give researchers some signposts in the direction of how to move further forward.

Modern Roundabout!

Modern Roundabout, Freiberg, Germany

I’ve written before of my love for “modern roundabouts”—the thinking man’s alternative to the dread traffic circle—but this was largely a theoretical proposition since we don’t have very many in the United States. So I was very excited when our bus drove around one in Freiberg.

The basic underlying idea is that instead of trying to use signals to create a false sense of security in an inherently dangerous situation, you need to design the road so as to psychologically demonstrate to everyone the need to drive in a calm, careful, and relatively slow manner. With everyone moving a bit slower, traffic as a whole can still proceed at a reasonable speed and you sharply reduce the kind of accidents that both kill people and produce severe congestion.

Nurse Home Visits in Health Reform

(cc photo by TedsBlog)

Raising kids is hard. It’s also incredibly important. And there’s tons of evidence that the environment children grow up in from the youngest age makes a big difference in long-term development and life trajectory. And one thing parents with a lot of financial resources and social capital do is draw on those resources to get a lot of help, both practical help and just advice, about what they should do. And as Mark Kleiman notes, it turns out that when you take parents who lack those resources and go out of your way to help them out the results are very positive:

Thirty years ago, a professor of pediatrics named David Olds (then at Cornell, now at the University of Colorado, Denver) came up with a straightforward idea: send nurses into the homes of poor and undereducated first-time teenage mothers to coach them through their children’s difficult first two years. There are now 18,000 families receiving that service in 29 states, from a variety of local government agencies and nonprofit groups, supported by some $80 million per year of federal, state, and foundation funds, under the watchful eye of the Nurse-Family Partnership National Service Office, a spinoff of the University of Colorado.

The program was designed to improve health, not to control crime, and the health-care savings from lower rates of sickness, substance abuse and welfare dependency among the mothers and children more than cover its costs. But it turned out that by the time the kids were 15 years old, those served by the program had been arrested less than half as often, and convicted only one fifth as often, as similar children who weren’t given the assistance.

Seems like the kind of program I would fund in expand in a national health reform effort. Or, if I were a conservative, the kind of thing I might demagogue and misdescribe in an effort to kill reform:

When a provision for nurse home visit grants was added to the House version of the health-care bill, the House Republican Conference promptly issued a statement mocking the program as a “nanny-state boondoggle.” They called it “billions for babysitters” and suggested buying copies of Dr. Spock’s child-care book instead. Lindsey Burke of the conservative Heritage Foundation warned of a “stealth agenda” to “impose a federally directed, top-down approach to parenting” and an increase in the federal role in preschool education. [...]

to Heritage legal expert David Muhlhausen, small-government principles outweigh crime control. “Open up your Constitution and read Article I, Section 8,” he says, referring to the section that enumerates the powers of the Congress. “Juvenile delinquency prevention is not in there.”

You see here the cost of a really irresponsible elite in the United States of America. Surely even Koch Industries and Ruper Murdoch don’t really have a problem with a cost-effective program to improve children’s health outcomes that turns out to also have substantial crime reduction benefits. But they can’t be bothered to think this kind of through.

Healthy Behavior Map

Interesting map from Gallup which takes a look at the geographical incidence of healthy behavior:

The midyear results from the AHIP State and Congressional District Resource for Well-Being, a product of the Gallup-Healthways Well-Being Index, find the nation as a whole dropping substantively on the Healthy Behavior Sub-Index, from 63.7 in 2008 to 62.6 in the first half of 2009. The Healthy Behavior Sub-Index is one of six sub-indexes that make up the Gallup-Healthways Well-Being Index, and asks Americans four questions: do you smoke; did you eat healthy all day yesterday; in the last seven days, on how many days did you exercise for 30 minutes or more; and in the last seven days, on how many days did you have five or more servings of fruits and vegetables. The Healthy Behavior Sub-Index scores for the nation and for each state are calculated based on a scale from 0 to 100, where 100 would be a perfect score.

At this point, I mostly just find it interesting any time you see a map that doesn’t just reduce the red/blue map of presidential politics. Instead we see that both the liberal coastal west and the conservative interior west are pretty similar, while the Great Lakes look indistinguishable from the Deep South. Of course it’s not clear to me that the methodology of this survey is so great.

Drug Prohibition and Drug Use

Peter Moskos and Stanford Franklin make many good points in their op-ed brief for drug legalization, but this is a silly argument: “If prohibition decreased drug use and drug arrests acted as a deterrent, America would not lead the world in illegal drug use and incarceration for drug crimes.” That just doesn’t follow logically. What’s more, the actual evidence from the alcohol prohibition era indicates that common sense is about right: making booze illegal caused less booze to be consumed, and the strength of the effect was related to the vigor with which the rules were enforced.

But that’s not to say that making alcohol illegal was a good idea and I certainly don’t think that handing out jail sentences for marijuana possession makes a great deal of sense. But in terms of hard drugs, I think that what Moskos and Franklin are mostly doing is marshaling the evidence for a dramatic change in police priorities rather than legalization of drugs as such. Tactics like the High Point Initiative appear to work as ways of shutting down overt drug markets. If a city can do that in its most problematic areas, the best thing to do seems to me to be to have its police . . . move on to worrying about something else. If people are selling drugs in a manner that’s not a nuisance for their neighbors and doesn’t involve violence, why not turn a blind eye? The knowledge that drug dealers who aren’t making problems for others will be left alone should encourage people to try to find less destructive business models. That’s still a far cry from saying that there should be heroin at the corner store, while CrackCo International hires the top marketing minds and lobbyists in the country to dream up exciting new ways of turning kids into addicts.

Cabbies on Cell Phones

(cc photo by augapfel)

It seems like every time I get into a cab these days, the driver is engaged in a non-stop cell phone conversation via a headset. I understand why cab drivers want to do this, but it’s incredibly dangerous:

A cabby paced beside his wrecked car, an earpiece dangling from the side of his head. An emergency worker, Ralph Ortiz, asked him what had happened.

“I was on the phone,” the driver told Mr. Ortiz, who several months later said he was still stunned by the response. “I didn’t see the light turn red.”

New York City cabbies have been banned from using cellphones for a decade — even the hands-free type, putting the city a step ahead of state law. But the stringent rules remain almost entirely unenforced, even amid research that shows drivers who talk on cellphones are four times as likely to cause a crash.

As long as the country is on the general subject of health care and public health, it’s worth pointing out that Americans’ tendency to die or be seriously injured in motor vehicle crashes seems much more amenable to policy remediation than does the country’s issues with obesity. Traffic engineering is reasonably well-understood by experts, and the research on things like the dangers of talking and texting while driving is pretty unambiguous. It would be a simple thing for a major city to mount a few “sting” operations aimed at handing out heavy fines to phone-using cabbies. And once stepped-up enforcement had been in place for a little bit, violations would drop rapidly, norms would change, and it would become much more practical for passengers to lean on drivers not to put everyone’s lives at risk.

You could even do something as simple as post a sign in the back of the cab clearly stating that the driver’s not supposed to be on the phone.

Dragging the Obesity Debate Back to Real Policy Issues