|
Use the drop down boxes below to find resources related to this page.
Mind your Business - 06 December 2004
Sexual Health - Can Governments Sort It?
The News
|
Following the recent announcement about measures to restrict smoking and steps to improve the state of the nation's health, the Government announced another major initiative on a different aspect of public health - that related to sexually transmitted diseases. The measures will cost £300 million and are a response to the rising levels of infections being reported.
What are the problems?
Image: Condom packets showing an HIV/AIDS awareness message - will increased spending on marketing reduce the number of new cases?
Copyright: Lotus Head, stock.xchng
The Health Protection Agency (HPA) report that 53,000 adults are living with HIV/AIDS and over a quarter are unaware that they have the infection. (http://www.hpa.org.uk/hpa/news/articles/press_releases/2004/041124_hiv_annual_report.htm)
It also seems that despite the level of education currently in place in schools and colleges about Sexually Transmitted Infections (STIs), the levels of ignorance about such infections amongst the most sexually active members of the population is relatively high. 21% of males aged between 16 and 24 did not recognise chlamydia as a sexually transmitted infection. At the other end of the population range, 40% aged between 45 and 49 and 48% of those aged between 50 and 69 were not aware of this. The levels for women were much lower, in the region of 10 to 20% across the age ranges. (Source: Department of Health [PDF, 377K]) (http://www.dh.gov.uk/assetRoot/04/08/99/46/04089946.pdf)
The cost of treating STIs is rising. Over 700,000 new cases were reported last year and the HPA estimate that the cost of HIV infection is between £500,000 and £1 million per individual in treatment and lost production. The same agency also estimates the annual cost of treating STIs at more than £700 million.
Associated problems:
Image: Teenage pregnancy in the UK is higher than in most other developed countries.
Copyright: Jyn Meyer, stock.xchng
The cost of treating such infections is not the only problem with our sexual health. There has been growing concern for a number of years at the rate of teenage pregnancy in the UK compared to most other developed countries. In 2002, there were 39,350 under 18 conceptions, 45% of which led to abortion. The rate for under-16s was 7,395 of which 55% were aborted. (Source: DFES Teenage Pregnancy Unit) (http://www.dfes.gov.uk/teenagepregnancy/dsp_Content.cfm?PageID=85)
The Joseph Rowntree Foundation estimated in 1999 that the cost of a single parent raising a child was £83,000 to the taxpayer (not including the cost of housing benefit or the fact that the individual may not be able to work and thus need support) compared to £50,000 if raised in a conventional family. (Source: House of Commons Hansard Debate) (http://www.parliament.the-stationery-office.co.uk/pa/cm199899/cmhansrd/vo990623/debtext/90623-06.htm)
Given the problems, the Government are intending to spend £300 million over the next three years to try to improve the situation. The Government plans to spend £130 million on genito-urinary medicine (GUM) clinics, £80 million will be spent on a chlamydia screening programme and a further £50 million on a nationwide advertising programme to raise awareness of the issues. £40 million will be spent on improving prevention services such as contraception services.
|
Theory
Public spending accounts for 40.6% of Gross Domestic Product (GDP) (Source: HM Treasury). The extent to which Government spends money on public services raises the question of how efficiently they do it. It also raises the question of whether the Government should be interfering in people's lives in this way - the so called 'nanny state'. (http://www.hm-treasury.gov.uk/media/50C/97/NOV04WEB.XLS)
The nanny state exists when the Government take action to influence the way people carry out their lives, be it on smoking, diet, exercise or sexual health. In this way, there are a number of concepts that can be looked at in relation to the nanny state - disproducts, merit goods, externalities and public goods.
- Disproducts - these are goods or services that are consumed that are not good for us but with which we seem unable to control ourselves. In this context, the level of sexual activity and the lack of awareness of the consequences and the impact of STIs is the disproduct. The effects of rising STI rates are damaging to the individual; most might know that STIs are not 'good' but do not take the responsibility themselves to do anything about it.
It could be that people simply do not understand the issues involved - the figures for the number of men who are ignorant of the nature of chlamydia may be testament to this view. It falls to the Government therefore to act by legislating, educating or regulating to influence the desired behaviour.
- Merit Goods - these are goods which could be provided by the state or by a private company but which, if provided privately, may not be accessible to some in the population through lack of income, or which individuals would not, for other reasons see fit to purchase themselves. In such circumstances, it is seen as being acceptable and necessary for the state to step in and provide such services, again because it is good for us even if we do not know it.
- Public goods - these are goods and services that could not be provided by a private sector business because of the principle of non-exclusivity in consumption. This means that it would not be possible for the provider to exclude from the benefits of the provision and consumption those who choose not to pay.
- Externalities - these are the costs and benefits to a third party of a decision. Every decision has some sort of cost and benefit; in some cases it is the decision maker that has to face those costs and enjoy the benefits but equally, society may have to suffer the costs of some decisions and also reap the benefits. Certain types of Government spending, therefore, could be justified from the point of view that the benefits to the population as a whole are greater than the costs that society would face without that Government intervention.
The issue arising from the news item is whether the Government is best placed to be able to achieve the desired outcome. There are many who argue that Government spending is inherently inefficient; there are not the incentives that exist in the private sector to focus on efficiency in spending tax payers' money.
There is also an issue as to whether the type of spending is also appropriate. For example, spending £50 million pounds on an advertising campaign to promote sexual health - will that spending make any difference or could the £50 million be used more effectively to achieve the desired outcome?
On the other hand, if governments do not take up these issues, it is argued that the cost to society will be greater. For example, if the Government decided to provide free condoms would this help to improve the sexual health of the nation? It would be relatively easy to calculate what the possible cost in terms of the provision would be - for the sake of argument, let us assume it might be £1 billion. On what basis could such spending be justified?
It could be justified if the benefits outweighed the cost. Let us assume that free provision of contraception led, after five years, to a reduction in the number of cases of HIV by 2,000. This would, according to the figures supplied by the HPA, save the country between £1 and 2 billion in treatment costs and lost output.
When couched in this way, the expenditure seems to represent good value. The question is, will the spending in the target areas lead to such benefits being realised?
Data / Facts / Figures
Diagnoses of STIs, % change, 2002-03
Diagnoses of STIs, % change, 1995-2003
Source: Health Protection Agency (HPA) (http://www.hpa.org.uk/infections/topics_az/hiv_and_sti/sti-chlamydia/epidemiology/epidemiology.htm)
Questions
- Which of the following could be classified as a merit good, public good, disproduct, etc?
- Screening services for chlamydia
- Provision of free condoms
- Provision of GUM clinics
- Advisory service for contraception
- An increase in the number of sexual partners per head amongst the 16-24 age group
- Provision of a confidential helpline for teenagers who are concerned they may be pregnant
- Providing educational materials for schools and colleges about the dangers of STIs
In each case, offer a brief explanation of why you have chosen the classification.
- What could be the external benefits of a successful advertising campaign promoting sexual health amongst the 16-24 age group?
- To what extent do you think the Government is the best body to take initiatives in improving the sexual health of the nation?
- How would you judge to what extent the proposed £300 million of spending will represent money well spent?
Related Web sites for Research
Mark Scheme
- Which of the following could be classified as a merit good, public good, disproduct, etc?
- Screening services for chlamydia
- Provision of free condoms
- Provision of GUM clinics
- Advisory service for contraception
- An increase in the number of sexual partners per head amongst the 16-24 age group
- Provision of a confidential helpline for teenagers who are concerned they may be pregnant
- Providing educational materials for schools and colleges about the dangers of STIs
In each case, offer a brief explanation of why you have chosen the classification.
When making your judgement ask yourself the following questions:
- Could the service/product be provided by the private sector and the public sector?
- Is it possible to exclude those not paying from gaining the benefits?
- Would people feel it was right to buy the product/service if not provided by the Government?
- Is the consumption of the good or service detrimental to others?
In answering these questions you will be able to narrow down what the likely answer might be - remember there is rarely one 'correct' answer but you might see some as possibly more than just sitting neatly into one category - the supporting judgement is the most important thing.
- What could be the external benefits of a successful advertising campaign promoting sexual health amongst the 16-24 age group?
You are being asked to consider the external benefit of the decision; you must think what benefits will accrue to society if the campaign is a success. This brings in the notion of opportunity cost. If the campaign is a success then the cost of treating those infected will fall, more funds will be available to treat those who are infected or the funds released could be made available for some other pressing matter. There might also be benefits to those who engage in an active sex life in that the risks of infection will be reduced both through safer practices and the reduced number of infected people.
- To what extent do you think the Government is the best body to take initiatives in improving the sexual health of the nation?
This is very much an evaluation question. The arguments between those who believe the free market is a better allocator of resources and those who believe that the Government can deal with such matters more efficiently is at the heart of the answer. Your judgment might include a consideration of whether there is an incentive for the private sector to get involved in such matters and what the driving force behind any Government spending might be. There might be caveats to your argument - will the Government need to put in place things like targets to ensure that they achieve the desired outcomes or might such targets distort the outcomes? When constructing your argument ensure you find points to support your case - use the suggested resources to help you in this.
- How would you judge to what extent the proposed £300 million of spending will represent money well spent?
The key point here is to have some idea of what represents 'value for money'. In most cases it will be something to do with benefits outweighing the costs but you will need to think about exactly what constitutes a benefit and how it could be measured, and what denotes a cost and again how this could be measured. An example is given in the theory section to give you some guidance. One of the problems is going to be measuring the value of the costs and the benefits. Again, any evidence you can find to support your case will be valuable and will contribute to the quality of the answer.
|
