Comparing Covid and Tobacco

post by rockthecasbah · 2020-11-17T16:13:57.715Z · LW · GW · 2 comments

This is a question post.

Contents

  Answers
    Maxwell Peterson
    rockthecasbah
    ChristianKl
    Alex N
    Dagon
    korin43
    gbear605
    AnthonyC
    bvbvbvbvbvbvbvbvbvbvbv
None
2 comments

Tobacco kills 5 million people every year [1]. Covid probably won't pass 5 million this year regardless of our policies or behavior. And yet, Covid has been the focus of far greater scarce political attention than Tobacco. We have accepted an increase of 150 million people in global severe poverty and the trillions in economic damage to prevent Covid deaths. Tobacco eradication has received far less attention. What do you think are the biggest reasons for this difference?

  1. Covid is new, people over-react to new threats.
  2. Covid affects the most politically organized and powerful world demographics: Old people in rich countries. Tobacco affects poor old people in poor countries.
  3. Covid is more tractable than Tobacco (the cost of preventing a Covid death is lower than preventing a Tobacco death). This seems unlikely, but I'm open to an argument.
  4. The tax incentives cause governments to neglect the Tobacco problem.
  5. People individually do not mind staying at home and watching Netflix. They therefore share/read/write more about Covid.
  6. The world's policy elite knows people with Covid but knows very few tobacco addicts in Lebanon or China.
  7. Policy Elite believes people can rationally decide to consume tobacco (hurt themselves) but not decide to social distance (hurt others)
  8. The Covid attention results from a massive availability cascade. Once an issue becomes available enough to the policy elite, it's salience is self-reinforcing.
  9. Individuals can affect Covid but organizing Tobacco policy NGO's for developing countries is a more complicated model.

Thoughts?

  1. WHO (World Health Organization). 2012b. ‘‘Why Tobacco Is a Public Health Priority.’’ www.who.int/tobacco/health_priority/en/.

Answers

answer by Maxwell Peterson · 2020-11-17T17:17:47.733Z · LW(p) · GW(p)

We already tried really really hard to reduce smoking in the US. I think all these curves, where effort is on the x axis and benefit on the y, see decreasing returns once you have already put in a lot of effort.

Another way of putting it: People I know who I advise to distance more and wear a mask more might disagree and argue with me, but they’ll at least consider my arguments and say why they’re right and engage. A person I know who smokes, who I advise to stop, will just laugh and blow me off: “whatever dude”. They’ve heard it before. So among people I know, “hey beware covid” is a way more effective message than “hey beware smoking”, so I barely ever bother with the latter.

comment by rockthecasbah · 2020-11-17T22:39:48.605Z · LW(p) · GW(p)

That's fairly compelling in the US.

But globally it is definitely false. For a trillion dollars, a fraction of he Covid economic loss so far, we could double the government budgets of the highest tobbacoo consuming countries (Egypt, Tanzania, Lebanon). The GoE would happily burn every tobacco farm in the country for a few billion dollars. The cost per life of paying Egypt to enact anti-smoking policy would inevitably be lower than Covid (not that its the most efficient cost per life).

So if we model Americans as rationally pursing QALY's for other Americans, the difference is much less surprising. But that hides why we value the lives of our countrymen so much more than the lives of Egyptians.

Your comment also brings up the perspective of policy entrepreneurs. They can get policies amd behavior changes implemented much faster by talking about Covid than Tobacco in 2020. So a rational public health PE might say "I'd love to say a million people from Tobacco, but no one will listen to that policy. But I can save a smaller number by advocacy on Covid".

comment by Maxwell Peterson (maxwell-peterson) · 2020-11-18T00:30:25.116Z · LW(p) · GW(p)

Those are good points.

answer by rockthecasbah · 2020-11-18T14:44:08.362Z · LW(p) · GW(p)

I'm surprised none of us mentioned this important explanation. I should have thought of it.

  1. Most people believe in the action/inaction dichotomy. Causing someone to die by not doing something is less morally bad than causing someone to die by doing something (different from intent-based ethics). So not donating 3000 dollars to save a life through nutrition is an inaction, and therefore not morally required. But going to the supermarket where you infect an old person and cause them to die is an action, and so protecting lives is morally required then. Peter Singer's comment on this

One objection to the position I have taken might be simply that it is too drastic a revision of our moral scheme. People do not ordinarily judge in the way I have suggested they should. Most people reserve their moral condemnation for those who violate some moral norm, such as the norm against taking another person's property. They do not condemn those who indulge in luxury instead of giving to famine relief. But given that I did not set out to present a morally neutral description of the way people make moral judgments, the way people do in fact judge has nothing to do with the validity of my conclusion. My conclusion follows from the principle which I advanced earlier, and unless that principle is rejected, or the arguments are shown to be unsound, I think the conclusion must stand, however strange it appears. It might, nevertheless, be interesting to consider why our society, and most other societies, do judge differently from the way I have suggested they should. In a wellknown article, J. O. Urmson suggests that the imperatives of duty, which tell us what we must do, as distinct from what it would be good to do but not wrong not to do, function so as to prohibit behavior that is intolerable if men are to live together in society. [3] This may explain the origin and continued existence of the present division between acts of duty and acts of charity. Moral attitudes are shaped by the needs of society, and no doubt society needs people who will observe the rules that make social existence tolerable. From the point of view of a particular society, it is essential to prevent violations of norms against killing, stealing, and so on. It is quite inessential, however, to help people outside one's own society.

answer by ChristianKl · 2020-11-18T00:04:20.864Z · LW(p) · GW(p)

When a lot of policy is made on the national level I don't think it makes sense to speak about world-wide health problems. US COVID policy is primarily about doing what's good for US citizens. 

COVID-19 has no lobbyists that advocate for the economic interests of it while big tobacco has strong economic interests. To the extend that the Chinese are willing to buy US tabacco, the US policy makers are happy that China buys something.

When BAT bullies African countries it's not something that damages US interests and thus the US doesn't try to stop that behavior. 

comment by rockthecasbah · 2020-11-18T03:35:52.428Z · LW(p) · GW(p)

So reason 2. Americans care more about deaths in America than elsewhere. I agree that is much of the explanation.

comment by ChristianKl · 2020-11-18T15:01:51.532Z · LW(p) · GW(p)

Tabacco deaths in the third-world are different from Malaria deaths. Americans don't care about Malaria deaths but they do care about the economic benefits it brings them to cause tabacco deaths in the third-world.

answer by Alex N · 2020-11-17T16:36:38.623Z · LW(p) · GW(p)

Smoking is a direct individual choice (unless talking about second-hand smoking, which is a moot subject). Getting infected with a virus is not a choice. An individual doesn't need a government to protect him from smoking. He may need it to help protect him from a virus (all overblown/ineffective/politicized issues and measures aside).

There is a trend to blame poor individual choices on the society. That may be in some part true, but for smoking in 2020 it is not.
 

comment by AnthonyC · 2020-11-17T19:17:59.910Z · LW(p) · GW(p)

Smoking is a direct individual choice (unless talking about second-hand smoking, which is a moot subject)... An individual doesn't need a government to protect him from smoking. 

 

I think you are pointing at this same thing with your final sentence's "in 2020," but calling second hand smoke a moot subject is only true because government has already done so much to protect individuals from it. I'm in my 30s and I remember restaurants with smoking and nonsmoking tables next to each other in the same room. My mother was perfectly able as a kid to go buy cigarettes, just by claiming they were for someone else, and had no idea why she shouldn't, because the relevant public health campaigns hadn't yet happened. My neighbor, now in her 80s, remembers as a kid not wanting to be around smokers and breathe in smoke; her family doctor basically told her she was crazy to worry about it and to get over it/get used to it - all while smoking during their appointment. 

I've read that most smokers start while in middle or high school, not exactly an age where we generally expect people to behave sanely with appropriate consideration of long term consequences. To whatever degree smoking is addictive and hard to quit later in life, that's the key timeframe for intervention, and kids do need authority figures to keep them from starting, one way or another. That doesn't have to be (in whole or in part) government, but I have no argument I find convincing as to why it shouldn't be.

comment by rockthecasbah · 2020-11-17T18:07:23.544Z · LW(p) · GW(p)

Number 7 is a popular one!

answer by Dagon · 2020-11-17T18:19:33.999Z · LW(p) · GW(p)

Some very major differences:

  1. Tobacco use (in high-income regions where indoor smoking is fairly rare, which is the relevant policy frontier) harms mostly the user.  Covid harms anyone who wants to be indoors with people.
  2. Tobacco prohibition has a long history of puritan and race/class-ist attacks on users.  This makes it much easier to distrust the motives for removal.
  3. Policy imposed by high-income regions on low-income regions has a similar history and reasons for suspicion.

Also, I think the premise is misleading.  Behaviors are both top-down and bottom-up.  Governments influence behaviors in many ways, but they're also influenced by the population.  It's worth examining why governments and elite are focusing on COVID more than tobacco, but it's even more worth examining why the populace in different areas is focusing more or less on either (or neither, in some cases).  

answer by korin43 · 2020-11-17T16:55:58.507Z · LW(p) · GW(p)

Policy Elite believes people can rationally decide to consume tobacco (hurt themselves) but not decide to social distance (hurt others)

I think this is basically the answer although I don't know if positing a secret cabal of Policy Elites adds anything. At least in the US, we've done things to prevent smokers from hurting other people (i.e. banning smoking in bars and restaurants) but there's not as much political will to prevent smokers from hurting themselves.

comment by Frank Bellamy (frank-bellamy) · 2020-11-17T17:03:31.480Z · LW(p) · GW(p)

I don't think I qualify as "policy elite", but my thoughts are along these lines. When I see a smoker, I see someone who is behaving stupidly with their own health and possibly as endangering mine, as a threat, not as someone I have any sympathy for. Whereas covid is not a choice, it often hits people who have done nothing wrong its victims can properly be called victims, they are much more sympathetic.

comment by rockthecasbah · 2020-11-17T17:52:57.687Z · LW(p) · GW(p)

No one said they were a secret cabal or anything. I'm not ascribing any collective agency to us other than mostly reading the same newspapers and books.

answer by gbear605 · 2020-11-17T21:43:06.244Z · LW(p) · GW(p)

Sweden precisely shows why your question is misguided. They had significantly fewer governmental restrictions, but their economy did the same or worse over the last year than the other Scandinavian countries. My interpretation is that average people care a lot about their personal pandemic risk and are willing to do all these measures regardless of the laws, while the laws help stop the super-spreader marginal cases. 

Because of this, the governmental restrictions have approximately zero economic cost while have a significant health benefit. The governmental expenditures have not truly been COVID-relief. Rather, they have been depression-relief, where the depression is caused by people's desire to avoid COVID.

For a specific example, everyone at my company is allowed to work at the office, both by the government and by the company. Despite that, not a single person does. Similarly, my area currently allows people to eat inside restaurants, but almost no one does.

comment by rockthecasbah · 2020-11-17T22:32:12.829Z · LW(p) · GW(p)

I think you are correct empirically, people are willing to make large changes in their lives in response to Covid. They do so regardless of government policies, and that does change the cost-benefit calculus about restrictions as a policy. Whatever effect the government restrictions have is very small relative to the voluntary restrictions, I agree.

But my question is "What process precisely makes people so willing to sacrifice for Covid, but not for other ways to save the lives of others." What do you think explains the difference?

comment by gbear605 · 2020-11-17T22:46:24.540Z · LW(p) · GW(p)

Other than wearing masks (which hardly is a burden), I don't really see people sacrificing too much to help prevent others outside their family and friends from getting COVID. There are obviously exceptions to this, such as the entire medical community, but I don't think that there was truly a huge personal sacrifice to prevent others from getting COVID versus preventing others from dying of smoking. What sacrifice there was can, I think, be explained up by the same reason that charities like the Against Malaria Foundation that operate primarily in Africa can be much more effective than charities that operate in the US - out of sight, out of mind.

answer by AnthonyC · 2020-11-17T17:07:18.370Z · LW(p) · GW(p)

I believe (1) and (2) are sufficient in themselves to explain this. It is a common cause of so many issues, I'd be surprised if it wasn't at least somewhat central here.

I think it's important here that in general, by default, we humans think in stories and metaphors, not numbers. Tobacco is an old story, we know how it has gone so many times in the past, we expect that if there were an easy way to change it someone would have told us and/or done it. Also, society already has institutions and rules based on that story - the drama and lawsuits and whatnot seem to have mostly already happened. Covid is a new story, we don't yet know how it ends, and so it seems like maybe our leaders can decide the ending more easily (especially for people who really don't have in mind a plausible physical model of how the relevant parts of the world work). Also, stories that seem like they could affect us or that do affect those like us feel more salient than distant stories affecting others. We understand them more intuitively.

comment by rockthecasbah · 2020-11-17T18:22:42.254Z · LW(p) · GW(p)

It makes me sad but I think 1 and 2 are enough as well.

answer by bvbvbvbvbvbvbvbvbvbvbv · 2020-11-17T16:38:59.074Z · LW(p) · GW(p)
  1. You could add the added uncertainty. Covid had all the more reasons to gather lots of attention at its beginning because we had no idea of the possible death rate. Whereas tobacco's risk has been known for a while. We still don't know anything about long term consequences of such an infection. Maybe none, maybe not.

  2. I think most people consider than smokers more or less choose to smoke, whereas covid kills and cripples far more arbitrarilly. This makes it way more of a threat for most people, who "could just decide not to smoke".

Aside from that, can you link to sources as to why only 5 million people would die if no policies or behavior were changed? A death rate of 0.1% out of 5 billion people would be 5 million but

  1. it doesn't take into account the possibility of reinfections : if covid has no barrier to spread and circles the earth for years, this could increase the death count dramatically, provided antibodies don't last that long or that a high percent of patients don't produce those antibodies
  2. 0.1% death rate is what can happen when you are in the ER, ie NOT what will happen to most patients if covid can propagate freely.first source from ddg
  3. There are more than 5 billion houmans.
comment by rockthecasbah · 2020-11-17T18:06:51.326Z · LW(p) · GW(p)

It will have been a year in a month and a half. We are currently at 1.33 million deaths. We are not going to have 3.7 million deaths in the next month. For why that won't happen regardless of the amount of policy attention see https://thezvi.wordpress.com/.

We know COVID has a barrier to reinfection, so Covid is very unlikely to "circle the world for years". Also the tobacco deaths are actually going to continue for decades, so this can't be an argument for more marginal attention to Covid.

Do you believe the marginal cost of preventing a Covid death is lower than the marginal cost of preventing a tobacco death? Why or why not?

comment by bvbvbvbvbvbvbvbvbvbvbv · 2020-11-17T18:52:26.667Z · LW(p) · GW(p)

It will have been a year in a month and a half. We are currently at 1.33 million deaths. We are not going to have 3.7 million deaths in the next month. For why that won't happen regardless of the amount of policy attention see https://thezvi.wordpress.com/.

I don't follow. I know there won't be 3.7M deaths in a month and a half, I'm arguing that without policies we would be at more than 1.33 million deaths and would plausibly end the year at more than 5M. If you disagree, could you point me to an article instead of the whole zvi website? I have no idea where to look.

We know COVID has a barrier to reinfection, so Covid is very unlikely to "circle the world for years". Also the tobacco deaths are actually going to continue for decades, so this can't be an argument for more marginal attention to Covid.

I didn't say the deaths that would happend at the n'th time around the earth would all be as high. I meant to say that there would be deaths chronically as opposed to just from this year.

Tobacco will be around for decade That's a fair point. But I think you dismiss too easily the possibility for covid to stay around for years. There are still numerous unknown around animal reservoir also. So covid could plausibly, gently circle the earth several times per decade, reinfecting some houmans and infecting younglings etc. I have no competence to judge on this matter but I can't see how that's not to be taken into account.

Do you believe the marginal cost of preventing a Covid death is lower than the marginal cost of preventing a tobacco death? Why or why not?

I am terrible at this but my guess is that there is a diminishing return when trying to reduce tobacco below a certain threshold as (somewhat) opposed to covid where you need more ressources to completely erase it but if you do it's done. Addiction cannot be that "easily" defeated given how diverse our psychiatric profiles are.

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comment by Donald Hobson (donald-hobson) · 2020-11-17T17:07:11.113Z · LW(p) · GW(p)

The important number is not how many people is not how many people covid does kill, but how many it would have killed if we hadn't tried to stop it. 

Extreme example, suppose a meteor headed for earth. We divert it at great cost and effort. Then people come along saying, look how much we spent on diverting the meteor, and it didn't kill anyone. The important question is how many people an undiverted meteor would kill.

comment by rockthecasbah · 2020-11-17T18:19:22.113Z · LW(p) · GW(p)

So we should look at countries where states spent less on preventing Covid and observe very high death rates, on the order of 5,000 per million, while countries that sacrificed more should have death rates much lower. A cursory look at the data find the difference is much smaller. A few hundred deaths per million is plausible, but differences of 1 thousand per million are clearly not observed. Mexico and Sweden are famous for their feeble responses but are only at 800 / million.

If you phrase the question as "if no one had done anything" than the current Covid response always looks like the best policy. But arguing that spending 10% less attention on Covid and more on Tobacco globally would have cost lives is almost impossible, because we are spending 1,000 times the effort on Covid as Tobacco. So the percentage change in Tobacco effort would be 10,000%. For this money we could go to heavy smoking countries and double their state budgets in exchange for Tobacco regulation.