Reducing the public health burden of Australia

Given the health benefits of eliminating meat and dairy consumption, I’ve often wondered whether a public health campaign around diet, similar to those performed historically around the world for tobacco and other damaging substances, could result in a net positive for a society. The rationale is that the costs, presumably spent by a government, would be outweighed by the gain from the reduced public health burden. Here I’ve attempted a simple estimate of this. There is already a vast body of research available for the health benefits of a plant based, whole foods diet, and so I haven’t spent too long on this.

90% of all deaths in Australia in 2011 were the result of chronic disease according to the Institute of Health and Wellness. 50% of the Australian population has at least 1 chronic disease, and 20% have 2 or more. Populations with a diet full of plant based food have a lower blood pressure,  lower risk of type 2 diabetes, and a lower risk of death from cardiovascular disease (CVD). A plant based diet can even prevent and reverse erectile dysfunction. Diet related issues in 2010 contributed to the burden of disease in the US more than smoking, high blood pressure and high blood sugar.

From 2004-2005 total health expenditure in Australia was $81.1 billion, $52.7 of which is attributable to specific disease categories. 29% of this expenditure was through admitted patient hospital services, 16% of out-of-hospital medical services, 11% for prescription pharmaceuticals and 7% for optometry and dental services. CVD accounted for $5.942 billion alone.

Given such high costs to society from chronic diseases that are treatable through dietary changes, might it be reasonable to assume that a public health campaign focused on diet, similar to the campaign against smoking, could yield significant returns to the government and a tax payer? Several similar campaigns have existed (e.g. Shape Up Australia), though these have lacked the focus and intensity the anti-smoking campaigns had. To determine whether this might be reasonable may take a major study. But we can take a series of assumptions, applying a worst case scenario for each, to estimate the costs and returns of such a campaign.

If we assumed that the only cost to society of chronic disease is the cost to public health, and the only chronic disease related to diet is CVD, then there is a cost of $5.942 billion. The first assumption here isn’t true, as chronic disease leads to decreased productivity and lost time in the workforce. Let’s assume now that only 50% of CVD can be treated through dietary changes (this is not true, and in fact almost all cases of CVD are treatable through diet change – see the end of this piece for a full list of related references). Therefore $2.971 billion of the cost from CVD can be eliminated.

The next step is to ask how much a public health campaign around diet might cost. A campaign that covered Sydney and Melbourne from 1983 to 1987 cost $620,000 ($1,560,700 in 2015 dollars) for the media and a ‘Quit Centre’ in Sydney. The population of Sydney in 1986 was 3,472,000. Assuming, accounting for inflation, that it costs the same to provide similar services per person today it would cost $10,768,800 to implement a national program for 4 years (population of 23,958,000 today, which is 6.9 times higher than the population of Sydney in 1986, so the cost is multiplied by 6.9). Again, this is likely conservative as it assumes there is no benefit from economies of scale in reaching the entire nation compared to just one city.

Now we can ask how effective such a campaign might be. The pilot anti-smoking campaign in Sydney and Melbourne immediately reduced smoking prevalence by 2.6%, and by a further 0.75% each consecutive year. Note that these percentages refer to the drop in smoking prevalence of the entire population, not just the smokers, which were around 38% of the population in Sydney before the campaign. As the percentage of people who don’t eat a plant-based whole food diet in Australia is significantly higher (over 90%), this estimate is even more conservative. We might assume that the dietary campaign would only be 50% as effective as the anti-smoking campaign, which is conservative as smoking is addictive and harder to quit than dietary practices. So we have a campaign that we estimate will reduce poor dietary practices by 1% immediately and an additional 0.375% each year. Going back to our figure of $2.971 billion for treatable CVD, we get an initial benefit of $29.71 million, with an ongoing benefit of $11.14 million per year. After 4 years, this results in a total benefit of $82.36 million for a cost of $10.77 million. This is a return on investment of over 7 times even with the generous assumptions.

The figures for cost and effectiveness of the anti-smoking campaign used here are around the same order as similar programs undertaken in USA from 1989 to 1996. This assumes that the reduction in smoking from the Sydney and Melbourne campaigns are entirely attributable to the campaign, though this assumption is supported by the data.

The estimates presented here are relatively rough, but given the generous assumptions made, it is clear that a detailed study on the costs and benefits of such a program is long overdue, and that it’s time to have a conversation about implementing a public health campaign that advocates for a plant-based, whole food diet.

The road to such a campaign is expected to be long, as Australia’s peak body for health advice and medical research, NHMRC, still recommends meat and dairy consumption as part of a healthy diet despite evidence otherwise. However, given the great expected reduction in Australia’s public health burden and the other benefits of it being significantly better for the environment (the livestock industry is responsible for the most greenhouse gas emissions of any sector) and drastically reducing unnecessary animal suffering, it is a cause worth promoting.

The last two points I have covered previously here.

Thanks to Micaela Karlsen for providing references, working with me and reading early drafts of this work.


Esselstyn CB, Jr., Ellis SG, Medendorp SV, Crowe TD. “A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician’s practice.” [In eng]. J Fam Pract 41, no. 6 (Dec 1995): 560-568.

Esselstyn CB, Jr., Favaloro RG. “More than coronary artery disease.” [In eng]. Am J Cardiol 82, no. 10B (Nov 26 1998): 5T-9T.

Esselstyn CB, Jr. “Changing the treatment paradigm for coronary artery disease.” [In eng]. Am J Cardiol 82, no. 10B (Nov 26 1998): 2T-4T.

Esselstyn CB, Jr. “Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology).” [In eng]. Am J Cardiol 84, no. 3 (Aug 1 1999): 339-341, A338.

Esselstyn CB, Jr. “In cholesterol lowering, moderation kills.” Cleveland Clinic journal of medicine 67, no. 8 (Aug 2000): 560-564.

Esselstyn CB, Jr. “Resolving the Coronary Artery Disease Epidemic Through Plant-Based Nutrition.” Preventive cardiology 4, no. 4 (Autumn 2001): 171-177.

Esselstyn CB, Jr. “Is the present therapy for coronary artery disease the radical mastectomy of the twenty-first century?” [In eng]. Am J Cardiol 106, no. 6 (Sep 15 2010): 902-904.

Ornish D, Scherwitz LW, Billings JH, et al. “Intensive lifestyle changes for reversal of coronary heart disease.” [In eng]. Jama 280, no. 23 (Dec 16 1998): 2001-2007.

Causality in altruism

You might hear stories of someone who influenced someone else to be vegan or to donate 100 dollars and then claimed to have caused X animal lives to be saved or $100 to be donated, which are very good things indeed. But the person who donated that $100 can also claim responsibility for donating that money, because they were an integral step in the outcome, without which the money wouldn’t have been donated.

But if both parties are claiming full responsibility for causing $100 to be donated, shouldn’t that imply that $200 was donated? So who can claim responsibility here? Are they both equally responsible? Is it reasonable to say that they were both fully responsible after all? Or is it, as many things are in the real world, much more complicated than that? This is important if we, as individuals and organisations interested in maximising impact, are going to be rigorous about measuring the impact of individuals.

A friend once told me a story that poses an ethical riddle. It goes like this:

A married woman had been growing bored. Her husband wasn’t paying her attention anymore, and had stopped treating her well. She started sneaking away at night to go and sleep with other men across the river from her house. There was a bridge but she took the ferry to reduce the risk of being seen. One night, she went across the river but the man whom she had arranged to sleep with didn’t show. She went back to the ferry, but the boat master had heard of what the woman was doing from a friend and didn’t want to ferry her anymore. The woman, desperate, went across the bridge, where a drunken man killed her in a fit of rage. Whose fault was it that the woman died?

Another, more complicated riddle is presented:

There were four men in a military camp in the middle of the desert. Three of them hated the fourth, John, and wanted to kill him, but they wanted it to look like an accident. One day, when it was John’s turn to go on patrol, one of the others took his chance and put poison in John’s water flask. A second soldier, not knowing what the first had done, poured out John’s water and replaced it with sand. The third then came and poked small holes in the bottle so its contents would slowly leak out. When John was halfway through his patrol and looked for a drink, he realised his flask was empty, and he died of thirst. Who killed John?

In safety, there is a concept known as the ‘root cause’. For example, take the Air France Flight 4590 in 2000 which involved a Concorde plane outside Charles de Gaulle International Airport in France. The plane crashed, killing all crew and passengers, and some bystanders on the ground. Was it the crew’s fault? No, because the plane’s engine had caught fire shortly before take-off. So was it the fault of the engine manufacturers?

No, as it was revealed that a tyre had ruptured during take-off which hit the fuel tank, which resulted in the flame. This in turn was caused by a piece of metal found on the runway, which had fallen off of another airplane that day. This led back to the operator who had replaced that particular piece of metal, who had incorrectly installed the piece. This was interpreted as the root and primary cause of the accident.

But even so we can go back further. Someone must have trained this operator – did they do a bad job? Is it the fault of the management of that company for not putting the correct practices in place to eliminate the occurrence of such events? Maybe someone had just upset the operator and he wasn’t thinking straight.

If we go back to our first example and apply the root cause logic, that suggests that the woman died because of her husband. But this is an uncomfortable result, as the one who is most at fault is surely the man who actually killed her. Some might argue that the root cause is really just the drunken man, but it has to be said that all individuals in that story played an integral part in the woman’s death.

It might even be argued that the man was not thinking straight. What if he was drugged through no fault of his own? To be clear here, I don’t mean to imply that each player in this chain of events should be held responsible, or indeed be ‘guilty’, but they did play an unknowing role.

Bringing this all back to the original question, I confess I don’t have an answer. But I’m convinced that the answer isn’t as simple as we think, and if we want to be rigorous about measuring the impact that individuals have through an action or over their life, we should consider this further. At the very least, we should define very clearly what we mean when we say “I/we caused $100 to be donated.”

Toothpaste, fluoride and vegan products


Recently I was reading my girlfriend’s toothpaste (because I’m cool like that) and I noticed that it claimed to be vegan and fluoride free. Are there non-vegan toothpastes, I wondered. And what’s wrong with fluoride? Don’t you need it for strong teeth? My dentist told me so!

Image from
Image from

What’s wrong with toothpaste?

Since I’m not a medical scientist, the first question is perhaps one I’m a little more qualified to answer. I quickly checked the ingredients of my toothpaste and breathed a sigh of relief when I didn’t see any animal products that I recognised. But just in case, I looked up the issue online. Apparently glycerine, a common ingredient in toothpastes (and a component of my toothpaste, uh oh…) can be sourced from either animal or vegetable fats. It would seem that most toothpaste don’t specify where the glycerine came from! Products such as Colgate claim to be animal free and have a vegetarian product guide on their website. But that doesn’t necessarily mean it hasn’t involved animal testing, so if you want to be certain, keep an eye out for toothpaste with a ‘vegan’ label on it.


The fluoride part might be a little trickier for me to explain, but I will certainly try. On the outset it appears to be a hotly contested issue. I’m well aware that such issues are difficult to research for newcomers, for example it is easy enough for someone new to reading about global warming to see a few websites claiming that global warming is false and believe that. One needs to be careful when reading something from a particular group and consider whether they may have any vested interests in having you believe something (this could be conscious or unconscious bias). Even your search entries make a difference, for example searching ‘negative health effects of fluoride’ will, of course, yield vastly different results compared to searching ‘positive health effects of fluoride’. Having said that, let’s dive in.

Fluoride is often added to and found in toothpaste and drinking water. The hypothesis is that it prevents tooth decay and cavities, is safe, and saves money. We can break down our research into these 3 categories. Does it really prevent decay? Is it really safe? And does it really save money? If the answer to all three is unequivocally yes, then fluoride is good. If all three are no, it’s bad. If it’s a mix, we’re in a spot of bother. (A note on doing your own research – I highly recommend setting your decision making based on some key criteria prior to starting the research to help reduce bias)

According to a report from 2004 by the World Health Organisation (WHO), fluoride may be essential for humans, but it has not been demonstrated unequivocally, “and no data indicating the minimum nutritional requirement are available.” Low concentrations of fluoride in drinking water do appear to protect against dental cavities, particularly in children. The benefits increase with concentration of fluoride in drinking water up to about 2 mg per litre, and the minimum concentration required is around 0.5 mg/litre. For context, the Australian Drinking Water Guidelines recommend a maximum concentration of fluoride in drinking water of 1.5mg/L, which aligns with the WHO guidelines from 2008. However, the 2004 WHO report also states that fluoride may have negative effects on tooth enamel and lead to mild dental fluorosis with drinking water concentrations from 0.9-1.2 mg/L. It is curious to note that this level is lower than the WHO guidelines in 2008.

Recently, researchers have been proposing that the recommended fluoride concentration in water is reduced to err on the side of caution. The United States Department of Health and Human Services has suggested that the recommended level of fluoride per litre in public drinking water be reduced from the range of 0.7-1.2 parts per million (ppm) to a flat 0.7 ppm.

So is it worth avoiding fluoride? Most likely not. The risk of developing dental cavities remains over a lifetime, while the risk of developing dental fluorosis is primarily in younger individuals. The 2012 Fluoride Guidelines for Australia include the following key recommendations (quoted):

  • From the time that teeth first erupt (about six months of age) to the age of 17 months, children’s teeth should be cleaned by a responsible adult, but not with toothpaste
  • For children aged 18 months to five years (inclusive), the teeth should be cleaned twice a day with toothpaste containing 0.5–0.55mg/g of fluoride (500–550ppm). Toothpaste should always be used under supervision of a responsible adult, a small pea-sized amount should be applied to a child-sized soft toothbrush and children should spit out, not swallow, and not rinse. Young children should not be permitted to lick or eat toothpaste.
  • Fluoride supplements in the form of drops or tablets to be chewed and/or swallowed, should not be used

As an aside, decay in children’s baby teeth has been increasing in recent times and is possibly linked to the increased use of bottled water, which is often not fluoridated.

According to the American Dental Association (ADA), $1 invested in water fluoridation can save $38 in dental treatment costs. This sounds great – essentially it means that we’re saving $37 that could go back to the tax payer or towards other projects. It’s not that unreasonable, as anti-smoking campaigns yielded similar returns through reduced burden on the public health system. But first we need to be sceptical. Would the ADA have a reason for people to believe this statistic? Maybe.

This article does a bit of a dive into the cost benefit analysis for fluoride, (including a review of the original Journal of Public Health Dentistry paper from 2001 that makes this claim) and finds that the claim is mostly true, but perhaps slightly over exaggerated (the real benefit looks closer to 30:1 compared to 38:1). This does not appear to account for any potential negative effects associated with fluoride.


If you’re old enough to read this, you should probably be using fluoride toothpaste and not avoiding fluoridated water. Fluoride is beneficial for reducing the risk of cavities, and the risk of developing dental fluorosis appears to be limited mainly to young children. It may depend on where you live, as different countries and even different regions within countries have varying fluoride concentrations in their water. Don’t take fluoride supplements if your water is sufficiently fluoridated. If you are at elevated risk of developing cavities, you may be advised by a medical professional to use a fluoride mouth-rinse in addition to toothpaste and water.


This also got me wondering what other products that I take for granted turn out to not be vegan. I did a bit of hunting and found a host of products that I never knew weren’t vegan, and which I use every day or support. Gulp! Other products include:

  • Plastic bags, which use animal fat
  • Car and bike tyres, which often use animal-based stearic acid
  • Fireworks, which use the same stearic acid (and also suck in terms of pollution)
  • Glue used for wood working and musical instruments, made from boiling animal tissue and bones
  • Biofuels, which can be made from beef (yeah, that’s a thing)
  • Fabric softener – certain brands contain dehydrogenated tallow dimethyl ammonium chloride which comes from cattle, sheep and horses
  • Shampoo and conditioner, which may animal products. Again, it’s tricky here as Panthenol, amino acids or vitamin B can be sourced either from plants or animals.
  • White and brown sugar – some brands use ash from animal bones to refine sugar
  • Bread, especially white bread, which often contains milk solids. Some breads contain egg.

The best way to be certain is to check for a vegan label or ask the manufacturer.

Most of the products in this article were taken from this list.

Do you have any unsuspecting everyday products to add to this list? Let us know by leaving a comment! If I’ve missed something in the fluoride write up or misrepresented some research, please comment below and I’ll be sure to fix it.


This is not intended as medical advice. I research as thoroughly and carefully as I can, but I’m a geophysicist, not a medical scientist, doctor or dentist. I am just seeking to clear the air on a highly contested issue. If you are concerned about your fluoride intake, please seek professional medical advice. Pseudoscientific medicinal practitioners such as homoeopathists don’t count!

Why be vegan?

A lot of people have asked me why I’m vegan recently, so I thought I’d do a post to answer everyone past, present and future at once. In short, there are three reasons:

  • I don’t support animal cruelty
  • I don’t want to cause uneccessary damage to the environment
  • It’s better for my health than a diet involving meat and dairy

Each of these categories could easily be their own post, but I’ll just summarise the main points of each.

Animal cruelty

Most animals raised for meat come from factory farms, where poor conditions include tight living quarters where the animals often can’t even turn around. Animals are slaughtered in abattoirs by stunning them with an electric shock or a bolt gun, are tied upside down and then have their throats slit.

What about dairy and eggs?

It’s obvious but many people don’t think about the fact that cows (and all milk producing animals) only produce milk while they are pregnant or shortly after. Cows are typically forcibly impregnated, and the male calves are either slaughtered on birth or raised for meat so the mother’s milk can be harvested. The females are killed once they can no longer consistently produce milk. Chickens living in close quarters have their beaks removed to stop them from fighting each other, and can be put under intense 24 hour light to make them lay eggs faster.

What about cruelty free farms?

‘Cruelty free’ is a bit of a misnomer. You can raise an animal in pleasant living conditions their whole life and kill them without them feeling a thing, but that doesn’t justify it any more than you might consider it sane to kill and eat your dog because you like the taste and you do it ‘humanely’.

I thought about including images of factory farming but they might be too hard for some to see, so have a happy pig instead. If you've never seen photos and you're up to it, you should look them up. Image from
I thought about including images of factory farming but they might be too hard for some to see, so have a happy/smug pig instead. If you’ve never seen photos and you’re up to it, you should look them up. Image from

But if you’re still not convinced…


The effects of animal product consumption on the environment are many-fold.

  • It takes 2-2.5 acres of land to grow one cow in a factory farm*. Free range farming is even worse, and can take 10 times the amount of land or even more*. To use some figures from the documentary Cowspiracy, growing beef on a free range farm, and assuming the average meat intake of an American, it would take 3.7 billion acres of land to satisfy beef demand, yet there are only 1.9 billion acres of land on mainland USA*. Not all of this is suitable land either, and the population keeps on growing, which means a lot of land needs to be cleared!
  • Factory farms produce significant amounts of waste which ends up in waterways and eventually in the ocean, producing dead zones and harming marine life, and just wrecks the environment in general.
  • Livestock has a major greenhouse footprint, and not just from cow farts! The transportation and other associated activities all take energy, not to mention that it takes many kilograms of grain to produce one kilogram of meat. Cattle alone accounts for 18% of global greenhouse emissions, compared to just 13% in the transport sector*.

Howard Lyman, a former cattle rancher, has stated that “You can’t eat meat and call yourself an environmentalist.”*

But if you’re still not convinced, do it for yourself.


  • Most chronic health diseases such as cardiovascular disease and diabetes can be cured with a plant-based, whole foods diet. The risk of getting cancer is non-trivially lower, and even erectile dysfunction is completely curable through a vegan diet!
  • Most health concerns about a vegan diet are moot. Vegans get more than enough protein, calcium and iron just by eating a variety of plants. The only supplement a vegan needs to take is vitamin B12, and there are many fortified food options such as soy milk and nutritional yeast available.
  • Livestock are given antibiotics en masse to keep them alive, contributing to global antibiotic resistance.


Once you learn a lot about meat and the livestock industry, it’s hard to continue supporting it without some severe level of cognitive dissonance and hypocrisy. I intend to do an extended piece on hypocrisy in general, but in the meantime, here are some of my favourite examples.

  • “I get distraught when a lion is needlessly shot dead by a dentist or dogs are eaten, but don’t mind when a cow is needlessly killed for my enjoyment, even though there are plenty of alternative products.”
  • “I can’t change, I’ve been doing this my whole life and humans have been doing it for a long time.” If this is an excuse you use, it’s hard to justify getting upset at slavers of the 17th century, as they could say the exact same thing to justify their ‘choice’, even though they’re not just choosing for themselves.
  • “It’s wrong to force your opinion on your kids and make them eat vegan.” Generally said by people who force their way of eating meat on their kids. Also said by those who don’t mind advertisements that tell (not suggest) people to eat meat, e.g. ‘Real men eat…’ above a meat section (I couldn’t make this up).
  • “Ugh tofu tastes disgusting!” Referring to an uncooked tofu. A bag of flour also tastes pretty bland uncooked.
  • “Aren’t you concerned about your health?” Generally said by people who consume a lot of red meat and cow milk, which are both quite bad for your health.

Your impact

If you consume an average amount of meat, every day you have the choice to save 4164 litres of water, 20 kg of grain, 2.8 square metres of forest, 9 kg of CO2 and 1 animal’s life*.

Bonus impact

If, like me, you decide you want to do more, you might consider donating to a charity such as the Humane League who produce and distribute advertising to encourage people to consume less animal products. In fact, the Humane League is so effective at what it does, it takes less than $1 to reduce 1 year of animal suffering, not including the other benefits.

Effect on me

People often ask me what the hardest part about being vegan is. “I bet you really miss meat.” “How do you get all your protein?” The hardest, and only hard part about being vegan is being insulted by non-vegans who don’t understand. I work in a professional setting and regularly am made fun of for my ethical choice. People might think it’s just a bit of fun, but it hurts, and as far as I’m concerned, that’s bullying, and it’s not ok. There’s no difference between making fun of someone for being vegan and calling them a rabbit or joking that you’ll make a salad for them and making fun of someone for what they wear or any other choice they make. I’ve been told by someone that they were embarrassed to introduce me to their friends because I was vegetarian. Even if you don’t decide to consume less animal products, I urge you to take care with what you say about those who do. Besides that, I’ve never been happier or felt more satisfied in life since going vegetarian and eventually vegan.

I hope you also decide to make the switch for the environment, for the animals and for yourself. If you have any questions I would love for you to get in touch or leave a comment!


If you’d like to hear more I’d highly recommend you watch Cowspiracy, which is now available free on Youtube. A lot of the figures and facts used here (marked with a *) are sourced from there.