A L I M E N T A T I O N A G R I C U L T U R E E N V I R O N N E M E N T Increasing Fruit and Vegetable Consumption: A Cost-Efficiency Analysis of Public Policies Mobilizing the food chain for health OECD, PARIS, October 25-26 2012 J. Dallongeville 1 , L. Dauchet 1 , O. de Mouzon 2 , V. Requillart 2 , L.G. Soler 3 1 Institut Pasteur, Lille 2 TSE (INRA-GREMAQ), Toulouse 3 INRA-ALISS UR 1303, Ivry sur Seine
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A L I M E N T A T I O N A G R I C U L T U R E E N V I R O N N E M E N T Increasing Fruit and Vegetable Consumption: A Cost-Efficiency Analysis of Public.
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A L I M E N T A T I O N
A G R I C U L T U R E
E N V I R O N N E M E N T
Increasing Fruit and Vegetable Consumption:A Cost-Efficiency Analysis of Public Policies
Mobilizing the food chain for health OECD, PARIS,
October 25-26 2012
J. Dallongeville1, L. Dauchet1, O. de Mouzon2, V. Requillart2, L.G. Soler3
1Institut Pasteur, Lille2TSE (INRA-GREMAQ), Toulouse3INRA-ALISS UR 1303, Ivry sur Seine
A L I M E N T A T I O N
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MOTIVATIONS
• Food and non communicable diseases (cancers, cardiovascular diseases ….)
• Public health actions to reach the recommended intake of 400g of fruit and vegetables (F&V) per day– Education and information campaigns – Economic instruments (consumption subsidies, ‘F&V’ stamps...)
• Many studies based on local experiments
• Very few studies integrating economic and health parameters
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A G R I C U L T U R E
E N V I R O N N E M E N T
Important challenges for policy makers :
-Targeted versus non targeted policies
-Economic instruments versus information
-Public (and private) costs / Heath benefits
- Efficiency versus Equity
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OBJECTIVES
• Evaluation of policy scenarios aiming at increasing F&V consumption in France
• Policies– P1: decrease in VAT – P2: F&V stamps for ‘poor’ consumers– P3 : Generic information campaign
• Cost-Efficiency analysis : cost per Life Year Saved
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OVERVIEW ON THE METHOD
• An economic model of the F&V market (Equilibrium Displacement Model)
Policy Changes in F&V consumption
• A health model
Changes in F&V consumption Number of Life Years Saved (LYS) using “Relative Risks” associated to an increase in F&V consumption
• Cost-effectivenessImplementation cost of the policy / LYS
• Simulations to take into account the uncertainties on the model inputs
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A G R I C U L T U R E
E N V I R O N N E M E N T
POLICIES
• P1: Reduction of VAT– Decrease consumer price (less than the VAT reduction)– Increase consumption– Effects at equilibrium depend on price elasticity of
demand, price elasticity of supply
• P2: F&V stamps to low income consumers (LIC)– Equivalent to an increase in income– Increase consumption of LIC– Increase consumer price– Decrease consumption of other consumers
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POLICIES• P3: General Information campaigns
– Increase ‘stock’ of information of consumers– Increase demand and mean consumption– Increase price – Consumption of some consumers might decrease if less
responsive to information
• Simulations
- Decrease in VAT : 3%- Budget for F&V stamps : 300M euros- Targeted consumers : 1 to 10% of the population- F&V stamp per person : 50 to 350 euros per year
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Relative Risks associated to the consumption of one additional portion (80g/day)
years of life lostRR for one aditional portion of fruit and vegetable:
Mean [CI 95%]
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0 1 2 3 4 5 6 7 8 9 100
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
5.5x 10
5
Targeted population (in income percentiles)
Cos
t by
Life
Yea
r Sav
ed (€
)
Line width meaning:
median
2.5 & 97.5 percentiles
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Conclusion
LIMITS
• Only F&V sector • Uncertainty on the values of some parameters (information
responsiveness in particular) • Decreased morbidity not taken into account• We assumed that people use the FV stamps they get
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• Generally speaking, modest impacts on consumption and health
• ...but cost/LYS often compatible with acceptable thresholds
• Information policies are cost-effective... because they are not very expensive. However they might increase (slightly) the health disparities among the population (different from the result of another study in the UK).
• Price policy dominates F&V stamp policy....
.... except if the F&V stamp policy is focused on a “small” part of the population (greater amount of individual stamps but for less people)
=“optimal” size of the targeted population (which depends on the total budget used for the implementation of the policy)
• Challenge : to determine the “best” policy mix
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Thank you for your attention
A L I M E N T A T I O N
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Median 2.5%ile 97.5%ile Median 2.5%ile 97.5%ile Median 2.5%ile 97.5%ile
Value of the F&V stamp (€/year for each targeted person) 126 314