IS A HEALTHY DIET ECONOMICALLY SUSTAINABLE? THE HEALTH EFFECTS OF PREVENTION POLICIES Michele Cecchini OECD – Health Division
Mar 30, 2015
IS A HEALTHY DIET
ECONOMICALLY SUSTAINABLE?
THE HEALTH EFFECTS OF
PREVENTION POLICIESMichele CecchiniOECD – Health Division
The Burden of Obesity on Health Systems
Normal-weight patient
Obese patient (US) Obese patient (EU)90
95
100
105
110
115
Rela
tive c
ost
of
pati
ents
In any given moment, obese patients cost more
Source: Brunello et al., 2008Bhattacharia & Sood, 2005
The OECD/WHO CDP Model
Physical activityadequate physical actinsuff .physical act
Body mass index
normal weightpre-obesityobesity
Blood pressurenormalhypertension
Cholesterolnormal
hypercholesterolemia
Glycaemianormaldiabetes
Cancers
Stroke
Ischemic heart
disease
Fatlow fat intakemedium fat intakehigh fat intake
Fibreadequate fibre intakelow fibre intake
Socio-economic statusupperlower
A Comprehensive & Affordable Prevention Package
OECD Countries Emerging Economies
Mass media campaigns Mass media campaigns
Compulsory food labelling Compulsory food labelling
Industry self-regulation of food advertising to children
Government regulation of food advertising to children
Physician-dietician counselling Fiscal measures
School-based interventions
Canada Europe Brazil China
24.03 $/cap 22.45 $/cap 0.40 $/cap 0.20 $/cap
Expectations Must Be Realistic
• Does prevention improve health?
• Does it reduce health expenditure?
• Does it improve health inequalities?
• Is it cost-effective?
Prevention Saves LivesLife Years Saved Every Year
China
Europe
Brazil
Canada
Life years (millions)
1 LY / 19 persons.
1 LY / 8
1 LY / 20
1 / 8
Prevention Keeps HealthyYears of Life Free of NCDs
0 7 14 21 28 35 42 490
10000000
20000000
30000000
40000000
50000000
60000000
70000000
80000000
90000000
100000000
Time (years)
Mil
lion
lif
e ye
ars
0 7 14 21 28 35 42 490
10000000
20000000
30000000
40000000
50000000
60000000
70000000
80000000
90000000
100000000
Time (years)
Mil
lion
lif
e ye
ars
Europe China Brazil Canada
Cancers (lung, colorectal, breast) Cardiovascular diseases
Prevention is a Good InvestmentImpact on Health Expenditure
0 5 10 15 20 25 30 35 40 45 50
-140
-120
-100
-80
-60
-40
-20
0
EuropeCanadaBrazilChina
Time (years)
$ /
capit
a
Cost-Effectiveness of Prevention
Brazil
China
Canada
Europe
Thousand $ / DALY
After 20 years After 50 years
0
5,00
0
10,0
00
15,0
00
20,0
00
25,0
00
30,0
00
35,0
00
Thousand $ / DALY
Impact on InequalitiesFiscal measures in Europe
0-10
11-2
0
21-3
0
31-4
0
41-5
0
51-6
0
61-7
0
71-8
0
81-9
0
91-1
000.0%
0.1%
0.2%
0.3%
0.4%
0.5%
0.6%
0.7%
high SES low SES
Different social groups:
• Different risk profiles:– Larger benefits in
those most at risk (~)
• Different responses to interventions:– Larger benefits with a
greater response
Key Policy Implications
• Obesity and NCDs are global economic issues
• Prices and regulations work best in emerging economies. Primary care doctors play a role in countries with stronger health systems
• Comprehensive intersectoral prevention strategies are more efficient and generate larger health gains
• We can afford to tackle obesity and prevention is good value for money
Health Effects of a Healthy Diet10% of Energy from Saturated Fats
Source: Lock et al., 2010
satu
rate
d f
at
YL
L (
IHD
)
YL
wit
h I
HD
pre
matu
re d
eath
s
satu
rate
d f
at
YL
L (
IHD
)
YL
wit
h I
HD
pre
matu
re d
eath
s
United Kingdom Brazil
-14%
-12%
-10%
-8%
-6%
-4%
-2%
0%
-22%
OECD Work on Health Behaviours
• OECD health working papers HWP 32, 45, 46, 48
• Paper in Lancet series on chronic diseases
• Lancet paper on priority interventions
• “Best buys” paper for the UN Summit on NCDs
• OECD/Euro Observatory [email protected] www.oecd.org/health/prevention