View
0
Download
0
Category
Preview:
Citation preview
Nutrition and inequalities in
health: the role of
prevention policy
Marion Devaux OECD – Health Division
Athens, 25th February 2014
1
OECD Work on Prevention
2
Health Risk Factors
• Nutrition and physical activity important determinants of health
• Risk factors for a number of chronic diseases
• Unequal distribution of healthy lifestyle habits across SES groups
3
Unhealthy Dietary Behaviours
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0 20 40 60 80 100
Age
Korea
Canada
England
US
Insufficient Fiber consumption
0%
10%
20%
30%
40%
50%
60%
70%
80%
0 20 40 60 80
Age
Korea
Canada
US
High Fat consumption
Source: OECD estimates on national survey data.
4
Fruit and vegetable consumption
by Education level
5
Source: EHIS 2008, Eurostat Statistics Database 2013
30
40
50
60
70
80
90
100
% Daily fruit eating
30
40
50
60
70
80
90
100Daily vegetable eating
6
Physical activity by area of residence
Note: insufficient level of physical activity is defined as less than WHO recommended levels
• People in urban areas are less likely to have sufficient levels of physical activity.
Source: OECD analysis on EHIS, Eurostat, 2008.
Strong correlation within households
7
%
Source: OECD, Health Working Paper 45, 2009
n.a
. n
.a.
n.a
. n
.a.
• People living in the same household share lifestyles.
Obesity: a Growing Problem
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
1970 1980 1990 2000 2010 2020
Rat
e o
f ob
esi
ty
Year
USA England
Spain
France
Canada
Korea
Italy
- - - Past projectionNew data points
Source: OECD Obesity Update 2012
8
Inequalities in Overweight
by Level of Education
1.6 1.4 1.4 1.3 1.2 1.2 1.1 1.0 1.0 0.9 0.7
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Rel
ati
ve
ind
ex o
f in
equ
ali
ty
5.0
3.2 2.9 2.7
2.2 1.8 1.7 1.7 1.4 1.4 1.3
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Men Women
Source: OECD Fit Not Fat 2010
9
Social Disparities in Child Obesity
0.0
0.5
1.0
1.5
2.0
2.5
3.0
England France Korea USA
Od
ds
rati
os
for
ob
esit
y
Boys Girls
-
0.5
1.0
1.5
2.0
2.5
3.0
England France Korea USA
Higher SES (ref.) Higher-middle SES Middle SES
Lower-middle SES Lower SES Source: OECD Fit Not Fat 2010
10
Interventions
Health education and health promotion
Regulation and fiscal measures
Primary-care based interventions
Mass media campaigns Fiscal measures
(fruit and vegetables and foods high in fat)
Physician counselling of individuals at risk
School-based interventions
Government regulation or industry self-regulation of
food advertising to children
Intensive physician and dietician counselling of
individuals at risk
Worksite interventions Compulsory food
labelling
11
Expectations Must Be Realistic
• Does prevention improve health?
• Does it reduce health expenditure?
• Is it cost-effective?
• Does it improve health inequalities?
12
Does Prevention Improve
Population Health?
13
Health Outcomes of Prevention
0 100 000 200 000 300 000 400 000 500 000
physician-dietician counselling
fiscal measures
physician counselling
food labelling
worksite interventions
food advertising regulation
school-based interventions
food adverting self-regulation
mass media campaigns
Disability-adjusted life years Life years
1 LY/DALY every 115/121 people
1 LY/DALY every 12/10 people
14
Average health effects per year
Does Prevention Reduce
Expenditure on Health Care?
15
Economic Effects of Prevention
0
1,000
2,000
3,000
4,000
5,000
Mil
lio
n (
Eu
ro)
intervention costs Reduction of health expenditure
16
Economic Effects of Prevention
0
1,000
2,000
3,000
4,000
5,000
Mil
lio
n (
Eu
ro)
intervention costs Reduction of health expenditure production gains
17
Is Prevention Cost-Effective?
18
Cost-Effectiveness of Prevention
0
50000
100000
150000
200000
250000
300000
10 20 30 40 50 60 70 80 90 100
Co
st-e
ffe
ctiv
en
ess
rati
o (
$P
PP
pe
r D
ALY
)
Years after initial implementation
school-based interventions worksite interventions mass media campaigns
fiscal measures physician counselling physician-dietician counselling
food advertising regulation food adverting self-regulation food labelling
19
Does Prevention Improve
Health Inequalities?
20
Impact on Inequalities
Different social groups have:
• Different risk profiles:
–Larger benefits in those most at risk (~)
• Different responses to interventions:
–Larger benefits with a greater response
21
Impact on Inequalities
22
0.00%
0.02%
0.04%
0.06%
0.08%
0.10%
0.12%
high SES low SES
Source: OECD, Health Working Paper 48, 2009
% H
ealth g
ain
Impact on inequalities
over the life course
0.0%
0.1%
0.2%
0.3%
0.4%
0.5%
0.6%
0.7%
high SES low SES
Worksite interventions Fiscal measures
0.0%
0.1%
0.2%
0.3%
0.4%
0.5%
0.6%
0.7%
high SES low SES23
Source: OECD, Health Working Paper 48, 2009
Policy Implications
• Prevention is an effective and cost-effective way to improve population health
• Prevention can decrease health expenditure and improve inequalities, but not to a major degree
• Comprehensive strategies combining population and individual approaches provide best results
• Multi-stakeholders approach is key to the success of prevention
24
Thanks for your attention
OECD Health Prevention work
www.oecd.org/health/prevention
OECD Health Statistics
www.oecd.org/health/healthdata
OECD Health Working Papers
www.oecd.org/els/health/workingpapers
Recommended