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 bookmichele.cecchini@oecd.org www.oecd.org/health/prevention