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IMPROVING LIFESTYLES,
TACKLING OBESITY: THE HEALTH
AND ECONOMIC IMPACT OF
PREVENTION Michele Cecchini OECD - Health Division
Obesity: a Top Health Priority
Good News for England, Italy and Spain
25%
35%
45%
55%
65%
75%
1972 1976 1980 1984 1988 1992 1996 2000 2004 2008 2012 2016 2020
Ra
te o
f o
ver
wei
gh
t
Year
USA England
Spain
France
Canada
Korea
Italy
Mexico
Australia
Switzerland
Source: OECD Obesity Update, 2014
Spanish Children Are More Likely to be
Overweight Than the Average
1 in 5 children in OECD-Europe is overweight or obese
But in some countries this figure is much higher
Source: OECD, Health at a Glance, 2013
0%
10%
20%
30%
40%
50%
boys girls
Pr
ev
ale
nc
e r
ate
OECD-Europe Spain
15%
11%
44%
38%
Most Affected Countries Are Likely to
Shift to More Unhealthy Behaviours
-0.1%
1.3%
2.4%
0.5%
1.5% 1.6%
-0,5
0,0
0,5
1,0
1,5
2,0
2,5
fruit/vegcons
snacks snack bars
av
era
ge
gro
wth
ra
te (
%)
20
08
-20
13
Source: OECD/Imperial College London analyses on Passport Database
Portugal, Ireland, Italy, Greece, Spain
Other OECD-Europe countries
• Recession have exacerbated unhealthy behaviours in vulnerable groups
• Families decreased food expenditure and shifted to cheaper calories
• The financial crisis is increasing inequalities in obesity and health
• Food insecurity associated to 22% higher probability of child obesity
Obese Patients Use More Healthcare
Services and Cost More
Use of healthcare services – US (2012)
Source: Cecchini, forthcoming
0
5.000
10.000
15.000
20.000
Hea
lth
ex
pen
dit
ure
by
BM
I ca
teg
(2
010
US
D)
2012 2025
Healthcare expenditure – US (2012-25)
0,5
1,0
1,5
2,0
2,5
Prescriptions Inpatient care Other care
Rel
ati
ve
use
of
serv
ices
(n
wei
gh
t b
ase
lin
e)
normal-weight overweight obese
• Increasing choice e.g. new products, reformulation, etc.
• Information, education, influencing established preferences (nudging) e.g. labelling, counselling, school-based int., etc.
• Raising prices on unhealthy choices e.g. fat/soda tax
• Banning unhealthy behaviours/products e.g. trans-fat regulation
Obesity: What Can We Do About It
What Policy Makers Needs to Know
• Does prevention improve health?
• Does it reduce health expenditure?
• Does it improve health inequalities?
• Is it cost-effective?
• When will desired effect show up?
A Comprehensive & Affordable
Prevention Package
High-income Countries Emerging Economies
Mass media campaigns Mass media campaigns
Compulsory food labelling Compulsory food labelling
Self-regulation of food advertising to children
(targets agreed with govs & independent monitoring)
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
Prevention Saves Lives Life Years Saved Every Year
0,0 0,1 0,2 0,3 0,4 0,5 0,6 0,7 0,8 0,9 1,0
China
Europe
Brazil
Canada
Life years (millions)
1 LY / 19 persons.
1 LY / 8
1 LY / 20
1 / 8
Source: OECD, HWP 48, Fit not Fat & Food Chain Network, 2012
Prevention Keeps Healthy Years of Life Free of NCDs
0
20
40
60
80
100
0 10 20 30 40 50
Mil
lio
n l
ife
yea
rs
Time (years)
0
20
40
60
80
100
0 10 20 30 40 50
Time (years)
Europe China Brazil Canada
Cancers (lung, colorectal, breast) Cardiovascular diseases
Source: OECD, HWP 48, Fit not Fat & Food Chain Network, 2012
Health Outcomes over Time England
0
2.500
5.000
7.500
10.000
0 10 20 30 40 50 60 70 80 90 100
DA
LYs
(per
mill
ion
po
pu
lati
on
)
Time (years)
worksiteinterventions
mass mediacampaigns
fiscalmeasures
foodadvertisingregulation
foodlabelling
Source: OECD, Fit not Fat
Prevention is a Good Investment Impact on Health Expenditure
-150
-125
-100
-75
-50
-25
00 10 20 30 40 50
$ /
ca
pit
a
Time (years)
Europe
Canada
Brazil
China
Source: OECD, HWP 48, Fit not Fat & Food Chain Network, 2012
Cost-Effectiveness of Prevention
Brazil
China
Canada
Europe
05101520253035
Thousand $ / DALY
After 20 years After 50 years
0 5 10 15 20 25 30 35
Thousand $ / DALY
Source: OECD, HWP 48, Fit not Fat & Food Chain Network, 2012
Key Policy Implications
• Obesity is a top health and economic priority
• Price interventions and regulation can produce the largest health gains. Primary care can be effective where capacity is less constrained
• Interventions on children produce results only in the long term. Regulation of food advertising is more efficient than school-based interventions
• Comprehensive strategies combining actions on different target groups provide best results
• Prevention is an effective and cost-effective way to improve population health and to decrease health expenditure
• Applying modelling to improve health and economic policy decisions in the Americas
• Tackling harmful alcohol use – economics and public health policy
• Lancet papers on NCDs and priority interventions
• WHO/OECD “Best buys” paper for the UN Summit on NCDs
• Obesity and the Economics of prevention – fit not fat
• OECD Health working papers
OECD Modelling Work to
Trigger Policy Change
[email protected] www.oecd.org/health/economics-of-prevention.htm