IS A HEALTHY DIET
ECONOMICALLY SUSTAINABLE?
THE HEALTH EFFECTS OF
PREVENTION POLICIES
Michele Cecchini
OECD – Health Division
The Burden of Obesity on Health Systems
In any given moment, obese patients cost more
Relative cost of patients
115
110
105
100
95
90
Normal-weight patient
Source:Brunello et al., 2008
Bhattacharia & Sood, 2005
Obese patient (US)
Obese patient (EU)
The OECD/WHO CDP Model
Blood pressure
normal
hypertension
Fibre
Cancers
adequate fibre intake
low fibre intake
Fat
low fat intake
medium fat intake
high fat intake
Body mass
index
normal weight
pre-obesity
obesity
Cholesterol
normal
Stroke
hypercholesterolemia
Physical activity
adequate physical act
insuff .physical act
Glycaemia
normal
diabetes
Socio-economic status
upper
lower
Ischemic heart
disease
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 Lives
Life Years Saved Every Year
Canada
Brazil
Europe
China
1/8
1 LY / 20
1 LY / 8
1 LY / 19 persons.
0.0
0.1
0.2
0.3
0.4
0.5
0.6
Life years (millions)
0.7
0.8
0.9
1.0
Prevention Keeps Healthy
Years of Life Free of NCDs
Cardiovascular diseases
100
100
90
90
80
80
70
70
Million life years
Million life years
Cancers (lung, colorectal, breast)
60
50
40
30
60
50
40
30
20
20
10
10
0
0
0
10
20
30
Time (years)
Europe
40
50
China
0
Brazil
10
20
30
Time (years)
Canada
40
50
Prevention is a Good Investment
Impact on Health Expenditure
Time (years)
0
10
20
30
40
50
0
-20
$ / capita
-40
-60
-80
-100
-120
-140
Europe
Canada
Brazil
China
Cost-Effectiveness of Prevention
After 20 years
After 50 years
Brazil
China
Canada
Europe
35
30
25 20 15 10
Thousand $ / DALY
5
0
0
5
10 15 20 25 30
Thousand $ / DALY
35
Impact on Inequalities
Fiscal measures in Europe
Different social groups:
0.7%
0.6%
• Different risk profiles:
– Larger benefits in those
most at risk (~)
• Different responses to
interventions:
– Larger benefits with a
greater response
0.5%
0.4%
0.3%
0.2%
0.1%
0.0%
high SES
low SES
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 Diet
10% of Energy from Saturated Fats
United Kingdom
saturated
fat
YLL (IHD)
0%
-2%
-4%
-6%
-8%
-10%
-12%
22%
-
-14%
Source: Lock et al., 2010
YL with
IHD
Brazil
premature saturated
deaths
fat
YLL (IHD)
YL with
IHD
premature
deaths
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
book
michele.cecchini@oecd.org
www.oecd.org/health/prevention