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

Michele.cecchini@oecd.org www.oecd.org/health/economics-of-prevention.htm