Nutrition and inequalities in health: the role of prevention policy

Transcription

1 Nutrition and inequalities in health: the role of prevention policy Marion Devaux OECD Health Division Athens, 25 th February

2 OECD Work on Prevention 2

3 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

4 Unhealthy Dietary Behaviours Insufficient Fiber consumption High Fat consumption 100% 80% 90% US 70% 80% 70% 60% England 60% 50% US 50% 40% 40% Canada 30% Canada 30% 20% 10% 0% Korea Age 20% 10% 0% Korea Age 4 Source: OECD estimates on national survey data.

5 Fruit and vegetable consumption by Education level % Daily fruit eating Daily vegetable eating Source: EHIS 2008, Eurostat Statistics Database

6 Physical activity by area of residence People in urban areas are less likely to have sufficient levels of physical activity. Note: insufficient level of physical activity is defined as less than WHO recommended levels Source: OECD analysis on EHIS, Eurostat,

7 n.a. n.a. n.a. n.a. Strong correlation within households People living in the same household share lifestyles. % Source: OECD, Health Working Paper 45,

8 Rate of obesity Obesity: a Growing Problem 45% 40% Past projection New data points 35% 30% 25% 20% 15% 10% USA Spain England Canada 5% France Italy Korea 0% Year 8 Source: OECD Obesity Update 2012

9 Relative index of inequality Inequalities in Overweight by Level of Education Men Women Source: OECD Fit Not Fat 2010

10 Odds ratios for obesity Social Disparities in Child Obesity Boys Girls England France Korea USA - England France Korea USA Higher SES (ref.) Higher-middle SES Middle SES Lower-middle SES Lower SES 10 Source: OECD Fit Not Fat 2010

11 Interventions Health education and health promotion Regulation and fiscal measures Primary-care based interventions Mass media campaigns School-based interventions Worksite interventions Fiscal measures (fruit and vegetables and foods high in fat) Government regulation or industry self-regulation of food advertising to children Compulsory food labelling Physician counselling of individuals at risk Intensive physician and dietician counselling of individuals at risk 11

12 Expectations Must Be Realistic Does prevention improve health? Does it reduce health expenditure? Is it cost-effective? Does it improve health inequalities? 12

13 Does Prevention Improve Population Health? 13

14 Health Outcomes of Prevention Average health effects per year mass media campaigns 1 LY/DALY every 115/121 people food adverting self-regulation school-based interventions food advertising regulation worksite interventions food labelling physician counselling fiscal measures physician-dietician counselling 1 LY/DALY every 12/10 people Disability-adjusted life years Life years 14

15 Does Prevention Reduce Expenditure on Health Care? 15

16 Million (Euro) Economic Effects of Prevention 5,000 4,000 3,000 2,000 1,000 0 intervention costs Reduction of health expenditure 16

17 Million (Euro) Economic Effects of Prevention 5,000 4,000 3,000 2,000 1,000 0 intervention costs Reduction of health expenditure production gains 17

18 Is Prevention Cost-Effective? 18

19 Cost-effectiveness ratio ($PPP per DALY) Cost-Effectiveness of Prevention Years after initial implementation school-based interventions worksite interventions mass media campaigns fiscal measures physician counselling physician-dietician counselling 19 food advertising regulation food adverting self-regulation food labelling

20 Does Prevention Improve Health Inequalities? 20

21 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

22 % Health gain Impact on Inequalities 0.12% high SES low SES 0.10% 0.08% 0.06% 0.04% 0.02% 0.00% 22 Source: OECD, Health Working Paper 48, 2009

23 Impact on inequalities over the life course Worksite interventions Fiscal measures 0.7% 0.6% 0.5% 0.4% 0.3% 0.2% 0.1% 0.0% 0.7% 0.6% 0.5% 0.4% 0.3% 0.2% 0.1% 0.0% high SES low SES high SES low SES 23 Source: OECD, Health Working Paper 48, 2009

24 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

25 Thanks for your attention OECD Health Prevention work OECD Health Statistics OECD Health Working Papers