Nutrition and inequalities in health: the role of prevention policy Marion Devaux OECD Health Division Athens, 25 th February 2014 1
OECD Work on Prevention 2
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
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 0 20 40 60 80 100 Age 20% 10% 0% Korea 0 20 40 60 80 Age 4 Source: OECD estimates on national survey data.
Fruit and vegetable consumption by Education level % 100 90 Daily fruit eating 100 90 Daily vegetable eating 80 80 70 70 60 60 50 50 40 40 30 30 Source: EHIS 2008, Eurostat Statistics Database 2013 5
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, 2008. 6
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, 2009 7
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% 1970 1980 1990 2000 2010 2020 Year 8 Source: OECD Obesity Update 2012
Relative index of inequality Inequalities in Overweight by Level of Education 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Men Women 5.0 4.5 4.0 3.5 3.0 2.5 5.0 2.0 1.5 3.2 2.9 2.7 1.6 1.4 1.4 1.3 1.2 1.2 1.1 1.0 1.0 0.9 0.7 1.0 0.5 2.2 1.8 1.7 1.7 1.4 1.4 1.3 0.0 9 Source: OECD Fit Not Fat 2010
Odds ratios for obesity Social Disparities in Child Obesity Boys Girls 3.0 3.0 2.5 2.5 2.0 2.0 1.5 1.5 1.0 1.0 0.5 0.5 0.0 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
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
Expectations Must Be Realistic Does prevention improve health? Does it reduce health expenditure? Is it cost-effective? Does it improve health inequalities? 12
Does Prevention Improve Population Health? 13
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 0 100 000 200 000 300 000 400 000 500 000 Disability-adjusted life years Life years 14
Does Prevention Reduce Expenditure on Health Care? 15
Million (Euro) Economic Effects of Prevention 5,000 4,000 3,000 2,000 1,000 0 intervention costs Reduction of health expenditure 16
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
Is Prevention Cost-Effective? 18
Cost-effectiveness ratio ($PPP per DALY) Cost-Effectiveness of Prevention 300000 250000 200000 150000 100000 50000 0 10 20 30 40 50 60 70 80 90 100 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
Does Prevention Improve Health Inequalities? 20
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
% 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
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
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
Thanks for your attention OECD Health Prevention work www.oecd.org/health/prevention OECD Health Statistics www.oecd.org/health/healthdata OECD Health Working Papers www.oecd.org/els/health/workingpapers