Nutrition and inequalities in

health: the role of

prevention policy

Marion Devaux OECD – Health Division

Athens, 25th 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

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 20 40 60 80 100

Age

Korea

Canada

England

US

Insufficient Fiber consumption

0%

10%

20%

30%

40%

50%

60%

70%

80%

0 20 40 60 80

Age

Korea

Canada

US

High Fat consumption

Source: OECD estimates on national survey data.

4

Fruit and vegetable consumption

by Education level

5

Source: EHIS 2008, Eurostat Statistics Database 2013

30

40

50

60

70

80

90

100

% Daily fruit eating

30

40

50

60

70

80

90

100Daily vegetable eating

6

Physical activity by area of residence

Note: insufficient level of physical activity is defined as less than WHO recommended levels

• People in urban areas are less likely to have sufficient levels of physical activity.

Source: OECD analysis on EHIS, Eurostat, 2008.

Strong correlation within households

7

%

Source: OECD, Health Working Paper 45, 2009

n.a

. n

.a.

n.a

. n

.a.

• People living in the same household share lifestyles.

Obesity: a Growing Problem

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

1970 1980 1990 2000 2010 2020

Rat

e o

f ob

esi

ty

Year

USA England

Spain

France

Canada

Korea

Italy

- - - Past projectionNew data points

Source: OECD Obesity Update 2012

8

Inequalities in Overweight

by Level of Education

1.6 1.4 1.4 1.3 1.2 1.2 1.1 1.0 1.0 0.9 0.7

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Rel

ati

ve

ind

ex o

f in

equ

ali

ty

5.0

3.2 2.9 2.7

2.2 1.8 1.7 1.7 1.4 1.4 1.3

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Men Women

Source: OECD Fit Not Fat 2010

9

Social Disparities in Child Obesity

0.0

0.5

1.0

1.5

2.0

2.5

3.0

England France Korea USA

Od

ds

rati

os

for

ob

esit

y

Boys Girls

-

0.5

1.0

1.5

2.0

2.5

3.0

England France Korea USA

Higher SES (ref.) Higher-middle SES Middle SES

Lower-middle SES Lower SES Source: OECD Fit Not Fat 2010

10

Interventions

Health education and health promotion

Regulation and fiscal measures

Primary-care based interventions

Mass media campaigns Fiscal measures

(fruit and vegetables and foods high in fat)

Physician counselling of individuals at risk

School-based interventions

Government regulation or industry self-regulation of

food advertising to children

Intensive physician and dietician counselling of

individuals at risk

Worksite interventions Compulsory food

labelling

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

0 100 000 200 000 300 000 400 000 500 000

physician-dietician counselling

fiscal measures

physician counselling

food labelling

worksite interventions

food advertising regulation

school-based interventions

food adverting self-regulation

mass media campaigns

Disability-adjusted life years Life years

1 LY/DALY every 115/121 people

1 LY/DALY every 12/10 people

14

Average health effects per year

Does Prevention Reduce

Expenditure on Health Care?

15

Economic Effects of Prevention

0

1,000

2,000

3,000

4,000

5,000

Mil

lio

n (

Eu

ro)

intervention costs Reduction of health expenditure

16

Economic Effects of Prevention

0

1,000

2,000

3,000

4,000

5,000

Mil

lio

n (

Eu

ro)

intervention costs Reduction of health expenditure production gains

17

Is Prevention Cost-Effective?

18

Cost-Effectiveness of Prevention

0

50000

100000

150000

200000

250000

300000

10 20 30 40 50 60 70 80 90 100

Co

st-e

ffe

ctiv

en

ess

rati

o (

$P

PP

pe

r D

ALY

)

Years after initial implementation

school-based interventions worksite interventions mass media campaigns

fiscal measures physician counselling physician-dietician counselling

food advertising regulation food adverting self-regulation food labelling

19

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

Impact on Inequalities

22

0.00%

0.02%

0.04%

0.06%

0.08%

0.10%

0.12%

high SES low SES

Source: OECD, Health Working Paper 48, 2009

% H

ealth g

ain

Impact on inequalities

over the life course

0.0%

0.1%

0.2%

0.3%

0.4%

0.5%

0.6%

0.7%

high SES low SES

Worksite interventions Fiscal measures

0.0%

0.1%

0.2%

0.3%

0.4%

0.5%

0.6%

0.7%

high SES low SES23

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