1 Workshop Economics of Prevention of Noncommunicable Diseases
1 Workshop Economics of Prevention of Noncommunicable Diseases and Risk Factors (obesity, physical inactivity and poor diets) Macroeconomic Impacts of Prevention Policies for NCDs Making the Case to the Finance Sector Sylvie Desjardins Senior Health Economist, Scientific Director WHO Collaborating Centre on Chronic Noncommunicable Disease Policy Public Health Agency of Canada Agence de la santé publique du Canada
NCDs are an increasing global challenge… Most significant cause of death (63%) worldwide 1 NCDs cause premature deaths under age 60: 13% in high income countries 29% in low middle income countries Even in African nations, NCDs are rising rapidly, projected to exceed communicable, maternal/perinatal, and nutritional diseases as the most common causes of deaths by 2020 Source: World Health Organization (WHO). Public Health Agency of Canada | Agence de la santé publique du Canada 1 Except in sub-Saharan Africa. 2
…and their impacts extend beyond health. • NCDs represent a major fiscal and productivity risks for the economies of low, middle, and high income countries • NCDs increase income inequities, deplete household wealth, increase health spending and lower labour productivity • Most countries will not be able to address NCD challenge with medical care alone: Prevention is critical Source: World Bank 2011. Public Health Agency of Canada | Agence de la santé publique du Canada 3
4 The Cost… Public Health Agency of Canada Agence de la santé publique du Canada
Deaths due to NCDs in Canada are increasing… 100 90 80 70 60 50 40 30 20 10 The proportion of people dying from chronic conditions is constantly increasing 0 Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using data from OECD HEALTH DATA 2010, June. Public Health Agency of Canada | Agence de la santé publique du Canada 5
…and NCD rates are increasing at 14 percent each year. Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using POHEM Model, Statistics Canada. Public Health Agency of Canada | Agence de la santé publique du Canada 6
Canadians are at high risk… 1 out of 2 reports not eating enough fruits and vegetables daily 1 out of 2 aged 20 years and older are physical inactive 1 out of 5 is smoking 1 out of 20 aged 15 years and older consumes alcohol daily Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using data from Canadian Community Health Survey, Statistics Canada. Public Health Agency of Canada | Agence de la santé publique du Canada 7
…and so is our economy. NCDs cost $190 billion in 2010. Economic burden of NCDs Individual Household Employer Government Health care COSTS Out of pocket drugs Lost productivity Disability Public Health Agency of Canada | Agence de la santé publique du Canada 8
Treating NCDs is costly. Canada’s declining deaths from heart disease due in part to an increase in treatment. 6 140 120 5 100 4 Deaths per 100, 000 pop. (sdr) Expenditures on cardiovascular 3 disease medication (Billion $) 80 60 2 40 1 20 Deaths Expenditures 0 0 Years Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using data from OECD HEALTH DATA 2010; and CMAJ, July 7, 2009 - 1881 (1 -2). Public Health Agency of Canada | Agence de la santé publique du Canada 9
In fact people with NCDs account for more than half of all annual health care spending… All infectious 7% Other NCDs 58% 33% Other diseases 28% 7% All injuries Proportion of health care costs by disease 25% Four major NCDs Cancer Respiratory diseases 5% 6% 2% Diabetes 12% Cardiovascular diseases Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using data from the Reports of the Economic Burden of Illness in Canada. Public Health Agency of Canada | Agence de la santé publique du Canada 10
… and will begin to escalate rapidly Health sector costs in Canada are increasing about 7% a year… This is about twice as fast as government revenues or GDP is rising. Public Health Agency of Canada | Agence de la santé publique du Canada 11
…but the economic impact goes beyond the health sector. Direct health care costs in 2010 = $68 billion Indirect costs due to income and productivity losses = $122 billion estimated Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using data from the Canadian Institute for Health Information and from the data of the Economic Burden of Illness in Canada, 1986, 1993, 1998. Public Health Agency of Canada | Agence de la santé publique du Canada about twice the direct health care costs 12
We can quantify the impact of NCDs on the economy. In the past 10 years: 60% increase of dialysis among Canadians 100% increase out of pocket drug expenditures per household 30% increase in number of hours lost by employees 20% increase in employees absent due to disability Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using data from OECD HEALTH DATA 2010 and the Labour Force Survey, Statistics Canada. Public Health Agency of Canada | Agence de la santé publique du Canada 13
14 The Cost-effectiveness Options… Public Health Agency of Canada Agence de la santé publique du Canada
Un de rly dr ing ive rs Be ris hav k f iou ac ra to lp rs hy Me sio tab ris lo oli k f gic c/ ac al to rs We understand the pathway to NCDs. . . NCDs Raised blood pressure Overweight/obesity Raised blood glucose Raised lipids Tobacco use Unhealthy diet Physical inactivity Harmful use of alcohol Social Determinants of Health Globalization Urbanization Population ageing Source: Global Status Report on Noncommunicable Diseases 2010, World Health Organization. Public Health Agency of Canada | Agence de la santé publique du Canada 15
…and we know prevention is critical. 80% of heart disease, diabetes and respiratory diseases and 40% of cancers are preventable by eliminating four common risk factors Common risk factors Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol Cardiovascular diseases Diabetes NCDs Cancer Respiratory diseases Public Health Agency of Canada | Agence de la santé publique du Canada Source: WHO, Raising the priority of non-communicable disease in development work at global and national levels. 16
Intervention for prevention works. . . For every $1 invested in labelling on cigarette packages there is a saving of $52 for the Canadian economy including $8 for Government 1 For Worksite Health Promotion, the Atlantic Health and Wellness Institute found that returns per dollar ranged from $1. 64 to $3. 98 based on employee risk factors after 3 months of intervention 2 Sources: 1 Health Canada, 2011. 2 Spencer & Associates, 2002. Public Health Agency of Canada | Agence de la santé publique du Canada 17
… and healthy promotion is everyone’s business. Health Outcomes at the Population Level (average effects per year) School-based interventions Disabilityadjusted life years Mass media campaigns Food advertising selfregulation Life years Food labelling Worksite interventions Food advertising regulation Physician counselling Fiscal measures 0 10, 000 20, 000 30, 000 40, 000 Assessing results of nine prevention approaches, a study using OECD/WHO model predict both the per capita investment costs and their likely outcomes in improving population health. Mainly, the study concluded the best return for the prevention dollar came from a combination of several interventions from public and private sector sources. Physician-dietician counselling Public Health Agency of Canada | Agence de la santé publique du Canada 18
19 The Macroeconomic options… Public Health Agency of Canada Agence de la santé publique du Canada
Actions by many sectors have an impact on our lifestyles and health. Finance Agri-food Trade Environment and Sustainable Development Work Places NCDs Urban Planning Transport Economic Development Income Education Public Health Agency of Canada | Agence de la santé publique du Canada 20
Sector actions are important… Transport – policies which create opportunities for safe, and active living can assist Canadians to choose healthier lifestyles Agri-food – the availability of a safe and nutritious food supply can influence patterns of healthy eating Trade – treaties that consider health impacts can promote good nutrition Public Health Agency of Canada | Agence de la santé publique du Canada 21
. . . for good health. A Canadian study: to estimate the macroeconomic impact of adopting a healthy diet in Canada using Global Trade Analysis Project (GTAP) model, and to estimate the impact on the Canadian economy and the economies of other trading partners. Public Health Agency of Canada | Agence de la santé publique du Canada 22
Adopting a Healthy Diet… • A comparison was made between the actual and the required consumption of three food categories: fruits and vegetables, dairy products, and meats. • Scenario 3: fruit and vegetable consumption increases by 35%, dairy product consumption by 46%, and meat consumption decreases by 43%. • Scenario 4: fruit and vegetable consumption increases by 50%, dairy increases by 41% and meat consumption decreases by 20%. Public Health Agency of Canada | Agence de la santé publique du Canada 23
… Impact on the Canadian GDP (%) Strategy 2 Scenario 3 Garriguet, 2006 Strategy 2 Scenario 4 Statistics Canada, 2010 0. 1217 0. 3411 0. 005 0. 0046 0. 001 -0. 0001 0. 0014 -0. 0003 Rest of LACs 0. 0249 0. 0064 0. 0286 0. 0073 Rest of OECD -0. 0005 0. 0001 0. 0034 0. 0047 0. 0008 0. 0012 Canada USA Brazil Chile Mexico Rest of Asia ROW Public Health Agency of Canada | Agence de la santé publique du Canada 24
… Impact on Canadian Trading Partners Strategy 2 Canada USA Brazil Chile Mexico Rest of LACs Rest of OECD Rest of Asia ROW Exports Scenario 3 Scenario 4 Imports Scenario 3 Scenario 4 0. 054 0. 524 0. 055 0. 601 0. 013 0. 061 0. 014 0. 043 0. 035 0. 040 0. 029 0. 055 -0. 081 -0. 050 -0. 030 -0. 021 -0. 182 -0. 137 0. 025 -0. 027 -0. 004 0. 034 0. 024 0. 057 0. 006 0. 005 -0. 002 -0. 004 0. 008 0. 004 0. 013 0. 006 0. 003 0. 004 0. 003 0. 002 Public Health Agency of Canada | Agence de la santé publique du Canada 25
…Impact on the Canadian Welfare. Strategy 2 Canada USA Brazil Chile Mexico Rest of LACs Rest of OECD Rest of Asia ROW Scenario 3 Scenario 4 328. 2 748. 03 1345. 79 880. 33 37. 41 20. 53 -29. 74 -45. 06 111. 23 155. 8 125. 44 84. 03 -105. 07 115. 07 174. 6 283. 66 139. 55 172. 64 Public Health Agency of Canada | Agence de la santé publique du Canada 26
27 Conclusions… Public Health Agency of Canada Agence de la santé publique du Canada
This study shows … • Following Canada’s Healthy Diet Guidelines would change food consumption patterns in Canada with increases in the consumption of fruits and vegetables and dairy products and a reduction in the consumption of meat products. • This change in food consumption would provide a significant increase in GDP (0. 34%) in Canada and would also have a positive impact for our trading partners. • Welfare would increase in Canada with marginal increases in welfare for our trading partners. • Total industrial output for Canada would increase. Public Health Agency of Canada | Agence de la santé publique du Canada 28
…Good Health is an Investment in Economic Growth. 29
30 Thank You Public Health Agency of Canada Agence de la santé publique du Canada
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