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Fat Is an Economic Issue! Combating Chronic Diseases in Europe

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Fat Is an Economic Issue! Combating Chronic Diseases in Europe XXXXXXXXXXXXXXXXXXXXXXXXXXX Fat is an economic issue! Combating chronic diseases in Europe Europeans are getting fatter, we are eating approximately 60% of the 56.5 million the wrong mix of foods and we are becom- total deaths and 46% of the global burden ing less physically active. These observed of disease, increasing to 57% by 2020.2 trends have been linked to the rise in Chronic diseases are usually associated chronic diseases, with potentially severe with older age groups, but with almost half consequences. While the indications are of total chronic disease deaths due to car- strong, more research is needed to guide diovascular disease (CVD), and the inci- politicians and policy makers, not only to dence of diabetes increasing dramatically in spell out the health and economic costs but some countries, these problems are also also to define effective intervention strate- starting to appear in the young.3 gies and promote investment in health pro- Worldwide, attention is focusing on the motion. We have to act now. most visible sign of this problem, obesity, though the related health problems go far Economic change can have a powerful Geof Rayner beyond this. What is clear is the perception impact on health, not always for the better; of obesity and excessive weight as prob- witness the dramatic impact of the eco- lems of appearance impedes their far more nomic collapse of the former Soviet Union. important health consequences. Equally, the burden of disease has impor- tant implications for economic perfor- Many in public health are beginning to mance and inequality: HIV/AIDS in ponder these big questions. How might Africa, has reduced regional GDP by as these disease trends affect Europe and what much as 30%, while the costs of new vari- are their economic costs, either to the ant Cruetzveld Jakobs Disease (BSE or health care system or to the broader econo- mad cow disease) in Europe, are approach- my? What is the impact of these diseases on ing A40 billion. Sudden Acute Respiratory household incomes or on health inequali- Syndrome (SARS), though still limited in ties? Perhaps the most important question its significance compared to the big killers, of all is what can be done to stem the has greatly damaged trade, investment, and mounting tide of NCDs? To answer these Mike Rayner tourism in south east Asia and Canada. questions, research is required across acad- emic disciplines. The traditional approach The Burden of NCDs adopted in health economics, focussing narrowly on medical care, has failed to With over 30 new infectious diseases address these public health concerns suffi- emerging over the past 30 years, the case ciently. Such research can have an impor- for better surveillance and investment in tant role in guiding politicians and policy health protection has been powerfully makers, but the evidence should also help made.1 What though of the burden of less to direct the media away from its preoccu- pin-pointable, less headline-grabbing ‘non- pation with ‘medical breakthroughs’ or communicable diseases’ (NCDs), often personal manifestations of disease and termed ‘lifestyle diseases’ or, inaccurately, treatment, storylines which invariably ‘diseases of affluence’? In terms of morbid- direct public attention away from a popula- ity rather than mortality these chronic dis- tion perspective and analysis of upstream eases occupy a growing burden of disease causation. worldwide. In 2001, they accounted for Obesity in the US If the significance of obesity and being Geof Rayner is chair of the UK Public Health Association and honorary overweight has not dawned upon many research fellow at the Institute of Health Sciences, City University, London European leaders, it has done so in the US. In June 2002, President Bush, announced Mike Rayner is head of the British Heart Foundation Health Promotion the revival of the President’s Council on Research Group, Division of Public Health and Primary Health Care, Physical Fitness, and emphasised the University of Oxford Institute of Health Sciences, England importance of 30 minutes of daily physical E-mail: [email protected] and [email protected] activity for adults (60 minutes for children), 1 eurohealth Vol 9 No 1 Spring 2003 XXXXXXXXXXXXXXXXXXXXXXXXXXX and the value of ‘five a day’ consumption weight and obesity are smaller, amounting of fruit and vegetables. Certainly, evidence to around $117 billion in 2000, or 10 % of from the US provides a warning to Europe, total health care costs.6 not just because of the implications for We believe the last assessment may be an health and financial costs, but also because underestimate. One recent study compar- of the clear identification of causes. As one ing the treatment costs of obesity with WHO expert group has noted: “In many those for smoking and alcohol has suggest- countries, perhaps most typified by the US, ed that obesity is associated with a 36 % changes in family eating patterns and the increase in inpatient and outpatient spend- consumption of fast foods, pre-prepared ing and a 77 % increase in the use of med- meals and carbonated drinks, have taken ications, compared with 21 and 28 % place over the past 30 years. Likewise, the increases respectively for current smokers, amount of physical activity has been great- and smaller increases related to alcohol.8 ly reduced, both at home and in school, as Demand for medical treatment for obesity well as by increasing use of mechanised is rising. In 1998, there were some 400,000 transport.”4 liposuction procedures in the US. Over Such changes have been immense in the 100,000 Americans per year, and the num- "Evidence from the US US. Food companies seemingly defined a bers are rising rapidly, now receive gastric new food culture as early as the 1950s. Per bypass surgery, the ‘last ditch’ technique provides a warning to annum it is estimated that $4.5 billion is for saving lives and tackling the symptoms 9 Europe" spent by the food industry on advertising of morbid obesity, such as diabetes. and $50 million on lobbying in Needless to say, the total costs of surgery, Washington.5 Around 90 % of US children ranging from $17,000 to $45,000 per opera- between 3 and 9 visit a hamburger restau- tion, are considerable. rant monthly. Average portions in ham- burger chains have doubled in 30 years, The situation in Europe with a similar trend in the consumption of How do these trends correspond with the sweetened carbonated drinks. Schools situation in Europe? From data collected appear to have a particular problem, as for the recent World Health Report, we children have been ‘trained’ to consume estimate that around 8% of deaths and dis- fast food and reject vegetables. The US ability are attributable to being overweight Surgeon General reports that that school or obese, only slightly less than the 12% foods have the highest saturated fat density attributed to smoking. How much does of all food outlets.6 this cost and, more importantly, could it be avoided? Cost of illness studies are general- Catastrophic consequences ly done by those with a vested interest in a If the health consequences are already seri- particular disease, such as pharmaceutical ous, they are set to become catastrophic. companies and health charities, and there Current estimates are that more than 60 are no standardised ways of carrying out million Americans have one or more types such analyses. So the short answer is that of CVD. According to the US Surgeon we have very little information to go on. General, approximately 300,000 deaths a We urgently need the European year are associated with obesity and being Commission, or another international overweight (compared with more than body, to commission a study looking at all 400,000 deaths a year associated with ciga- diseases and all the main causes of ill health rette smoking). Furthermore recent gov- in a comparable way. At the moment it is ernment projections estimate that health only possible to make provisional estimates care spending in the United States will of attributable costs. reach $2.8 trillion in 2011, up from $1.3 What is known, however insufficient, is trillion in 2000, and health care spending is worrying. It has been estimated that each expected to reach 17 % of GDP by 2011, year approximately A74 billion is spent on up from 13.2 % in 2000.7 (Bear in mind treating CVD in the EU and about another that approximately 41 million Americans in A106 billion a year are incurred in indirect 2001, 14.6% of the population, were with- costs due to the lost production of goods out health insurance for some of this year.) and services.10 WHO estimates that Expenditure on prevention in the US is a between one quarter and one half of CVD tiny fraction of the amount spent on med- is attributable to being overweight or ical care. According to official assessments, obese, and as about two thirds of death and CVD accounts for approximately 61 % of all health care spending. The total direct disability from being overweight or obese and indirect costs attributed to being over- are related to CVD this suggests total costs to European society of between A70 and 2 eurohealth Vol 9 No 1 Spring 2003 XXXXXXXXXXXXXXXXXXXXXXXXXXX "Better information A135 billion a year. In comparison the total whose death could be attributed to obesity budget for the Common Agriculture Policy lost nine years of life.11 These figures were based on solid (CAP) is approximately A40 billion a year. picked up in the UK Treasury’s assessment of health spending, which prompted its Working out how much things cost is, of collaboration focusing author, Derek Wanless, to call for a ‘fully course, only half the battle.
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