1 / 103

Three Parts

Genuine Progress Index for Atlantic Canada Indice de progrès véritable - Atlantique Estimating the Cost of Preventable Illness Genuine Progress Institute Halifax, NS, 7 July, 2011. Three Parts. 1 ) The larger context - measuring progress more accurately

becky
Télécharger la présentation

Three Parts

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Genuine Progress Index for Atlantic CanadaIndice de progrès véritable - AtlantiqueEstimating the Cost of Preventable IllnessGenuine Progress InstituteHalifax, NS, 7 July, 2011

  2. Three Parts 1) The larger context - measuring progress more accurately 2) Estimating the cost of chronic disease and its preventable portion (=purpose) 3) Estimating the cost of specific risk factors (in this case obesity) & cost-effectiveness of preventive interventions

  3. 1) The larger context 1) Measuring progress - what’s wrong with the way we do it now: Wednesday! 2) Doing it better - Population health as a key indicator 3) Why economic valuation? - Strategy; always derived from physical indicators

  4. What kind of Nova Scotia are we leaving our children?

  5. Therefore, context for obesity cost estimates: 1) Need for better indicators, which include value of natural, social, human capital - Population health as core indicator of national, social progress 2) Economic valuation as strategy, language, based on physical indicators (e.g. voluntary work, crime, forests). In an ideal world, economic valuation unnecessary - all policy decisions include health, social, envt. impacts

  6. 2) Chronic disease as cost;Prevention as investment • Medical expenditures conventionally counted as economic gain; here = cost • Indirect costs, particularly, are huge • What proportion of costs preventable? (= purpose of costing exercise) • Disease prevention (esp. dealing with root causes) is cost-effective

  7. Costs of chronic disease: • In west: four types of chronic disease account for about 3/4 of all deaths (cf 1900) Cardiovascular - 36%; Cancer - 30% COPD - 5%; Diabetes - 3%+ • Chronic diseases account for 60% medical costs; 3/4 of productivity losses due to disability and premature death; 70% total burden of illness = 13% GDP

  8. E.g.: Cost of Chronic Illness in Nova Scotia 1998 (2001$ million)

  9. These are under-estimates • Exclude diseases: Digestive, cirrhosis of liver, congenital, perinatal/LBW, blood, skin, genitourinary (chronic renal failure), etc. • “Principal diagnosis”: e.g. injury/fall vs osteoporosis; diabetes under-reported (complications: blindness, kidney failure, amputations, cardiovascular disease, infections)

  10. What portion is preventable? Excess risk factors account for: • 40% chronic disease incidence • 50% chronic disease premature mortality • Small number of risk factors account for 25% medical care costs • 38% total burden of disease (includes direct and indirect costs)

  11. A few risk factors cause many types of chronic disease • Tobacco - heart disease, cancers, respiratory disease • Obesity - hypertension, diabetes 2, heart disease, stroke, some cancers • Physical inactivity - heart disease, stroke, hypertension, colon and breast cancer, diabetes 2, osteoporosis • Diet/fat - heart disease, cancer, stroke, diabetes • Alcoholism – first step = epidemiology: PAFs

  12. Design cost-effective prevention strategyknowing costs of key risk factors (e.g. Nova Scotia(2001 $ millions)

  13. Socio-economic Determinants of Health • Education, income, employment, stress, social networks are key health determinants. These too are modifiable • Lifestyle interventions effective for higher income/education groups, not lower - can widen inequity, health gap

  14. Health Costs of Poverty • Most reliable predictor of poor health, premature death, disability: 4x more likely report fair or poor health = costly • e.g. Increased hospitalization (Canada): Men 15-39 = +46%; 40-64 = +57% Women 15-39 = +62%; 40-64 = +92%

  15. Health Cost of Inequality • British Medical Journal: “What matters in determining mortality and health is less the overall wealth of the society and more how evenly wealth is distributed. The more equally wealth is distributed, the better the health of that society.” • e.g. Sweden, Japan vs USA; Gap widened

  16. E.g. Excess use of physicians • No high school diploma use 49% more physician services than those with BA • Lower income groups use 43% more than higher income; lower middle = 33% more • In NS: excess physician use due to educational inequality = $42.2 M./yr; excess use due to income inequality = $27.5 M./yr = small % total health costs

  17. Heart Health Costs of Poverty • Low income groups have higher risk of smoking, obesity, physical inactivity, cardiovascular risk = costly • Canada could avoid 6,400 deaths, $4 billion/year if all Canadians were as heart healthy as higher income groups

  18. Health costs of child poverty • 31 indicators - as family income falls, children have more health problems, (NLSCY, NPHS, Statistics Canada) • Child poverty -> higher rates of respiratory illness, obesity, high blood lead, iron deficiency, FAS, LBW, SIDS, delayed vocabulary development, injury+….

  19. BUT... Doesn’t a successful preventive strategy just defer costs to older ages? • NS 65+: 2001 = 14%; 2036 = 28% • e.g. Philip Morris’ Czech Republic study • + Prevention hard to sell: 1) Successful prevention = nothing happens; 2) Costs won’t be diverted from health care Answer these objections

  20. Aging - Delay vs Cure Saves $ • 5-year delay in onset cardiovascular disease could save US $100 billion / yr; hip fracture 5-yr delay save $7.3 billion • Physically active - lower lifetime illness • Nutritional intervention - reduce hospital use 25%-45% among elderly • Ethics, methods of PM study • Accepting death – Bhutan example

  21. Prevention saves: “... A strategic aging research effort would benefit the nation’s economy and boost productivity.... The United States will save billions of dollars by keeping older people out of hospitals, out of operating rooms and out of nursing homes.... Long life can be healthy and productive to the end.” American Federations for Aging Research

  22. “Compression of Morbidity” • Fries: “The amount of disability can decrease as morbidity is compressed into the shorter span between the increasing age at onset of disability and the fixed occurrence of death.” (= about 85: analysis of 1900s data) • “Successful aging” can preserve independence into old age

  23. Disease Prevention is Cost-Effective Investment • E.g. Workplace = 2:1 • WIC = 3:1 (mostly avoided LBW) • “Smoke-Free for Life” = 15:1 • Pre-natal counselling = 10:1 A chronic disease prevention strategy is responsibility of all sectors

  24. 3) Cost of Obesity 1) How we currently count obesity costs 2) Costs of obesity - health impacts 3) Global epidemic; U.S. trends 4) Economic costs: Methodology and cost estimates (direct and indirect) 5) Causes and solutions: cost-effective interventions

  25. Is obesity a “cost”, or is it good for the economy? • Americans spend more than $100 billion a year on fast food = 44% of all food service sales • Fast food, candy, sugared cereals = 1/2 of $30 billion annual food industry advertising in U.S. (Kelloggs spends $40 million /year to promote Frosted Flakes alone)

  26. Overeating contributes to economy many times over • Excess foods grown, processed, advertised, transported, warehoused, sold • Diet drug and weight loss industries then add $35 billion to US economy • Liposuction = leading form of cosmetic surgery in US = 400,000 operations / year = up 62% in 2 years = a growth industry

  27. Obesity-related illness • Costs U.S. $118 billion / year (Colditz) - now exceeds smoking; but doctor, drug, hospital costs make economy grow • More than 50% diabetes 2 due to obesity • Type 2 diabetes grown 5-fold globally since 1985 from 30 to 150 million (17 million in US). WHO predicts 300 million by 2025

  28. In the words of the pharmaceutical industry: “The type 2 diabetes market will double to $17.2 billion in 2011, reflecting sustained, robust annual growth of 7% from 2001 through 2011” • Consumption of oral diabetic drugs will grow five-fold from 2001 to 2011

  29. Eli Lilly - $119 bill. firm • Announced construction of world’s largest factories devoted to single drug (insulin) = $1/2 bill. plants in Virg. and PR (11% of PR population has diabetes) • Lilly global insulin sales up 16% in 2001 Humalog (Virg, PR) up 79%; Actos up 61% from 2000 (2001 sales = $901 mill) • James Kappel (Lilly): “You’ve got to be in diabetes.”

  30. Counting it wrong • So long as we count growth in fast food and diabetes industries as good news for the economy, the health policy agenda is unlikely to shift • So long as we use economic growth statistics as the primary measure of social wellbeing, we won’t give population health and prevention the attention they deserve

  31. Counting it right: Obesity as serious cost • Obese (BMI >30) = 50-100% increased risk of death (all causes) cf healthy weight • Overweight = higher premature death rate even if no smoking, otherwise healthy (American Cancer Society - 1 million subjects) • Second-leading preventable cause of death in US (Joann Manson - Harvard)

  32. Health Impacts • BMI >30 = 4x diabetes; 3.3x high blood pressure; 56% more likely have heart disease; 2.6 times urinary incontinence; 50% less likely rate health positively (Statcan) • Association with some cancers, gallbladder disease, stroke, asthma, arthritis, thyroid problems, back problems, sleep disorders, impaired immunity, depression, etc.

  33. A “Global Epidemic” (WHO) • Obesity increased 400% in the western world in the last 50 years. • Underfed and Overfed: The Global Epidemic of Malnutrition: “ for the first time in human history the number of overweight people in the world now equals the number of underfed people, with 1.1 billion each.” March, 2000, Worldwatch Institute, Washington D.C.

  34. Unequal distribution not food scarcity is the problem • 80% of world’s hungry children live in countries with food surpluses; 36% Brazilians, 41% Colombians overweight • 50%+ US, UK, Germans overweight; 50%+ Bangladesh, India children underweight • U.S. - 20% children overweight or obese (50% increase since 1980); Nearly 1/5 U.S. children “food insecure” (USDA)

  35. Underfed and Overfed • The hungry and the overweight share high levels of sickness and disability, shortened life expectancies, and lower levels of productivity -- all of which impede a country's development • Among the overweight, "obesity often masks nutrient starvation," as calorie-rich junk foods squeeze healthy items from the diet. In Europe and North America, fat and sugar now account for more than half of total caloric intake

  36. Low-income, poorly educated, elderly = higher rates overweight, obesityPercent of Canadians who believe that low-fat foods are expensive, 1994-95

  37. Overweight- by Education and Age (20-64), Canada, 1997 (%)

  38. Obesity Trends* Among U.S. Adults, 1985Source: Mokdad A H, et al. J Am Med Assoc1999;282:16, 2001;286:10.

  39. Obesity Trends* Among U.S. AdultsBRFSS, 1985 Source: Mokdad A H, et al. J Am Med Assoc1999;282:16, 2001;286:10. BRFSS – Behavioural Risk Factor Surveillance System - CDC

  40. Obesity Trends* Among U.S. AdultsBRFSS, 1986 Source: Mokdad A H, et al. J Am Med Assoc1999;282:16, 2001;286:10.

  41. Obesity Trends* Among U.S. AdultsBRFSS, 1987 Source: Mokdad A H, et al. J Am Med Assoc1999;282:16, 2001;286:10.

  42. Obesity Trends* Among U.S. AdultsBRFSS, 1988 Source: Mokdad A H, et al. J Am Med Assoc1999;282:16, 2001;286:10.

  43. Obesity Trends* Among U.S. AdultsBRFSS, 1989 Source: Mokdad A H, et al. J Am Med Assoc1999;282:16, 2001;286:10.

  44. Obesity Trends* Among U.S. AdultsBRFSS, 1990 Source: Mokdad A H, et al. J Am Med Assoc1999;282:16, 2001;286:10.

  45. Obesity Trends* Among U.S. AdultsBRFSS, 1991 Source: Mokdad A H, et al. J Am Med Assoc1999;282:16, 2001;286:10.

More Related