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OBESITY The economics of the increasing prevalence of obesity: a UK perspective James Robertson | National Audit Office, UK | 25 May 2005
OBESITYThe economics of the increasing prevalence of obesity: a UK perspective
James Robertson | National Audit Office, UK | 25 May 2005
Presentation will cover
Key findings of NAO work on obesity
Key messages for the future
http://www.nao.org.uk/publications/nao_reports/00-01/0001220.pdf
February 2001
The NAO Study
Trends in the prevalence of obesity amongst men and women in England extrapolated to 2010
Note
Figures beyond 1998 were extrapolated on a straight line by the least squares method on the basis of data from 1980
Source National Audit Office analysis of data from the Health Survey for England
30
25
20
15
10
5
0
Year
Men Women
1980
1985
1990
1995
2000
2005
2010
% o
bese
(B
MI
>3
0)
Focus of NAO study
Health costs and costs to the economy
How the NHS manages obesity in primary and secondary care
How government agencies join up to tackle the issue
Key facts about obesity in England, 2001
1 in 5 adults is obese
The number has trebled over the last 20 years
Nearly two thirds of men and over half of women are overweight or obese
Key facts about obesity in England
The four most common problems linked to obesity are:
– Heart disease– Type 2 diabetes– High blood pressure– Osteoarthritis
Key facts about obesity in England
The estimated human cost:
– 18 million sick days a year
– 30,000 deaths a year, resulting in 40,000 lost years of working life
– Deaths linked to obesity shorten life by9 years on average
Key facts about obesity in England
The estimated financial cost:
– £0.5 billion a year in treatment costs to the NHS
– Possibly £2 billion a year impact on the economy
Health Select Committee update May 2004
NAO had deliberately been conservative in its estimates
Some of the more expensive areas excluded (eg drugs, depression, back pain)
NHS costs 2x NAO estimate at £1bn a year
Economy wide £2.5bn
Total £3.5bn compared to NAO £2.5bn total
NAO Key Recommendations
Assemble evidence base for what works
Develop a Cross government strategy to promote physical exercise
Support healthy modes of travel and activity
Reinforce and monitor physical activity in schools
NAO Key Recommendations
Implement NHS Plan initiatives on nutrition
Monitor impact of initiatives to improve nutritional quality of school food
Strengthen guidance for schools on commercial sponsorship
Key messages for the future
1) Plan with a long time horizon
Tackling Cancer in England: Saving More Lives, National Audit Office, March 2004
http://www.nao.org.uk/publications/nao_reports/03-04/0304364.pdf
Lung cancer incidence and mortality rates for men and women reflect smoking patterns in earlier decades
120
100
80
60
40
20
0
Lung cancer incidence and mortality (England and Wales)
Incidence (men)
Time
Mortality (men)
Incidence (women)
Mortality (women)
1951 1955 1959 1963 1967 1971 1975 1979 1983 1987 1991 1995 1999 2002
70
60
50
40
30
20
10
0
Smoking Rates (men) Smoking Rates (women)
Smoking rates (Whole of UK)
1951 1955 1959 1963 1967 1971 1975 1979 1983 1987 1991 1995 1999 2002
Rat
es p
er 1
00,0
00
(E)
Per
cen
tage
sm
okin
g
2) Maintaining a high profile
There are no quick fixes
Consistent and repeated public health messages about healthy life styles in relation to preventing obesity (cf anti-smoking)
3) Empowering knowledge and choices
Equipping young people for a healthy lifestyle
General food and exercise health messages for population
Good food labelling
Power of the market? Brands
4) Anti-obesogenic environment
Healthy school weight environment– On the way to school– In school eg meals– Promoting school activity within and outside the
curriculumHealthy adult weight environment– Activity friendly (see Denmark)– Recreational facilities– Value not just “more sport”– Healthy places of employment
5) Early intervention on weight gain
In life:– at school– at home
In weight gain:– education of medics– personal insurance industry– school teachers, school nurses– occupational health workers
6) Multi faceted approach
Public and private sector stakeholders with the potential to influence lifestyle and bodyweight
Health authorities, local NHS bodies and general practices
Health professions
Department of the Environment, Transport and the Regions
Media and advertising
Food industry
Local Education Authorities and schools
Department for Education and Employment
Department for Culture,Media and Sport
Employers
Consumer representatives
Specialist voluntary bodies (eg Association for the Study of Obesity)
Local authorities
Food Standards Agency
Private sector slimming industry
Sport England
Ministry of Agriculture, Fisheries and Food
Health Development Agency
Department of Health
The ways in which the public sector influences the prevalence of obesity
Local Authorities & Social Services
Primary Care Groups (Primary Care Trusts when established)
Local agencies and communities
NHS Trusts
Department for Culture, Media and Sport
Department for Education and Employment
Department of the Environment, Transport and the Regions
Ministry of Agriculture, Fisheries and Food
Food Standards Agency
Health Development Agency
Highways Agency
Sport England and the Sports Councils
Department of Health with responsibilities for public health and ensuring that appropriate treatments are available and provided
1999 Our Healthier Nation
2000 National Service Framework for Coronary Heart Disease
2000 NHS Plan2000 Cancer Plan
NHS bodies with overview of local public health planning and responsibility for monitoring performance in the NHS
NHS bodies with responsibility for commissioning health services
Other Government departmentsAgencies whose roles
impact on healthier livingOBESITY
Identify where public agency objectives intersectPromote ‘conjoined’ approach in public sectorJoint policy development and implementationLocal planning of health needs to take explicitaccount of obesityRecognise social class inequalitiesSet targets?
7) research
What works? Develop evidence base
Psychology of eating and exercise
Guidelines for primary carers
Drug therapy
Surgery
8) Fiscal or other measures?
Fat tax or calorie tax (& salt tax) on products?– Facing inelastic demand and regressive?
Tax on producers of high calorie density food?
Subsidise exercise?
Advertising restrictions?
Employer tax breaks to provide facilities?
The 7+ approach
Recognise the long term horizonMaintain a high profile for the issueEmpower peopleFacilitate anti-obesogenic environmentEarly intervention on weight gainPromote multi-faceted approachContinue ResearchOther?
Main Conclusions
No quick fixes
Cannot be the issue of the moment
Action must be long term and unrelenting
