1. Childhood obesity is a major health challenge in Europe, affecting 21% of children, with rates up to 2.5 times higher among disadvantaged children. 2. Prevention strategies can improve health outcomes and reduce healthcare costs, though interventions targeting children may take many years to produce effects. 3. A multi-pronged approach combining initiatives across different groups through multi-stakeholder collaboration may be most effective in addressing obesity.

1. Obesity and the Economics of Prevention
Franco Sassi PhD
Professor of International Health Policy and Economics, Imperial College Business School
Senior Health Economist – OECD
Nordic Welfare States and Public Health – Helsinki, 16th November 2016

2. Child Obesity:
a Top Health Challenge for Europe
21%
Of children in
OECD-Europe are
overweight or
obese
0%
10%
20%
30%
40%
50%
boys girls
Prevalencerate
44%
38%
15%
11%
But in some
countries this
figure is much
higher
Child obesity in OECD-Europe
Source: OECD, Health at a Glance

3. Disadvantaged Children up to
2.5 Times More Likely to Be Obese
1,0
1,5
2,0
2,5
3,0
Boys Obesity Girls Obesity Boys Obesity Girls Obesity
France England
Riskofobesitycomparedtohigher-SES
For each category, columns are ordered, left to the right, in decreasing order of SES
Highest level of SES as reference (i.e. equals to 1)
Source: OECD, Fit not Fat, 2010

4. Intergenerational transmission
Boys and girls with at least one obese parent
are more likely to be obese
Source: OECD, Health Working Paper 45, 2009
4
1
2
3
4
England France
Riskofchildhoodobesity
accordingtoparentalobesity
Boys Girls

5. The Crisis Has Worsened
the Quality of Nutrition
Source: OECD, 2014 Obesity Update
• Recession have exacerbated
unhealthy behaviours in
vulnerable groups
• Families decreased food
expenditure and shifted to
cheaper calories
• The financial crisis is increasing
inequalities in obesity and health
• Food insecurity associated to 22%
higher probability of child obesity
-8%
-4%
0%
4%
Growth rate 1st Q 2014 - Italy

6. The Cost of Obesity
0% 1% 2% 3% 4% 5% 6% 7%
US
Portugal
New Zealand
Canada
Germany
Australia
France
% of healthcare budget
Roux & Donaldson, 2004
Konnopka, Bodemann, Konig, 2011

7. What Policy Makers Needs to Know
• Does prevention improve health?
• Does it reduce health expenditure?
• Does it improve health inequalities?
• Is it cost-effective?
• When will it produce its effects?

8. Prevention Saves Lives…
West-central Europe (EUR-A)
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
Source: OECD, Health Working Paper 48

9. But Interventions Targeting Children
Take Time (England)
0
2 000
4 000
6 000
8 000
10 000
0 10 20 30 40 50 60 70 80 90 100
DALYs(permillionpopulation)
Time (years)
worksite
interventions
mass media
campaigns
fiscal measures
food
advertising
regulation
food labelling
Source: OECD, Fit not Fat, 2010

10. Financial Impacts
-50
50
150
250
350
450
550
Cost(billion$PPP)
intervention costs health expenditure

11. School-based Interventions More Effective
in Lower-SES Children
0
200
400
600
800
1000
1200
Personspermillionpopulation
high SES low SES
On average, school-based
interventions have a
Effects on life expectancy by SES
Effect on children from lower
income groups compared to
individuals from higher
income groups
14%
HIGHER
Source: OECD, Health Working Paper 48

12. EU School-Fruit Scheme Effectively
Promotes Healthier Diets
0% 20% 40% 60% 80% 100%
FR
IR
NL
AT
ES
DE
IT
BE
PT
BG
RO
EL
SK
EE
LU
SI
CZ
LT
PL
HU
LV
MT
DK
Participating target group children
• Main target group: children
aged 6-10 (up to high-school in
some countries)
• Children are offered F&V and
other side activities (e.g. farm
visits, gardening)
• An educational component
(e.g. pedagogical kits) is
usually included
• Similar effectiveness in
children of different SES (Bere et
al., 2010)

13. A Multi-Stakeholder Approach
Reducing Trans Fat in Children’s Food - Korea
• Collaboration between
industry, universities,
research institutes and
government
• Content of trans fat to be
compulsory on the label of
child food products
• Government (KFDA)
provides R&D support for
the industry
0,0
0,4
0,8
1,2
Biscuits Chocolate Snacks
Trans fats per serving (g)
before
after
Source: OECD, Fit not Fat, 2010

14. Food Taxes
• Commodity taxes generally used to:
a. Raise revenues
b. Compensate for external costs
• Argument in favour less clear-cut than for, e.g.,
tobacco and alcohol
• Common arguments against:
a. Insensitive demand
b. Regressive effects

15. Country1 Nutrient/Product taxed
Denmark (2011-12) Saturated fat content
Denmark Sugar- and artificially-sweetened beverages, sweets, ice cream,
chocolate
Finland Sugar- and artificially-sweetened beverages, confectionary, chocolate,
ice cream
France Sugar- and artificially-sweetened beverages, energy drinks
Hungary Sugar-sweetened beverages, energy drinks, salty snacks, biscuits, ice
cream, chocolate
Ireland (1916-92) Sugar- and artificially-sweetened beverages
Mexico Sugar-sweetened beverages, high-calorie processed foods
Norway Sugar- and artificially-sweetened beverages, chocolate, sugar
Berkeley, United
States
Sugar-sweetened beverages
Food taxes in OECD countries
1.Currently in place unless otherwise stated.

16. What Impact? Effects in Mexico
Source: Colchero et al., BMJ, 2016

17. What Impact?
1. UK study (Ng et al., Br J Nutr, 2012) estimated a
price elasticity of about -0.5
2. United States (Zhen et al., Amer J Agr Econ, 2013):
own price elasticity of about -1
3. US: half cent per ounce tax would reduce average
BMI by about 0.2 in 10 years
4. Average BMI has grown by 0.2-0.4 points every 10
years in recent decades
5. Will the tax be regressive?

18. Distributional Impacts
Household expenditure by income quintiles
0%
5%
10%
15%
20%
25%
Food at home Food away from home
UK US
In US a 10% fat tax on
diary products would
weigh 10 times more on
household with an
income of $20,000
(0.24%) than on those
with an income of
$100,000 (0.024%)
(Chouinard et al., 2007)
This may amount to a
difference of $19 vs.
$23 per year for a SSB
tax
(Zhen et al., 2013)
%averagehouseholdincome

19. Key Messages
• Child obesity is a top health priority; less well off children suffer
the majority of the burden
• Prevention is an effective and cost-effective way to improve
population health, decrease health expenditure and improve
inequalities
• Interventions targeting children are effective but produce results
in the medium- to long- term
• Comprehensive strategies combining actions on different target
groups provide best results
• Multi-stakeholder approaches have challenges but offer
opportunities