1. Public Health Agency of Canada Agence de la santé publique du Canada Macroeconomic Impacts of Prevention Policies for NCDs 1 Making the Case to the Finance Sector Workshop Economics of Prevention of Noncommunicable Diseases and Risk Factors (obesity, physical inactivity and poor diets) Sylvie Desjardins Senior Health Economist, Scientific Director WHO Collaborating Centre on Chronic Noncommunicable Disease Policy

2. Public Health Agency of Canada | Agence de la santé publique du Canada2 1 Except in sub-Saharan Africa. NCDs are an increasing global challenge… Most significant cause of death (63%) worldwide 1 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 NCDs cause premature deaths under age 60: 13% in high income countries 29% in low middle income countries Source: World Health Organization (WHO). 2

3. Public Health Agency of Canada | Agence de la santé publique du Canada3 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 …and their impacts extend beyond health. Source: World Bank 2011. 3

4. Public Health Agency of Canada Agence de la santé publique du Canada The Cost… 4

5. Deaths due to NCDs in Canada are increasing… Public Health Agency of Canada | Agence de la santé publique du Canada5 The proportion of people dying from chronic conditions is constantly increasing Source: Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, using data from OECD HEALTH DATA 2010, June. 100 90 80 70 60 50 40 30 20 10 0 5

6. Public Health Agency of Canada | Agence de la santé publique du Canada6 …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. 6

7. Public Health Agency of Canada | Agence de la santé publique du Canada7 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. 7

8. Public Health Agency of Canada | Agence de la santé publique du Canada8 COSTS IndividualHouseholdEmployerGovernment Health care Out of pocket drugs Lost productivity Disability Economic burden of NCDs …and so is our economy. NCDs cost $190 billion in 2010. 8

9. Canada’s declining deaths from heart disease due in part to an increase in treatment. Public Health Agency of Canada | Agence de la santé publique du Canada9 Treating NCDs is costly. 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). 9

10. Public Health Agency of Canada | Agence de la santé publique du Canada10 In fact people with NCDs account for more than half of all annual health care spending… 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. Cardiovascular diseases Respiratory diseases Cancer Diabetes Proportion of health care costs by disease Four major NCDs Other NCDs 58% All infectious Other diseases All injuries 10

11. 11 … 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

12. 12 …but the economic impact goes beyond the health sector. about twice the direct health care costs 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. 12

13. Public Health Agency of Canada | Agence de la santé publique du Canada13 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 We can quantify the impact of NCDs on the economy. In the past 10 years: 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. 13

14. Public Health Agency of Canada Agence de la santé publique du Canada The Cost-effectiveness Options… 14

15. Source: Global Status Report on Noncommunicable Diseases 2010, World Health Organization. Public Health Agency of Canada | Agence de la santé publique du Canada15 Metabolic/ physiological risk factors Underlying drivers Behavioural risk factors NCDs Raised blood pressure Overweight/obesity Raised blood glucose Raised lipids Tobacco use Unhealthy diet Physical inactivity Harmful use of alcohol Globalization Urbanization Population ageing Social Determinants of Health We understand the pathway to NCDs... 15

16. Public Health Agency of Canada | Agence de la santé publique du Canada16 80% of heart disease, diabetes and respiratory diseases and 40% of cancers are preventable by eliminating four common risk factors NCDs Common risk factors Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol Cardiovascular diseases Diabetes Cancer Respiratory diseases Source: WHO, Raising the priority of non-communicable disease in development work at global and national levels. …and we know prevention is critical. 16

17. Public Health Agency of Canada | Agence de la santé publique du Canada17 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 Intervention for prevention works... Sources: 1 Health Canada, 2011. 2 Spencer & Associates, 2002. 17

18. Public Health Agency of Canada | Agence de la santé publique du Canada18 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. … and healthy promotion is everyone’s business. Health Outcomes at the Population Level (average effects per year) School-based interventions Mass media campaigns Food advertising self-regulation Food labelling Worksite interventions Food advertising regulation Physician counselling Fiscal measures Physician-dietician counselling 0 10,000 20,000 30,000 40,000 Disability- adjusted life years Life years 18

19. Public Health Agency of Canada Agence de la santé publique du Canada The Macroeconomic options… 19

20. Public Health Agency of Canada | Agence de la santé publique du Canada20 Actions by many sectors have an impact on our lifestyles and health. NCDs Agri-food Work Places Transport Economic Development Education Income Urban Planning Environment and Sustainable Development FinanceTrade 20

21. Public Health Agency of Canada | Agence de la santé publique du Canada21 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 21

22. Public Health Agency of Canada | Agence de la santé publique du Canada22... 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. 22

23. 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%. 23Public Health Agency of Canada | Agence de la santé publique du Canada

24. … Impact on the Canadian GDP (%) Strategy 2 Scenario 3Scenario 4 Garriguet, 2006Statistics Canada, 2010 Canada 0.12170.3411 USA 0.0050.0046 Brazil 0.0010.0014 Chile -0.0001-0.0003 Mexico 0.02490.0286 Rest of LACs 0.00640.0073 Rest of OECD -0.00050.0001 Rest of Asia 0.00340.0047 ROW 0.00080.0012 24Public Health Agency of Canada | Agence de la santé publique du Canada

25. Strategy 2Exports Imports Scenario 3Scenario 4Scenario 3Scenario 4 Canada 0.0540.5240.0550.601 USA 0.0130.0610.0140.043 Brazil 0.0350.0400.0290.055 Chile -0.081-0.050-0.030-0.021 Mexico -0.182-0.137 0.025-0.027 Rest of LACs -0.0040.0340.0240.057 Rest of OECD 0.0060.005-0.002-0.004 Rest of Asia 0.0080.0040.0130.006 ROW 0.0030.0040.0030.002 … Impact on Canadian Trading Partners 25Public Health Agency of Canada | Agence de la santé publique du Canada

26. …Impact on the Canadian Welfare. Strategy 2 Scenario 3Scenario 4 Canada 328.2748.03 USA 1345.79880.33 Brazil 37.4120.53 Chile -29.74-45.06 Mexico 111.23155.8 Rest of LACs 125.4484.03 Rest of OECD -105.07115.07 Rest of Asia 174.6283.66 ROW 139.55172.64 26Public Health Agency of Canada | Agence de la santé publique du Canada

27. Public Health Agency of Canada Agence de la santé publique du Canada 27 Conclusions…

28. 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. 28Public Health Agency of Canada | Agence de la santé publique du Canada

29. 29 …Good Health is an Investment in Economic Growth.

30. Public Health Agency of Canada Agence de la santé publique du Canada Thank You 30