Oecd Health Working Papers the Prevention of Lifestyle-related Chronic Diseases: an Economic Framework

.................................................................................................................................................. 4 RÉSUMÉ ........................................................................................................................................................ 5 EXECUTIVE SUMMARY ............................................................................................................................ 7 INTRODUCTION .......................................................................................................................................... 9 Section 1 .................................................................................................................................................... 10 Chronic diseases: an economic problem? ................................................................................................. 10 1.1. The burden of chronic diseases on health and longevity ................................................................ 10 1.2. The implications for social welfare and the role of prevention ...................................................... 11 1.3. Will preventive interventions improve social welfare? Testing the hypothesis ............................. 13 1.4. The determinants of health and disease .......................................................................................... 14 1.5. Main messages and conclusions ..................................................................................................... 20 Section 2 .................................................................................................................................................... 22 Are interventions to prevent chronic diseases justified? ........................................................................... 22 2.1. Is there an economic case for intervention? .................................................................................... 22 2.2. Market failures in lifestyle choices: a neoclassical economics perspective.................................... 23 2.3. Failures of rationality in lifestyle choices ....................................................................................... 26 2.4. Market failures and the determinants of health .............................................................................. 30 2.5. Unintended health consequences of existing government policies ................................................. 31 2.6. Main messages and conclusions ..................................................................................................... 32 Section 3 .................................................................................................................................................... 33 Preventive interventions: the options and the actors ................................................................................. 33 3.1. Government intervention and theories of paternalism .................................................................... 33 3.2. Non-governmental and concerted action ........................................................................................ 38 3.3. Establishing what interventions are viable ..................................................................................... 39 3.4. A taxonomy of preventive interventions ........................................................................................ 41 3.5. Main messages and conclusions ..................................................................................................... 44 Section 4 .................................................................................................................................................... 46 Assessing the efficiency and distributional impact of preventive interventions ....................................... 46 4.1. The economic evaluation of health interventions ........................................................................... 46 4.2. Assessing the health impact of prevention programmes................................................................. 47 4.3. Discounting long term impacts ....................................................................................................... 50 4.4. Assessing the distributional impacts of prevention programmes ................................................... 51 4.5. Main messages and conclusions ..................................................................................................... 55 Section 5 .................................................................................................................................................... 57 Conclusions. The role of economics in the prevention of chronic diseases .............................................. 57 REFERENCES ............................................................................................................................................. 64 APPENDIX – A TAXONOMY OF PREVENTIVE INTERVENTIONS ................................................... 72