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Health co-benefits are a key potential advantage of transport decarbonisation policy. However, health effects will occur in the context of existing transport–health inequities and decarbonisation policies will themselves affect inequities. This research examines the effects of national decarbonisation pathways for transport on population health, health inequity, and health-system costs in Aotearoa New Zealand.

BackgroundInterventions that reduce morbidity, in addition to mortality, warrant prioritisation. It is important to understand the magnitude of potential morbidity and health gains from changing risk factor distributions. We quantified the impact of tobacco compared with overweight/obesity eradication on future morbidity and health-adjusted life expectancy (HALE) for the New Zealand population alive in 2011.MethodsBusiness-as-usual (BAU) future smoking rates were set based on past falling rates, but we assumed no future change in Body Mass Index (BMI) distribution, given historic trends. Population impact fractions and the percentage reduction in incidence rates for 16 tobacco-related and 14 overweight/obesity-related diseases (allowing for time lags) were calculated using the difference between BAU and eradication risk factor scenarios combined with tobacco and BMI incidence rate ratios. We used two multistate lifetable models to estimate HALE changes over the remaining lifespan and morbidity rate changes 30 years hence.ResultsHALE gains always exceeded life expectancy (LE) gains for overweight/obesity eradication (ie, absolute compression of morbidity), but for eradication of tobacco, the pattern was mixed. For example, among 32-year-olds in 2011, overweight/obesity eradication increased HALE by 2.06 years and LE by 1.21 years, compared with 0.54 and 0.50 years for tobacco eradication.Morbidity rate reductions 30 years into the future were considerably greater for overweight/obesity eradication (eg, a 15.8% reduction for 72-year-olds in 2041, or the cohort that was aged 42 years in 2011) than for tobacco eradication (2.7%). The same rate of morbidity experienced at age 65 years under BAU was deferred by 5 years with overweight/obesity eradication.ConclusionsPreventive programmes that reduce overweight and obesity have strong potential to reduce or compress morbidity, improving the average health status of ageing populations. This paper simulated eradication of tobacco and overweight/obesity; actual interventions will have lesser health impacts, but the relativities of morbidity to mortality gains should be similar.

Climate protection and other environmental concerns render it critical that diets and agriculture systems become more sustainable. Mathematical optimization techniques can assist in identifying dietary patterns that both improve nutrition and reduce environmental impacts. Here we review 12 recent studies in which such optimization was used to achieve nutrition and environmental sustainability aims. These studies used data from China, India, and Tunisia, and from 7 high-income countries (France, Finland, Italy, the Netherlands, Sweden, the United Kingdom, and the United States). Most studies aimed to reduce greenhouse gas emissions (10 of 12) and half aimed also to reduce ≥1 other environmental impact, e.g., water use, fossil energy use, land use, marine eutrophication, atmospheric acidification, and nitrogen release. The main findings were that in all 12 studies, the diets optimized for sustainability and nutrition were more plant based with reductions in meat, particularly ruminant meats such as beef and lamb (albeit with 6 of 12 of studies involving increased fish in diets). The amount of dairy products also tended to decrease in most (7 of 12) of the studies with more optimized diets. Other foods that tended to be reduced included: sweet foods (biscuits, cakes, and desserts), savory snacks, white bread, and beverages (alcoholic and soda drinks). These findings were broadly compatible with the findings of 7 out of 8 recent review articles on the sustainability of diets. The literature suggests that healthy and sustainable diets may typically be cost neutral or cost saving, but this is still not clear overall. There remains scope for improvement in such areas as expanding research where there are no competing interests; improving sustainability metrics for food production and consumption; consideration of infectious disease risks from livestock agriculture and meat; and researching optimized diets in settings where major policy changes have occurred (e.g., Mexico’s tax on unhealthy food).

Background/Objectives: The goal of this article is to present and demonstrate the applicability of an original method to assess the economic and health impacts of compliance with food-based recommendations. The method takes account of consumers’ preferences and the associated adoption cost in the assessment of various recommendations. Subjects/Methods: We combine an economic model of diet choice with an epidemiological model to compute the health impacts of dietary changes. To demonstrate the use of the method, we analyse the impacts of a 5% variation in the consumption of seven food groups taken separately: a 5% increase in consumption of fruits and vegetables (F&V) and milk products; and a 5% decrease in consumption of red meat, all meats, salty/sweet products, ready meals and butter/cream/cheese. Results: A recommendation, when adopted by consumers, generates important changes in the whole diet due to substitutions and complementarities among foods. All simulated recommendations have a positive impact on health. The F&V recommendation has the largest impact on the number of DALYs averted, but the highest adoption cost for consumers, especially for low-income consumers. Alone, the change in energy intake explains from 71% to 98% of the DALYs averted induced by a recommendation. Conclusions: Small increases in recommended foods have the potential of generating relatively significant health gains. Preference-driven substitutions among foods have a major effect on simulated health outcomes and should be included in the assessment of dietary recommendations, together with the adoption cost borne by consumers.

Background/Objectives: It is not known if diets lower in greenhouse gas (GHG) emissions are also healthier. We evaluated the population health implications of changing to more sustainable diets in the UK, France, Finland, Italy and Sweden. Subjects/Methods: We developed a life table model to simulate mortality and morbidity from diet-related diseases over the lifetime of the current population. Populating the model with locally available data for each country, we simulated the impact of country-specific dietary scenarios that had been optimised to meet dietary recommendations and reduce GHG emissions. Outcome measures included a change in disease-specific deaths, life expectancy and disability-adjusted life years (DALYs). Results: Diets that meet nutritional recommendations lead to substantial improvements in population health, ranging from 0.19 (95% uncertainty interval: 0.18–0.21) DALYs per person in Italy up to 0.89 (0.80–0.98) DALYs per person in Finland. Simultaneously reducing GHG emissions does not reduce the size of this impact, and in some cases produces additional health benefits. If sustainable diets can be maintained throughout adulthood, life expectancy would increase by between 2.3 (1.6–3.2) and 6.8 (5.5–8.5) months by country. However, results are sensitive to assumptions about how quickly changes in diet can influence disease, and future trends in disease. Conclusions: Modelling the health impact of diets that are both nutritional and low in GHG emissions shows the potential for significant co-benefits in health and sustainability from dietary changes. Future work is needed to find effective interventions to deliver healthy sustainable diets.

BackgroundAlcohol is an important risk factor for road transport injuries. We aimed to determine if raising alcohol taxes would be a cost-effective intervention strategy for reducing this burden.MethodsWe modelled the effect of a one-off increase in alcohol excise tax (NZ$0.15 (US$0.10)/standard drink) on alcohol consumption in New Zealand, using price elasticities to determine change in on-trade and off-trade sales of beer, cider, wine, spirits and ready-to-drink products. We simulated change in alcohol-attributable motor vehicle and motorcycle injuries, by age, sex and ethnicity, over the lifetime of the current population, and from changes in injuries, we determined changes in costs of health care, productivity, crime and vehicle damage.ResultsThe modelled increase in tax led to a net 4.3% reduction in pure alcohol consumption and a 27% increase in excise tax revenue. Lifetime population health improved by 640 quality-adjusted life years (95% uncertainty interval: 450 to 860) and costs of treating transport injuries reduced by NZ$3.6 million ($0.88 million to $6.8 million), although this was countered by a $3.8 million ($2.9 million to $4.8 million) increase in costs of treating other diseases. Health care costs were far outweighed by a $240 million ($130 to $370 million) reduction in lost productivity, crime and vehicle damage costs. Cost-effectiveness was not highly sensitive to price elasticity values, discount rates or time horizons for measurement of outcomes.ConclusionRaising alcohol excise tax in this high-income country would be highly cost-effective and could lead to substantial cost-savings for society.

ObjectiveThere is growing international interest in advancing ‘the tobacco endgame’. We use New Zealand (Smokefree goal for 2025) as a case study to model the impacts on smoking prevalence (SP), health gains (quality-adjusted life-years (QALYs)) and cost savings of (1) 10% annual tobacco tax increases, (2) a tobacco-free generation (TFG), (3) a substantial outlet reduction strategy, (4) a sinking lid on tobacco supply and (5) a combination of 1, 2 and 3.MethodsTwo models were used: (1) a dynamic population forecasting model for SP and (2) a closed cohort (population alive in 2011) multistate life table model (including 16 tobacco-related diseases) for health gains and costs.ResultsAll selected tobacco endgame strategies were associated with reductions in SP by 2025, down from 34.7%/14.1% for Māori (indigenous population)/non-Māāori in 2011 to 16.0%/6.8% for tax increases; 11.2%/5.6% for the TFG; 17.8%/7.3% for the outlet reduction; 0% for the sinking lid; and 9.3%/4.8% for the combined strategy. Major health gains accrued over the remainder of the 2011 population’s lives ranging from 28 900 QALYs (95% Uncertainty Interval (UI)): 16 500 to 48 200; outlet reduction) to 282 000 QALYs (95%UI: 189 000 to 405 000; sinking lid) compared with business-as-usual (3% discounting). The timing of health gain and cost savings greatly differed for the various strategies (with accumulated health gain peaking in 2040 for the sinking lid and 2070 for the TFG).ConclusionsImplementing endgame strategies is needed to achieve tobacco endgame targets and reduce inequalities in smoking. Given such strategies are new, modelling studies provide provisional information on what approaches may be best.

ObjectiveThe health gains and cost savings from tobacco tax increase peak many decades into the future. Policy-makers may take a shorter-term perspective and be particularly interested in the health of working-age adults (given their role in economic productivity). Therefore, we estimated the impact of tobacco taxes in this population within a 10-year horizon.MethodsAs per previous modelling work, we used a multistate life table model with 16 tobacco-related diseases in parallel, parameterised with rich national data by sex, age and ethnicity. The intervention modelled was 10% annual increases in tobacco tax from 2011 to 2020 in the New Zealand population (n=4.4 million in 2011). The perspective was that of the health system, and the discount rate used was 3%.ResultsFor this 10-year time horizon, the total health gain from the tobacco tax in discounted quality-adjusted life years (QALYs) in the 20–65 year age group (age at QALY accrual) was 180 QALYs or 1.6% of the lifetime QALYs gained in this age group (11 300 QALYs). Nevertheless, for this short time horizon: (1) cost savings in this group amounted to NZ$10.6 million (equivalent to US$7.1 million; 95% uncertainty interval: NZ$6.0 million to NZ$17.7 million); and (2) around two-thirds of the QALY gains for all ages occurred in the 20–65 year age group. Focusing on just the preretirement and postretirement ages, the QALY gains in each of the 60–64 and 65–69 year olds were 11.5% and 10.6%, respectively, of the 268 total QALYs gained for all age groups in 2011–2020.ConclusionsThe majority of the health benefit over a 10-year horizon from increasing tobacco taxes is accrued in the working-age population (20–65 years). There remains a need for more work on the associated productivity benefits of such health gains.

To review Australian policies on active transport, defined as walking and cycling for utilitarian purposes. To estimate the potential health impact of achieving four active transport policy scenarios.

Objective: To review Australian policies on active transport, defined as walking and cycling for utilitarian purposes. To estimate the potential health impact of achieving four active transport policy scenarios. Methods: A policy review was undertaken, using key words to search government websites. Potential health benefits were quantified using a cohort simulation Markov model to estimate obesity and transport injury‐related health effects of an increase in active transport. Health adjusted life years (HALYs) gained and healthcare cost savings from diseases averted were estimated. Budget thresholds to achieve cost‐effectiveness were estimated for each scenario. Results: There is broad recognition of the health‐related benefits of active transport from all levels of Australian government. Modelling results suggest significant health‐related benefits of achieving increased prevalence of active transport. Total HALYs saved assuming a one‐year effect ranged from 565 (95%UI 173–985) to 12,105 (95%UI 4,970–19,707), with total healthcare costs averted ranging from $6.6M (95%UI $1.9M‐11.3M) to $141.2M (95%UI $53.8M–227.8M). Conclusion: Effective interventions that improve rates of active transport may result in substantial healthcare‐related cost savings through a decrease in conditions related to obesity. Implications for public health: Significant potential exists for effective and cost‐effective interventions that result in more walking and cycling.

Objective:To estimate the cost‐effectiveness of fiscal measures applied in remote community food stores for Aboriginal Australians. Methods:Six price discount strategies on fruit, vegetables, diet drinks and water were modelled. Baseline diet was measured as 12 months’ actual food sales data in three remote Aboriginal communities. Discount‐induced changes in food purchases were based on published price elasticity data while the weight of the daily diet was assumed constant. Dietary change was converted to change in sodium and energy intake, and body mass index (BMI) over a 12‐month period. Improved lifetime health outcomes, modelled for the remote population of Aboriginal and Torres Strait Islanders, were converted to disability adjusted life years (DALYs) saved using a proportional multistate lifetable model populated with diet‐related disease risks and Aboriginal and Torres Strait Islander rates of disease. Results:While dietary change was small, five of the six price discount strategies were estimated as cost‐effective, below a $50,000/DALY threshold. Conclusion:Stakeholders are committed to finding ways to reduce important inequalities in health status between Aboriginal and Torres Strait Islanders and non‐Indigenous Australians. Price discounts offer potential to improve Aboriginal and Torres Strait Islander health. Verification of these results by trial‐based research coupled with consideration of factors important to all stakeholders is needed.

To estimate the cost‐effectiveness of fiscal measures applied in remote community food stores for Aboriginal Australians.

Objective:Intensive weight loss programs that incorporate dietary counselling and exercise advice are popular and are supported by evidence of immediate weight loss benefits. We evaluate the cost‐effectiveness of two weight loss programs, Lighten Up to a Healthy Lifestyle and Weight Watchers. Methods:Health gains from prevention of chronic disease are modelled over the lifetime of the Australian population. These results are combined with estimates of intervention costs and cost offsets (due to reduced rates of lifestyle‐related diseases) to determine the dollars per disability‐adjusted life year (DALY) averted by each intervention program, from an Australian health sector perspective. Results:Both weight loss programs produced small improvements in population health compared to current practice. The time and travel associated with attending group‐counselling sessions, however, was costly for patients, and overall the cost‐effectiveness ratios for Lighten Up ($130,000/DALY) and Weight Watchers ($140,000/DALY) were high. Conclusion:Based on current evidence, these intensive behavioural counselling interventions are not very cost‐effective strategies for reducing obesity, and the potential benefits for population health are small. Implications:It will be critical to consider other strategies (e.g. changing the ‘obesogenic’ environment) or explore alternative methods of intervention delivery (e.g. Internet) to see if they offer a more cost‐effective approach by effectively reaching a high number of people at a low cost.

Intensive weight loss programs that incorporate dietary counselling and exercise advice are popular and are supported by evidence of immediate weight loss benefits. We evaluate the cost‐effectiveness of two weight loss programs, Lighten Up to a Healthy Lifestyle and Weight Watchers.