EUR/RC62/wd08 (Eng) - WHO/Europe - World Health Organization

EUR/RC62/8
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The evidence base
103. The WHO Regional Office for Europe has promoted collaborative work aimed at
presenting the economic case for public health action, particularly preventing chronic
noncommunicable diseases. This work moves beyond what is known about the economic
benefits of specific actions within health care systems, such as vaccinations and screening, to
examine research endeavours to make the economic case for investing upstream – that is, before
the onset of noncommunicable diseases and before health care services are required. The work
highlights priority actions supported by sound cost–effectiveness or cost–benefit analyses,
including actions to limit risky behaviour such as tobacco use and alcohol consumption, to
promote physical and mental health through diet and exercise, to prevent mental disorders and
to decrease preventable injuries, such as from road crashes, and exposure to environmental
hazards. The full results of this work are forthcoming (36), but some of the early evidence is
presented below.
104. Strong evidence indicates the cost–effectiveness of tobacco control programmes, many of
which are inexpensive to implement and have cost-saving effects. Such programmes include
raising taxes in a coordinated way with a high minimum tax (the single most cost-effective
action), encouraging smoke-free environments, banning advertising and promotion, and
deploying media campaigns. Adequate implementation and monitoring, government policies
independent of the tobacco industry and action against corruption are all needed to support
effective policies.
105. A substantive evidence base of systematic reviews and meta-analyses supports the cost–
effectiveness of alcohol policies. Impressive cost-effective interventions include restricting
access to retailed alcohol; enforcing bans on alcohol advertising, including in social media;
raising taxes on alcohol; and instituting a minimum price per gram of alcohol. Less, but still
cost-effective measures include enforcing drink–driving laws through breath-testing; delivering
brief advice for higher-risk drinking; and providing treatment for alcohol-related disorders.
106. Actions to promote healthy eating are especially cost-effective when carried out at the
population level. Reformulating processed food to decrease salt, trans-fatty acids and saturated
fat is a low-cost intervention that may be pursued through multistakeholder agreements, which
may be voluntary or ultimately enforced through regulation. Fiscal measures (including taxes
and subsidies) and regulating food advertising for children also have a low cost and a favourable
cost–effectiveness. However, conflicting interests could hinder feasibility. Programmes to
increase awareness and information, such as mass-media campaigns and food labelling
schemes, are efficient investments but have poorer effectiveness, particularly in lower
socioeconomic groups.
107. Promoting physical activity through mass-media campaigns is a very cost-effective action
and relatively inexpensive. However, returns in terms of health outcomes may be lower than
those provided by more targeted interventions, for instance at the workplace. Changes in the
transport system and the wider environment have the potential to increase physical activity, but
they require careful evaluation to ascertain their affordability and feasibility, and whether the
changes reach those with greater health and social needs. Actions targeting the adult population
and individuals at higher risk tend to produce larger effects in a shorter time frame.
108. Robust evidence indicates that preventing depression, the single leading cause of
disability worldwide, is feasible and cost-effective. Depression is associated with premature
death and reduced family functioning, it directly affects people’s individual behaviour and it
entails extremely high economic costs due to health care and productivity losses, which can be
partly avoided through appropriate forms of prevention and early detection. Evidence supports
actions across the life-course, starting with early action in childhood to strengthen social and