Beruflich Dokumente
Kultur Dokumente
Matthias Helble
Senior Economist, Co-Chair, Research Department
Asian Development Bank Institute
20/03/2018
3
1. What we know about obesity:
Prevalence and Determinants
Prevalence Rate of Obesity and Overweight
Asia-Pacific is becoming fatter...
by regions of ADB DMCs
Overweight Obesity
.6
.6
Prevalence rate
.4
.4
.2
.2
0
East South East South Central Pacific 0 East South East South Central Pacific
60.0
50.0
40.0
30.0 1990
2013
20.0
10.0
0.0
7
The poor are catching up quickly...
9
2. What we want to know:
Costs of Obesity
in Asia and the Pacific
Overweight as major risk factor...
DALYs Loss Attributable to High BMI, both Sexes, All Ages, ADB Member
Countries, 2013
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Overweight as major risk factor for diabetes...
100
50
0
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Costs of Overweight and Obesity
Direct costs: Health care costs (medical expenditures)
• Health care costs associated with obesity vary between 2-5 % in Europe and
between 5-8 % in the United States.
• Medical expenses 2,741 USD higher for obese Americans (Cawley and
Meyerhoefer, 2012, JHE).
• Studies for Asia:
Authors Country Year Costs as % of health Absolute costs
spending
Zhao et al, 2008 PRC 2003 3.7 % 2,74 billion USD
Ko, 2008 Hong Kong 2002 8.2–9.8 % 430 million USD
Kang et al, 2011 Korea 2005 - 1,1 billion USD
Lee et al, 2012 Korea 2011 4.6 % 2,128 billion Won
Pitaya. et al, 2014 Thailand 2009 1.5 % 725 million USD
Source: Helble and Francisco (2017)
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Costs of overweight and obesity (BMI ≧ 25)
Direct costs:
Higher health care costs (medical expenditures) for the
person and health care system.
Indirect costs:
All costs due to absenteeism from work, lower
productivity at work, disability costs and costs due to
higher mortality.
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Costs of Overweight and Obesity
• Few studies for developing Asia
• Some recent studies:
Zhao et al, 2008 PRC 2003 D+I 3.7 % 2,74 billion USD
Ko, 2008 Hong Kong 2002 D+I 8.2–9.8 % 430 million USD
Lee et al, 2012 Korea, Rep. 2011 D - 2,13 billion Won
Lee et al, 2015 Korea, Rep. 2013 D+I - 6,77 billion Won
Chung, 2017 Korea, Rep. 2013 D - 0,54 billion Won
Pitaya. et al, 2014 Thailand 2009 D+I 1.5 % 725 million USD
15
Direct costs in Asia and Pacific
Main data challenges:
• Few countries with data on costs of medical procedures
• Few countries with household level data on medical
expenditures available
Solution:
• Collect sparse data and check for correlation with deflators,
e.g. GDP per capita.
• Approximation of direct cost based on existing data for
developed countries (e.g. Japan) and adjusted for lower GDP
per capita.
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Direct costs in Asia and Pacific
% of Total Health
Country Value Care % of GDP
Brunei 76,900,000 16.27 0.43
Cambodia 2,415,455 0.27 0.02
Indonesia 450,000,000 1.68 0.05
Lao PDR 1,429,996 0.66 0.01
Malaysia 1,090,000,000 8.40 0.34
Myanmar 5,002,899 0.39 0.01
Philippines 145,000,000 1.17 0.05
Thailand 640,000,000 3.80 0.15
Viet Nam 53,500,000 0.44 0.03
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Indirect costs of overweight and obesity
• Based on the disability-adjusted life year (DALY) metric from
the 2010 Global Burden of Disease (GBD) study.
• DALYs measure the life lost due to premature death
(mortality) as well as the time lived with disability (morbidity).
• Calculated as the sum of years of life lost due to premature
mortality (YLL) in the population and the equivalent of
healthy years lost due to disability (YLD):
𝐷𝐴𝐿𝑌 = 𝑌𝐿𝐿 + 𝑌𝐿𝐷
• DALY represents a year loss of healthy life.
• Method developed by Institute for Health Metrics and
Evaluation (IHME)
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Indirect costs of overweight and obesity
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Indirect costs for South East Asia:
Country DALY all Contributio Productive % of health Percentage
diseases n of years lost care of GDP
overweight due to expend.
& obesity obesity
Brunei 72,185 0.81 585 5.5 0.1
Cambodia 5,736,940 0.31 17,795 2.0 0.1
Indonesia 72,340,657 1.05 1,771,258 10.4 0.3
Lao PDR 2,635,899 0.42 11,002 8.1 0.2
Malaysia 63,836,217 0.09 59,586 4.9 0.2
Myanmar 19,078,657 0.52 99,270 9.0 0.2
Philippines 28,205,496 0.73 204,948 4.6 0.2
Singapore 763,405 0.50 3,852 1.6 0.1
Thailand 19,075,344 0.47 89,665 3.3 0.1
Viet Nam 21,840,038 0.27 58,439 0.9 0.1
Source: Helble and Francisco (2017)
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Total costs for South East Asia (2013)
Country Estimated direct Estimated indirect
costs % of health costs % of health
care expend. care expend.
Brunei 2.2 5.5
Cambodia 1.1 2.0
Indonesia 1.5 10.4
Lao PDR 1.1 8.1
Malaysia 2.0 4.9
Myanmar 1.3 9.0
Philippines 1.4 4.6
Singapore 1.5 1.6
Thailand 1.7 3.3
Viet Nam 1.1 0.9
Source: Helble and Francisco (2017)
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Costs of Overweight and Obesity
Indirect costs (absenteesim, lower productivity, disability and
mortality costs)
• Higher level of absenteeism observed in United States and
European countries (e.g. Bungum et al, 2003; Wolfenstetter et al,
2011; Neovius et al, 2012)
• Relationship stronger for women than for men (Finkelstein et al,
2005).
• Obesity-related job absenteeism costs US business 4.3 billion USD
(Cawley, 2007, JOEM).
• Lower productivity costs US business 31 billion USD every year
(Finkelstein et al., 2010).
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3. Policies to Fight Obesity
Multifaceted Policies to Curb Obesity
Improve intake of food and nutrition:
• Healthy school foods
• Regulate advertising of unhealthy foods
• Nutritional labelling
• Zoning of restaurants
• Taxes on unhealthy foods (ex. sugar tax)
Promote physical activity and healthy lifestyle:
• Make physical activity easier, safer, and more attractive
• Reduce TV watching and videogaming
• Use new technologies (e.g. Pokemon Go)
• Incentive schemes in health insurance
25
Fiscal Policies
26
Asian Countries with SSB Taxes or Plans
Obesity (adult Overweight
Countries SSB Policy Status
2016) (adult 2016)
China 6.2% 32.3% Discussing option of introducing SSB tax
Maldives 8.6% 30.6% Has import tarrifs on energy and soft drinks
27
Price of Foods
28
Pathways for the effect of fiscal policy interventions
29
Fiscal policy development and
implementation framework
30
Source: WHO (2015)
Conclusion
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Many thanks.
Questions?