Australia could save billions of dollars on medicines by using cheap generic products, and these savings could be ploughed into prevention interventions that would make a huge difference to the community’s health.

That’s the message that will be put to Department of Health and Ageing staff and other senior health policy types at a meeting in Canberra tomorrow (Friday, Oct 15).

The bearers of such happy tidings will be some of the researchers involved in the landmark Assessing Cost-Effectiveness of Prevention (or ACE-Prevention) study, which, as previously reported at Croakey, has been billed as “the most comprehensive evaluation of health prevention measures ever conducted world-wide”.

One of the study’s authors, Professor Theo Vos, of the Centre for Burden of Disease and Cost-Effectiveness at the University of Queensland, says he will be asking the meeting why Australia cannot make more use of cheap generics. “New Zealand can,” he says. “Generic simvastatin costs <$20 per year in NZ vs $400 in Aus.”

Meanwhile, the study also made many recommendations around obesity prevention, including calling for taxing of unhealthy foods, and saying that encouraging laparoscopic gastric banding in the severely obese would be better value than dietary and exercise interventions, which tend not to lead to long-term weight loss. The study also recommends disinvesting in most approaches to promoting fruit and vegetable intake and weight loss programs.

So how should policy makers respond to the study’s findings around obesity?

Start with a tax on sugary soft drinks, and evaluate its impact.

That’s the suggestion from Jane Martin, Senior Policy Adviser of the Obesity Policy Coalition, who has provided this analysis of the study for Croakey readers.

How to act on obesity

Jane Martin writes:

The mantra, ‘prevention is better than cure’ has been a catch cry uttered frequently by government over the last few years, and there is now a large body of work around what government could do to give them the best bang for their buck in this area.

The latest Assessing the Cost Effectiveness of Prevention (ACE-Prevention) report adds to this evidence base, and signals some of the best buys for government of the 123 prevention interventions examined.

The burden of disease due to overweight and obesity, in particular diabetes, is expected to place significant health and social costs into the future.

The ACE-Prevention study analysed a range of interventions to reduce overweight and obesity including policies that have the potential to reduce the impact of our current obesity-promoting environment.

This is welcome, as we know from tobacco control that merely focussing on the individual will not be enough, it is important to tip the scales to make the healthy choices the easy choices. It was recognised by the researchers, that despite there being less evidence on the effectiveness of these broad policy interventions, that they are potentially very potent.

Another similar analysis shows that regulatory and tax interventions were least costly from a health sector perspective.

In particular, front-of-pack ‘traffic-light’ nutrition labelling and a 10 percent tax on unhealthy food (‘junk-food’ tax) were likely to be cost-saving and have a potentially large benefit.

However, the OPC believes the broader evidence-base indicates that it would be important to supplement a junk-food tax with policies that would reduce the price of healthy food. This is particularly important for those on a low income.

A phased approach to taxation could start with a tax on foods that contribute most to overweight and obesity, such as sugary soft drinks. This could have a significant impact on the weight and health of children.

In addition, it would enable a landmark evaluation of the impact of taxing unhealthy foods in Australia.  This approach could also require that the taxes collected are spent on reducing the cost of fresh fruit and vegetables and other healthy foods, in particular for families in need.

In relation to physical activity, the ACE-Prevention report found that the evidence around potential interventions was weak, so careful evaluation would be required if these were implemented on a large scale. The best buys are use of pedometers, mass media campaigns and referral to general practitioners. Less cost-effective (but still under the commonly used threshold of $50,000 per disability adjusted life year saved) are internet-based interventions, GP prescriptions and programs to encourage more active transport.

Also, let’s not forget a previous report examining the impact of restrictions on junk food advertising on television and its impact on children and adolescents. This was shown to be effective, cost-effective and was by far the best prevention intervention of those studied.

In its response to the Preventative Health Taskforce recommendations, the Commonwealth Government said that it is committed to refocussing the health system towards prevention.

Action in tobacco control to increase the tax on tobacco and implement plain packaging has cemented Australia as a leader, and this long-term commitment to a comprehensive approach has borne fruit with declines in both adult and youth smoking prevalence.

It is now time for government to take stock of the evidence, stop sitting on its hands and tackle obesity head on.

***

Previous posts related to this study:

http://blogs.crikey.com.au/croakey/2010/09/29/what-does-the-evidence-say-about-how-to-improve-indigenous-health-a-challenge-to-current-policy/

http://blogs.crikey.com.au/croakey/2010/09/08/at-last-a-blueprint-for-spending-on-prevention-here-is-what-is-worthwhile-and-what-is-not/

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