ELSHMIN10 › Healthy choices
Unprecedented improvements in population health have taken place in OECD countries over the course of the past century due to economic growth, public policies in education, sanitation, public health, and the development of welfare systems. Life expectancy has increased on average by as much as 25-30 years. Major infectious diseases have been eradicated. Infant mortality rates have been dramatically reduced. People have gained in height and weight over time, with a substantial number moving out of under-nutrition. However, industrialisation and prosperity have been accompanied by increases in the incidence of a number of chronic diseases.
Much of the burden of chronic diseases is linked to lifestyles, particularly smoking, obesity and harmful use of alcohol. Social and environmental conditions often drive lifestyle choices, and the most disadvantaged social groups bear a disproportionate burden of lifestyle-related diseases. However, OECD governments spend only a small fraction of their health budgets on public health and prevention (3% of total health spending on average) and policies having undesirable impacts on population health (e.g. in agriculture, transport, or urban planning) may be adopted without coordination with health ministries.
Many prevention programmes are highly cost-effective in improving health and longevity, and may generate substantial gains in labour productivity. Triggering changes in health-related behaviours requires policies which go far beyond the boundaries of health systems and which may interfere with individual choices. More intrusive measures such as regulation and fiscal measures are not always more effective in changing behaviours than appealing to individual responsibility, expanding choice, or informing people about the health effects of lifestyles, but they are generally less expensive in the short-term.
Issues to be discussed