Health policies and data

Third Lancet Series on Chronic Diseases



The Lancet, Volume 376, Issue 9754, Pages 1775-1784


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Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness


Michele Cecchini, Franco Sassi, Jeremy A Lauer, Yong Y Lee, Veronica Guajardo-Barron, Daniel Chisholm

The obesity epidemic is spreading to low-income and middle-income countries as a result of new dietary habits and sedentary ways of life, fuelling chronic diseases and premature mortality. In this report we present an assessment of public health strategies designed to tackle behavioural risk factors for chronic diseases that are closely linked with obesity, including aspects of diet and physical inactivity, in Brazil, China, India, Mexico, Russia, and South Africa. England was included for comparative purposes. Several population-based prevention policies can be expected to generate substantial health gains while entirely or largely paying for themselves through future reductions of health-care expenditures. These strategies include health information and communication strategies that improve population awareness about the benefits of healthy eating and physical activity; fiscal measures that increase the price of unhealthy food content or reduce the cost of healthy foods rich in fibre; and regulatory measures that improve nutritional information or restrict the marketing of unhealthy foods to children. A package of measures for the prevention of chronic diseases would deliver substantial health gains, with a very favourable cost-effectiveness profile.

Key messages

  • Cost-effective interventions aimed at tackling obesity by improving diets and increasing physical activity could usefully be added to a package of measures designed to deal with chronic diseases in low-income and middle-income countries.
  • Price interventions and regulation can produce the largest health gains in the shortest timeframe. Interventions in primary care can be very effective in countries with less capacity constraints.
  • A strategy of several interventions would generate substantially larger health gains than would individual interventions, often with a favourable cost-effectiveness profile.
  • Health gains from interventions targeting children occur in the long term. Regulation of food advertising to children can be more effective and efficient than can school-based health promotion.
  • Private-sector initiatives might contribute to tackling some risk factors while alleviating the burden on public-sector budgets, but more evidence of their effectiveness is needed.

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