Promoting sport and physical activity in Italy: a cost-effectiveness analysis of seven innovative public health policies.

BACKGROUND: Inactive lifestyles are a key risk factor underpinning the development of many chronic diseases, yet more than half of the Italian population does not meet WHO thresholds for at least moderate physical activity. This study aims to make the economic case to upscale investments in policy actions to promote exercise and physical activity. STUDY DESIGN: Modelling-based cost-effectiveness analysis in Italy. METHODS: The study assesses the impact on health and healthcare expenditure of seven public health policies to promote exercise and physical activity against a business as usual scenario. Assessed policies include: promotion of active transport, workplace sedentarily interventions, investments in sports and recreation, mass media campaigns, prescription of physical activity in primary care, school-based interventions and mobile apps. RESULTS: Public policies to promote exercise have the potential to improve population health and produce savings in healthcare expenditure. Assessed policies can avoid hundreds of cases of cardiovascular diseases and diabetes per year and tens of cases of cancer resulting in gains in DALYs in the order of thousands per year. In the medium-term, the vast majority of policies show excellent cost-effectiveness ratio, below internationally recognized thresholds. CONCLUSIONS: Investing in policies to promote active lifestyles is a good investment for Italy.

Assessing the potential outcomes of achieving the World Health Organization global non-communicable diseases targets for risk factors by 2025: is there also an economic dividend?

OBJECTIVES: This study assesses the change in premature mortality and in morbidity under the scenario of meeting the World Health Organization (WHO) global targets for non-communicable disease (NCD) risk factors (RFs) by 2025 in France. It also estimates medical expenditure savings because of the reduction of NCD burden. STUDY DESIGN: A microsimulation model is used to predict the future health and economic outcomes in France. METHODS: A 'RF targets' scenario, assuming the achievement of the six targets on RFs by 2025, is compared to a counterfactual scenario with respect to disability-adjusted life years and healthcare costs differences. RESULTS: The achievement of the RFs targets by 2025 would save about 25,300 (and 75,500) life years in good health in the population aged 25-64 (respectively 65+) years on average every year and would help to reduce healthcare costs by about €660 million on average per year, which represents 0.35% of the current annual healthcare spending in France. Such a reduction in RFs (net of the natural decreasing trend in mortality) would contribute to achieving about half of the 2030 NCD premature mortality target in France. CONCLUSIONS: The achievement of the RF targets would lead France to save life years and life years in good health in both working-age and retired people and would modestly reduce healthcare expenditures. To achieve RFs targets and to curb the growing burden of NCDs, France has to strengthen existing and implement new policy interventions.

Impact of primary care-initiated interventions promoting physical activity on body mass index: systematic review and meta-analysis.

INTRODUCTION: Physical inactivity is a risk factor for obesity, overweight and for a number of chronic diseases. Although primary care may be an ideal setting to encourage people to do more exercise, there are still significant gaps in the literature on the effectiveness of primary care-initiated policies to promote physical activity. METHODS: In this paper, we systematically review and meta-analyse the evidence on the impact of primary care-initiated interventions to promote exercise on the body mass index and on physical activity energy expenditure levels among people at an increased risk of having potentially disabling non-communicable diseases (but healthy enough to exercise). RESULTS: We find that such interventions reduce body mass index by about 0.21 kg m-2 (95% confidence interval: -0.41 to -0.01) and increase physical activity-related energy expenditure (based mostly on self-recall) by about 1.77 metabolic equivalent of task-hours a week (95% confidence interval: 0.58 to 2.95). DISCUSSION: This study suggests that primary care-initiated interventions promoting physical activity can be an effective strategy to reduce weight and increase exercise levels in this population group, although the question remains about whether such interventions can be cost-effective.

Obesity and socioeconomic status in developing countries: a systematic review.

We undertook a systematic review of studies assessing the association between socioeconomic status (SES) and measured obesity in low- and middle-income countries (defined by the World Bank as countries with per capita income up to US$12,275) among children, men and women. The evidence on the subject has grown significantly since an earlier influential review was published in 2004. We find that in low-income countries or in countries with low human development index (HDI), the association between SES and obesity appears to be positive for both men and women: the more affluent and/or those with higher educational attainment tend to be more likely to be obese. However, in middle-income countries or in countries with medium HDI, the association becomes largely mixed for men and mainly negative for women. This particular shift appears to occur at an even lower level of per capita income than suggested by an influential earlier review. By contrast, obesity in children appears to be predominantly a problem of the rich in low- and middle-income countries.