Background: The rapid increase in child and adolescent overweight and obesity (OAO) in China has a significant health and economic impact. This study undertook an investment case analysis to evaluate the health and economic impacts of child and adolescent OAO in China and the potential health and economic returns from implementing specific policies and interventions.
Methods: The analysis estimates the reduction in mortality and morbidity from implementing a set of evidence-based interventions across China between 2025 and 2092 using a deterministic Markov cohort model. Modelled interventions were identified by literature review and expert recommendation and include fiscal and regulatory policies, eHealth breastfeeding promotion, school-based interventions, and nutritional counselling by physicians. The study applies a societal costing perspective to model the economic impact on healthcare cost savings, wages, and productivity during adulthood. By projecting and comparing the costs between a status quo scenario and an intervention scenario, the study estimates the return on investment (ROI) for interventions separately and in combination.
Findings: Without intervention China will experience 3.3 billion disability-adjusted life years (DALYs) due its current levels of child and adolescent OAO and a lifetime economic impact of CNY 218 trillion (USD 31.6 trillion), or a lifetime CNY 2.5 million loss per affected child or adolescent (USD 350 thousand). National implementation of all five interventions would avert 179.4 million DALYs and result in CNY 13.1 trillion of benefits over the model cohort's lifetime. Implementing fiscal and regulatory policies had the strongest ROI, with benefits accruing at least 10 years after implementation. Scaling up China's current school-based interventions offers China significant health and economic gains, however, the ROI is lower than other modelled interventions.
Interpretation: Effective prevention and treatment of child and adolescent OAO is critical to China's health and economic development. Multiple interventions offer a comprehensive approach to address the various factors that increase risk of child and adolescent OAO. Nonetheless, fiscal and regulatory policies offer the strongest health and economic gains.
Funding: Funding was provided by UNICEF China.
背景: 儿童超重肥胖的迅速增长对中国的健康和经济产生了深远的影响. 本研究旨在通过投资案例分析来探讨中国儿童超重肥胖带来的健康及经济影响, 并评估实施特定政策与干预措施可能带来的健康和经济效益.
方法: 采用确定性Markov队列模型, 预测2025-2092年间在中国实施基于循证的几项干预措施后, 对相关疾病的发病率和死亡率的影响. 纳入模型的5项干预措施是基于文献综述研究和专家建议确定的, 包括对含糖饮料征收20%的税收、限制向儿童销售不健康食品、通过手机短信传播母乳喂养知识、以学校为基础的儿童肥胖干预及医生提供营养咨询. 本研究从社会成本视角模拟了对成年期医疗成本的节约、工资以及劳动生产力的经济影响. 通过预测和比较采取干预措施和不采取干预措施的经济成本, 估计了上述5种干预措施单独或组合使用的投资回报率.
结果: 基于目前儿童超重肥胖现状, 如果不采取任何干预措施, 2025-2092年间, 中国将面临33亿残疾调整生命年 (DALYs) 的损失、218万亿元人民币 (约31.6万亿美元) 的经济损失、平均每个受影响的儿童将面临250万元人民币 (约35万美元) 的经济损失. 如果在中国全面实施上述5项干预措施, 预计能够减少1.794亿DALYs的损失, 并带来13.1万亿元的经济收益. 其中, 对含糖饮料征收20%税收和限制向儿童销售不健康食品两项干预措施的投资回报率最高, 预计在实施后的10年内开始显现经济效益. 实施以学校为基础的儿童肥胖干预能够带来显著的健康和经济收益, 然而, 其投资回报率低于其他4项干预措施.
解读: 有效预防和治疗儿童超重肥胖对中国的健康和经济发展至关重要. 多项干预措施将针对超重肥胖的多种危险因素提供综合和全面的解决方案. 然而, 在所有的干预措施中, 对含糖饮料征税和限制向儿童销售不健康食品两项干预措施能带来最大的健康和经济收益.
资助信息: 本研究得到了联合国儿童基金会驻华办事处的资助.
Editor note: This translation in Chinese was submitted by the authors and we reproduce it as supplied. It has not been peer reviewed. Our editorial processes have only been applied to the original abstract in English, which should serve as reference for this manuscript.
Keywords: Adolescent health; Child health; China; Economic evaluation; Health policy; Investment case; Obesity; Overweight.
© 2023 The Authors.