Transcript Diet and Health Issues - European Union Center

Diet and Health Issues in Europe: The Case of
Norway
Kyrre Rickertsen
Paper presented at the conference: “Food Safety, Health and Diet: TransAtlantic Challenges” organized by the European Union Center of Excellence
at Texas A&M University, College Station, April 20, 2007
2111
2005
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Overview
• Briefly about the development of the Norwegian nutritional policy
• Current nutritional policy (2007)
• Targets
• Strategies used to implement targets
• Predicted effects of taxes and subsidies on the consumption of
(based on joint work with Geir W. Gustavsen):
• Vegetables
• Milk
• Sugar-sweetened carbonated soft drinks (SSCSD)
• Candy
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The Development of a Nutritional Policy
 After World War II: Provide the population with a
sufficient and nutritionally satisfactory diet
 First country in the world with a nutritional policy.
Established in 1975 in the document: “About
Norwegian Nutritional and Food Security Policy”
– Main nutritional objective: Reduce the intake of
(saturated) fats and increase the intake of
carbohydrates
 Followed up with documents in 1981, 1993, and 2007
 These documents are joint policy documents involving
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(among others) the Department of Agriculture and the
Department of Health with partly conflicting interests
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European and US Diets around Year 2000
Annual per Capita Consumption in kilograms/liters (imprecise
disappearance data). Norwegian figures for 1980 in the parentheses
Product
Germany
Norway
US
Meat
88
93
60 (52)
92
Fish and shellfish
25
14
25 (22)
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Fats and oils
22
29
17 (20)
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Grains and cereals
88
76
122 (106)
92
213 (193)
326
Fruits and vegetables
(incl. potatoes)
4
France
253
Fluid milk
69
88
129 (166)
86
Carbonated soft
drinks
43
82
115
197
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Results of the Nutritional Policy (and Other
Factors)
 As intended, the intake of fats was reduced:
– The consumption of whole milk was reduced from 143 liters to 43
liters
– The annual death rate from cardiovascular diseases was reduced from
550 to 320 (per 100,000) for males and from 463 to 370 for females
over the period 1980 to 2005
 As intended, the consumption of carbohydrates increased:
– Grains and cereals (about 15%) and fruits and vegetables (about 10%)
– Carbonated soft drinks (more than 100%), a not intended change!
 Compared with other countries:
– High consumption of: Fish, grains and cereals and milk
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– Low consumption of: Meat, fats and oils, fruits, and vegetables
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WHO (Fact Sheet, 2005) Reports European Obesity
Rates (BMI > 30)
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Percentage of Population with BMI > 30 in the U.S.
Men
Women
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16
11
17
12
13
17
28
31
31
33
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1960-62 1971-74 1976-80 1988-94 1999-02 2003-04
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Source: Flegal et al., JAMA, Oct. 2002; Ogden et al., April 2006
Copied from Variyam (2006)
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Percentage of Overweight Population (BMI > 25) by Country
(OECD Health Statistics 2004 reported in Nayga, 2005)
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Percentage of Population with BMI > 30
40-42 Years Old
 Female / Male
 Currently about 15% of age




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group have BMI > 30
Rapid increase since the early
1990s
About 1-2% of 15 to 16 years
old have BMI>30
Obesity rates about half
among people with MSc as
compared with people who
have not completed high
school
Diet, physical activities, (lack
of sleep)?
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Costs of Overweight and Obesity
 Direct costs (preventive, diagnostic, and treatment) as
well as indirect costs (lost wages due to illness and
premature deaths)
 The costs (including welfare losses) associated with
obesity are estimated to be 0.5 – 1 percent of GDP in
the Nordic countries. Corresponds to about US$ 250
per capita and year in Norway
 Obesity consumes 2 – 8% of health care budgets in
European countries (OECD, 2005, Fact Sheet)
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Current Norwegian Nutritional Policy Stated in: “A
Recipe for a Healthier Diet”
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Health Issues and Food Consumption I
 The document focuses on the average diet:
– A direct link between the population’s average diet
and the prevalence of diseases such as: type 2
diabetes, cardiovascular diseases, certain types of
cancer and osteoporosis as well as other health
problems
– An indirect link between the populations average
diet and obesity, which increases the risk for
diseases such as cardiac infarction, stroke, cancer,
type 2 diabetes, and muscular and joint diseases. The
emphasis on this indirect link is new in the
Norwegian debate
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Health Issues and Food Consumption II
 The document also focuses on the distribution of
consumption and the diet of specific target groups:
– People with unhealthy consumption in general
– Children (to prevent unhealthy habits)
– Older people (reduced food intake may result in
inadequate diet)
– Non-Western immigrants (high rates of obesity and
diabetes 2)
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The Official Quantitative Targets I
 Average consumption:
– Double the intake of fruits and vegetables
– Increase intake of whole grain bread and fish
 Distribution of consumption with a 20% increase in
the number of:
– People who daily consume vegetables (now about
63%)
– People who daily consume fruits ( now about 61%)
– People who consume fish at least once per week
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– Young people who daily eat breakfast
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The Official Quantitative Targets II
 Reduce average consumption of
– Fats. Recommended level 30% of energy intake
(now 34%)
– Saturated fats. Recommended level <10% of
energy intake (now 14%)
– Transfats. Recommended level <1% (at
recommended level)
– Sugar. Recommended level <10% of energy intake
(now 14%)
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– Salt. Recommended level <5 grams per day (now 10
grams)
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The Official Quantitative Targets III
 Distribution of consumption with a 20% reduction in
the number of:
– Children and young people who daily consume
sweets and candies
– People who daily consume sugar-sweetened soft
drinks
– People who get more than 10% of the energy intake
from sugar (now more than 80% of children aged 4
– 11 years get more than 10% of the energy intake
from sugar)
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– People who get more than 10% of the energy intake
from saturated fats
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What is Needed? A Policy Mix!
 Information?
– Campaigns are never well funded (typically less than 1 mill. $)
 Regulation?
– Transfats
– Vending machines in schools
– Mandatory labeling
 Free provisions?
– Fruits and vegetables in schools
– Low-fat milk and high-quality drinking water in schools
– School lunches?
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 Taxes and subsidies?
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Five Strategies to Improve the Diet I
 In general, none of the strategies are very likely to substantially
change the diet
 The strategies represent few specific actions
 S 1: Increase the availability of healthy food
– Co-operation with the food industry to develop and market healthy
foods
– Increase sales of subsidized fruits, vegetables and milk in public
schools (by information encouraging the participation of more schools
and more students in each school in such programs)
– Encourage the counties and schools to “reduce the access to less
healthy soft drinks” and “increase the access to water”
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– Encourage more healthy eating at workplaces
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Five Strategies to Improve the Diet II
 S 2: Increase the public information to
improve consumers’ knowledge
– Continue the work with a mandatory nutritional labeling
system
– Decide if Norway will follow EU-labeling rules
– In general, TV advertising targeted directly towards children is
not allowed for radio and TV channels broadcasting from
Norway. But many foreign broadcasters are popular and can
advertise according to their national laws
– Evaluate if TV marketing and other marketing (Internet,
magazines, stores, etc) for unhealthy foods aimed at children
and youth should be further restricted by law. Currently they
work on voluntary guidelines with the industry
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Five Strategies to Improve the Diet III
 S 3: Increase the scientific knowledge among health workers
and other providing nutritional information
– Education at different levels in the school system concerning
health and nutrition should be improved
– More basic nutritional research and public health research
related to the effects of food consumption on health outcomes
 S 4: Improve the local co-operation between public and
private partners
– Review guidelines for food in public institutions (e.g. kinder
gardens, schools, homes for old people, jails, hospitals, etc)
 S 5: Improve the preventive aspects in the public health
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services
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What Is Missing:
A Stronger Price Policy?
 Taxes and subsidies:
– Taxes or subsidies are not a part of the suggested
strategies
– From 2007, the value added tax (VAT) is 14% for
food and beverages and 25% for most other goods
– An additional (small) sugar tax (revenue about 180
mill $ in 2007)
– Foods are also taxed and subsidized through a very
complicated agricultural policy system with very
high import tariffs. This policy results in high prices
for domestically produced foods (healthy or
unhealthy)
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What Is Missing:
A Better Labeling Policy
 Current nutritional labeling system is not very
informative neither for those asking for specific
information nor for those who seek basic advises
– Required to list the ingredients in declining order (the main
ingredients listed first, etc). Voluntary to reveal the exact
nutritional content
– Have to list the nutritional content in nutritionally fortified
foods
– Have to list nutritional supplements and preservatives in the
food
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– Can label a product as a “light” product if the energy content is
reduced by at least 30% as compared with the original product
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Our Research (with Geir Wæhler Gustavsen)
 Evaluate effects of removing or increasing the value
added tax (VAT is currently 14%) on the purchases of
healthy and unhealthy foods
 Cross-sectional data from Norwegian purchase surveys
 1986 – 2001 (1997)
 15,700 – 20,500 households
 Focus on households with low consumption of healthy
products or high consumption of unhealthy products
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Our Research
 Quantile regressions are used
 Quantiles are points on the cumulative distribution
function of a random variable
 A household that purchases at the θth quantile of the
purchase distribution buys more than the proportion θ
of households and less than the proportion (1-θ)
– Thus at the 0.75th quantile, 75% of the households
buy no more than does the specified household and
25% buys more
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Vegetables
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Effects of VAT Removal
- Own-price elasticities are different in different quantiles
- VAT removal would cost about $50 per household
- Does not substantially increase purchases in lowconsuming households. Will primarily benefit highconsuming households
Quantile
0.10
0.25
0.50
0.75
0.90
Tobit
Own-price
elasticity
-0.15
-0.39
-0.42***
-0.36***
-0.40***
-0.44***
VAT removal,
change %
1.49
3.86
4.16
3.56
3.96
4.36
VAT removal,
change kg
0.06
0.58
1.25
1.85
3.25
1.66
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Milk
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Effects of VAT Removal
- Own-price elasticities are different in different quantiles
- VAT removal would cost about $48 per household
- Increase purchases of low-consuming households but no
significant effect in high-consuming households
Quantile
0.10
0.25
0.50
0.75
0.90
Tobit
-1.81***
-0.52***
-0.02
0.11
-0.09
-0.05
VAT removal,
change %
20.82
5.98
0.23
-1.27
1.04
0.58
VAT removal,
change liters
2.08
2.33
0.17
-1.61
1.92
0.53
Own-price
elasticity
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Sugar-Sweetened Carbonated Soft Drinks
(SSCSD)
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Effects of Doubling VAT
- Own-price elasticities are different in different quantiles
- Predicted decreases among heavy drinkers are questionable
(insignificant own-price elasticities)
- Predicted significant decreases among light and moderate
drinkers
Quantile
0.35
0.50
0.75
0.90
0.95
Tobit
-2.41**
-1.65**
-1.39***
-0.84
-0.88
-1.02
Doubling of
VAT, change %
-25.6
-17.5
-14.7
-8.9
-9.3
-10.8
Doubling of
VAT, change in l
-5.1
-6.8
-11.5
-13.9
-19.2
-6.2
Own-price
elasticity
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Candy
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Effects of Doubling VAT
- Own-price elasticities are different in different quantiles
- Will significantly reduce consumption in all the quantiles
Quantile
0.40
0.50
0.75
0.90
0.95
Tobit
Own-price
elasticity
-1.49***
-1.23***
-0.71***
-0.67***
-0.62***
-1.67***
Doubling of VAT,
change %
-15.79
-13.04
-7.53
-7.10
-6.57
-17.70
Doubling of VAT,
change in kg
-0.49
-0.60
-0.88
-1.51
-1.94
-1.55
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Conclusions
 The effects of taxes and subsidies vary across
products
 The effects of taxes and subsides are different
among low-consuming and high-consuming
households, i.e. QRs are useful
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Conclusions: VAT removal I
 Vegetables
– Small or no effects on low-consuming households
– Stronger effects on high-consuming households
 Milk
– Some effects among low-consuming households
– No effects among moderate- and high-consuming
households
 Candy
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– Large effects among all households
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Conclusions: VAT Removal II
 SSCSD
– Large effects except among really heavy drinkers (in
the 0.90th and 0.95th quantiles)
– More than a 10 liters annual reduction in
consumption likely
– Are the effects of a 10 liters reduction trivial?
– In one year, the weight gain resulting from such a
reduction is about 0.50 kg (or 1 pound)
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– But the weight gain adds up to about 5 kg over ten
years
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Thank you for your attention
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