Increasing Fruit and Vegetable Consumption: A Cost-Efficiency Analysis of Public Policies

1. Mobilizing the food chain for health OECD, PARIS, October 25-26 2012 Increasing Fruit and Vegetable Consumption: A Cost-Efficiency Analysis of Public Policies J. Dallongeville1, L. Dauchet1, O. de Mouzon2, V. Requillart2, L.G. Soler3 1Institut Pasteur, Lille 2TSE (INRA-GREMAQ), Toulouse 3INRA-ALISS UR 1303, Ivry sur Seine

2. MOTIVATIONS • Food and non communicable diseases (cancers, cardiovascular diseases ….) • Public health actions to reach the recommended intake of 400g of fruit and vegetables (F&V) per day • Education and information campaigns • Economic instruments (consumption subsidies, ‘F&V’ stamps...) • Many studies based on local experiments • Very few studies integrating economic and health parameters

3. Important challenges for policy makers : • Targeted versus non targeted policies • Economic instruments versus information • Public (and private) costs / Heath benefits • Efficiency versus Equity

4. OBJECTIVES • Evaluation of policy scenarios aiming at increasing F&V consumption in France • Policies • P1: decrease in VAT • P2: F&V stamps for ‘poor’ consumers • P3 : Generic information campaign • Cost-Efficiency analysis : cost per Life Year Saved

5. OVERVIEW ON THE METHOD • An economic model of the F&V market (Equilibrium Displacement Model) Policy  Changes in F&V consumption • A health model Changes in F&V consumption  Number of Life Years Saved (LYS) using “Relative Risks” associated to an increase in F&V consumption • Cost-effectiveness Implementation cost of the policy / LYS • Simulations to take into account the uncertainties on the model inputs

6. POLICIES • P1: Reduction of VAT • Decrease consumer price (less than the VAT reduction) • Increase consumption • Effects at equilibrium depend on price elasticity of demand, price elasticity of supply • P2: F&V stamps to low income consumers (LIC) • Equivalent to an increase in income • Increase consumption of LIC • Increase consumer price • Decrease consumption of other consumers

7. POLICIES • P3: General Information campaigns • Increase ‘stock’ of information of consumers • Increase demand and mean consumption • Increase price • Consumption of some consumers might decrease if less responsive to information • Simulations • - Decrease in VAT : 3% • - Budget for F&V stamps : 300M euros • - Targeted consumers : 1 to 10% of the population • - F&V stamp per person : 50 to 350 euros per year

8. Relative Risks associated to the consumption of one additional portion (80g/day)

14. Conclusion LIMITS • Only F&V sector • Uncertainty on the values of some parameters (information responsiveness in particular) • Decreased morbidity not taken into account • We assumed that people use the FV stamps they get

15. Generally speaking, modest impacts on consumption and health • ...but cost/LYS often compatible with acceptable thresholds • Information policies are cost-effective... because they are not very expensive. However they might increase (slightly) the health disparities among the population (different from the result of another study in the UK). • Price policy dominates F&V stamp policy.... • .... except if the F&V stamp policy is focused on a “small” part of the population (greater amount of individual stamps but for less people) • =“optimal” size of the targeted population (which depends on the total budget used for the implementation of the policy) • Challenge : to determine the “best” policy mix

16. Thank you for your attention

18. Related Literature • Unhealthy food taxation, healthy food subsidizing : Chouinard et al (2007), Mytton (2007), Allais et al. (2010), Bonnet et al. (2007), ... • Cost-efficiency analysis: Cash et al (2005) • Food stamps: Alston et al. (2009), Meyerhoefer et Pylipchuk (2008), Chen et al. (2005) • Information campaign : Pomerleau et al (2005) • ........