As previously noted, we regularly scan eleven journals for new studies of particular population health relevance (the list of journals is at the end of this post). Two recent articles caught our eye:
While the health and societal consequences of excessive alcohol consumption are well established, the positive economic impacts of reducing alcohol consumption are seldom addressed. This article (Magnus et al. American Journal of Public Health. Ahead of Print.Doi: 10.2105) systematically estimates these impacts for Australia. This country consumes 9.6 liters per capita annually, estimated to contribute 2.3% to overall health burden. Using Norway’s level of 6.4 liters per capita as a benchmark of what might be realistically achieved, the authors estimated the following results: one third fewer incident cases of disease (98 000), deaths (380), working days lost (5 million), days of home-based production lost (54 000), and a A$789-million health sector cost reduction. The authors claim that these results can be potentially larger than gains through targeted reductions in smoking prevalence modeled in a similar process. Australia provides an interesting focal point for this study, as the nation has both historically been socially accepting of alcohol yet has prevalent and effective policy countermeasures. The authors conclude that “a suitable next step would be a consideration of cost-effective interventions and attention to stakeholder concerns to facilitate such a reduction in excessive alcohol consumption.”
It is known that socio-economic status and nutrient intake are positively correlated, but this article (Monsivals et al. Journal of Epidemiology & Community Health. 66: 530-535) delves deeper into this relationship to examine the effect of cost of nutritious food on these diet disparities. As foods with high nutritional value also tend to be more costly, the authors assert that that the monetary barrier of healthy food can partially mitigate the nutrient disparity once food cost is considered. The study found that mean diet cost varied considerably with education level and household income, with the better-educated and more affluent households spending significantly more in terms of food dollars per day ($1.09 and $1.37 respectively). This resulted in more educated and affluent households’ nutrient density being considerably higher (11% and 9% respectively). The authors conclude that since socio-economic differences in diet quality and nutrient intake are related to the cost of food, then “ food prices should be viewed as a critical component of the greater economic environment, which is a recognised determinant of health.”
Commentaries of note: Because of the relevance of health care spending to population health outcomes, we recommend these two rationing essays to you as well.
Beyond the “R Word”? Medicine’s New Frugality. M. Gregg Bloche. New England Journal of Medicine; 366:1951-1953
From an Ethics of Rationing to an Ethics of Waste Avoidance. Howard Brody. New England Journal of Medicine; 366:1949-1951.
I want to acknowledge the assistance of Erik Bakken, BA for his assistance in scanning the literature and drafting this post.
Journals we follow:
American Journal of Preventive Medicine
American Journal of Public Health
Annual Review of Public Health
Journal of the American Medical Association (JAMA)
Journal of Epidemiology and Community Health
Journal of Health and Social Behavior
New England Journal of Medicine
Preventing Chronic Disease
Social Science and Medicine
David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health. Follow him on twitter: @DAKindig.