Investing in non-communicable disease risk factor control among adolescents worldwide: a modelling study

Abstract

IntroductionExposure to non-communicable disease (NCD) risk factors is increasing among adolescents in most countries due to demographic, economic and epidemiological forces. We sought to analyse the potential health impact and costs of implementing NCD risk reduction interventions among adolescents worldwide.MethodsWe identified six interventions targeted at adolescent tobacco smoking, heavy episodic drinking and obesity and supported by effectiveness and cost-effectiveness evidence. Based on a population-level cohort of adolescents in 70 representative countries, we assessed the global mortality consequences of fully implementing these interventions over 2020–2070 using the potential impact fraction approach. We calculated the economic benefits of reduced mortality and estimated the required financial costs, discounting both at 3% annually. We also conducted best-case and worst-case scenario analyses.ResultsFull implementation of these interventions worldwide could avert nearly 10% of premature deaths among this cohort, translating to about US$400 billion in cumulative economic benefits. Cumulatively, the required costs would be about US$85 billion, suggesting that every US$1 of public money invested would generate US$5 in increased human capital. Tobacco taxes generally conferred the highest economic returns; however, an in-depth analysis of three countries illustrated the potential for different priorities, such as alcohol control, to emerge.ConclusionFrom a life course perspective, implementation of a package of interventions to reduce NCD risk among adolescents worldwide would substantially reduce premature mortality at reasonable costs. Our analysis illustrates the importance of integrating NCD prevention policies into the emerging global agenda for adolescent health and well-being.

Proactive prevention: Act now to disrupt the impending non-communicable disease crisis in low-burden populations

“…Obesity in children and adolescents continues to increase worldwide and is recognized as a major contributing risk factor to premature mortality due to NCDs [ 45 ]. However, most school-based educational strategies have had little to no impact on prevention of obesity and have been characterized by sustainability challenges [ 4 , 46 , 47 ]. A recent modeling study assessed a package of interventions for NCD risk reduction among adolescents, targeting tobacco smoking, alcohol use, tax on sugar-sweetened beverages, and a school-based program for physical activity and healthy diet [ 4 ].…”

“…However, most school-based educational strategies have had little to no impact on prevention of obesity and have been characterized by sustainability challenges [ 4 , 46 , 47 ]. A recent modeling study assessed a package of interventions for NCD risk reduction among adolescents, targeting tobacco smoking, alcohol use, tax on sugar-sweetened beverages, and a school-based program for physical activity and healthy diet [ 4 ]. Although the study predicted a mortality benefit from the school-based program, its benefit-cost ratio was very low because costs were so high [ 4 ].…”

“…The most compelling reason to initiate proactive prevention is to slow or eliminate the development of a high disease burden at the population level. Even in countries with already high NCD burden, segments of the population, particularly children and adolescents, are at low risk or have not yet been afflicted [ 4 ]. Early health promotion efforts could delay or wholly prevent progression to overt NCDs over the course of their lifetime [ 4 , 5 ], thus reducing premature death and disability.…”

“…Even in countries with already high NCD burden, segments of the population, particularly children and adolescents, are at low risk or have not yet been afflicted [ 4 ]. Early health promotion efforts could delay or wholly prevent progression to overt NCDs over the course of their lifetime [ 4 , 5 ], thus reducing premature death and disability. The critical window to pursue proactive prevention will soon no longer be present and the time to act is now!…”

Policy options for tackling diet-related noncommunicable diseases

“…Achieving larger reductions, for example through mandatory targets, could mean greater health gains 4 . Health gains, particularly in relation to noncommunicable disease incidence and mortality, would most likely increase after 2030 as younger cohorts age 10 . The global community can learn greatly from country experimentation with different types of policies to find out what works and what does not.…”