Summary

  • The focus of this report is the provision of estimates of the cost to the health delivery system of diet-related disease in the year 1989-90.
  • The major causes of death, illness and disability in. Australia thought to have a nutrition component in their etiology and for which some form of prevention is likely to be applicable are: coronary heart disease, stroke, hypertension, atherosclerosis, some forms of cancer (stomach, colon, rectal, breast and endometrial), diabetes (non-insulin dependent), osteoporosis, dental caries, gallbladder disease, and non-cancer disorders of the large bowel (diverticular disease, constipation and hemorrhoids).
  • With the exception of alcohol-related disease and cancer, there is limited information in the literature on the population attributable fractions necessary to ascertain what proportion of these diseases is directly due to diet. This study has utilised three values- high and low estimates of the population attributable fractions to indicate upper and lower bounds, with the mid value representing the most likely relationship.
  • Using the mid value of the population attributable fractions, premature deaths in 1989-90 due to poor diet contributed 36,604 potential years of life lost (PYLL) to age 65 and 100,055 to age 75.
  • PYLL due to poor diet (excluding alcohol) is 70 per cent as large as PYLL due to smoking. If alcohol-related disease is included in the diet category, PYLL is 180 per cent as large as PYLL due to smoking.
  • Using the mid value population attributable fractions, the direct cost (ie. the cost of health care services- hospital, medical, pharmaceutical, allied professional and nursing home) of diet-related disease is $1,520 million in 1989-90. The indirect cost (ie. earnings foregone through illness and premature death) is $746 million irr·1989-90, giving total costs of $2,267 million.
  • If the total cost of diseases due to alcohol is added, the total estimate in 1989-90 rises to $3,620 million.
  • This cost-of-illness study is useful for a number of purposes, including use as an indicator of public health significance of diet-related disease. It should not be used to justify health promotion activity without regard to allocational efficiency, which requires a realistic consideration of both costs and outcomes of individual projects.
  • The direct cost of diet-related disease ($1,520 million in 1989-90) represents the maximum possible annual"savings" that health promotion programs focusing on food and nutrition policy could hope to achieve. It should not be interpreted as an estimate of financial cost savings realisable by government in the short term, but rather as an approximate estimate of the "opportunity cost" of resources devoted to the treatment of preventable disease, that could be available for the treatment of non preventable disease. Conversion of "opportunity costs" (ie benefits foregone) into expenditure savings involves a number of difficult and complex considerations beyond the scope of this paper.
  • The scope and limitations of this study are specified in the text and should be carefully noted before utilising the cost-of-illness estimates.