1. A L I M E N T A T I O N A G R I C U L T U R E E N V I R O N N E M E N T Increasing Fruit and Vegetable Consumption: A Cost-Efficiency Analysis of Public Policies Mobilizing the food chain for health OECD, PARIS, October 25-26 2012 J. Dallongeville 1, L. Dauchet 1, O. de Mouzon 2, V. Requillart 2, L.G. Soler 3 1 Institut Pasteur, Lille 2 TSE (INRA-GREMAQ), Toulouse 3 INRA-ALISS UR 1303, Ivry sur Seine

2. A L I M E N T A T I O N A G R I C U L T U R E E N V I R O N N E M E N T 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. A L I M E N T A T I O N A G R I C U L T U R E E N V I R O N N E M E N T  Important challenges for policy makers : -Targeted versus non targeted policies -Economic instruments versus information -Public (and private) costs / Heath benefits - Efficiency versus Equity

4. A L I M E N T A T I O N A G R I C U L T U R E E N V I R O N N E M E N T 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. A L I M E N T A T I O N A G R I C U L T U R E E N V I R O N N E M E N T 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. A L I M E N T A T I O N A G R I C U L T U R E E N V I R O N N E M E N T 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. A L I M E N T A T I O N A G R I C U L T U R E E N V I R O N N E M E N T 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. A L I M E N T A T I O N A G R I C U L T U R E E N V I R O N N E M E N T Relative Risks associated to the consumption of one additional portion (80g/day)

9. A L I M E N T A T I O N A G R I C U L T U R E E N V I R O N N E M E N T

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14. A L I M E N T A T I O N A G R I C U L T U R E E N V I R O N N E M E N T 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 14

15. A L I M E N T A T I O N A G R I C U L T U R E E N V I R O N N E M E N T 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. A L I M E N T A T I O N A G R I C U L T U R E E N V I R O N N E M E N T Thank you for your attention

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18. A L I M E N T A T I O N A G R I C U L T U R E E N V I R O N N E M E N T 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)........ 18