Conclusion
The aim of this M.Sc. dissertation is to focus on the relationship between lifestyles, socio-economic position and the onset of noncommunicable diseases.
Hence in the first chapter I have introduced the WHO’s definition of chronic degenerative diseases, those pathologies that cannot be transmitted from person to person; diseases of long duration and slow progression; moreover I have reported the main non-modifiable and modifiable risk factors. Among the first we have genetic predisposition and ageing. Between the second we have behaviours such as unhealthy diet, tobacco consumption, alcohol abuse and physical inactivity. The first chapter ends discussing the increasing relevance of obesity in our society, the prevalence of obesity continues to rise in many OECD countries, the worldwide prevalence of obesity nearly doubled between 1980 and 2008. According to countries estimates for 2008, over 50% of both men and women in the European region were overweight, and roughly 23% of women and 20% of men were obese. Estimates of the number of overweight infants and children in the European region rose steadily from 1990 to 2008.
In the second chapter I have highlighted the relationship existing between food habits and income levels, in particular I have noted as low-income households, attempting to reduce diet costs, select energy dense foods, leading them to increased energy intakes and overweight. (Adam Drewnowski, 2004). Households with limited resources to buy enough food often try to stretch their food budgets by purchasing cheap, energy-dense foods, that is, they try to maximize their calories per dollar in order to stave off hunger (Drewnowski et al., 2009). Moreover low-income communities have greater availability of fast food restaurants especially near schools (Fleischacker et al., 2011; Larson et al., 2009; Simon et al., 2008). These restaurants serve many energy-dense, nutrient poor foods at relatively low prices. After having discussed the direct relationship between food quality and income level, the second chapter ends with a review of some interesting paper present in health economics literature. In particular, Hu et al., (1997), found that a higher dietary intake of saturated fat and trans unsaturated fat was associated with an increased risk of coronary disease, whereas a higher intake of monounsaturated and polyunsaturated fat was associated with a decreasing risk. Colditz et al., (1991), obtained the following results: calories from alcohol were added to energy intake from other sources in men. Conversely, in women, energy from alcohol intake displaced sucrose. Consumption of candy and sugar is inversely related to alcohol consumption. Larrson et al., (1984), found that abdominal adipose tissue distribution can be used as a predictor of cardiovascular disease and death, but not independently of serum cholesterol concentration and blood pressure. Stampfer, (1988), found a strong inverse association between
alcohol drinking and body weight. Rimm, (1996), found that all alcoholic drinks are linked with lower risk of coronary heart disease. Thus, a substantial portion of the benefit, cardio-protective, is from alcohol intake rather than other components of each type of drink. Di Castelnuovo et al., (2002), report a statistically significant inverse association between wine intake and vascular risk up to a daily intake of 150 ml of wine. De Vogli et al., (2014), found after adjustment for covariates that each 1 –unit increase in annual fast food transactions per capita was associated with an increase of 0.033 kg/!! in age standardized body mass index.
After having reviewed some interesting paper present in the literature, in the third chapter I started turning my attention to data on the main causes of death. In Italy in 2010 public expenditure on health was approximately 115 billion euros, corresponding to 7.4 percent of GDP, and to over 1,900 euros per capita per year, values which are lower than those of other major European countries.
According to the collaborative project “The global burden of disease study 2010” led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, the three risk factors that account for the most disease burden in Italy are high blood pressure, tobacco smoking, and dietary risks.1 Actually2, the diseases of the circulatory system constitute the main cause of death in almost all EU countries. In general the first causes of death in all countries are attributable to chronic degenerative diseases, hence I started to estimate, using an Italian dataset, the relationships existing between pathologies and risk factors. In particular I have obtained the following results: drinking beer up to a maximum of 1 liter reduces the probability to develop type 2 diabetes. As already noted by Stampfer et al., (1988), drinking alcohol, up to a maximum of 300 ml per day, reduce the probability to suffer from diabetes. Always considering my estimates I have to underline the direct relationship existing between the probability to develop diabetes and body mass index, in particular obese individuals are more likely to suffer from diabetes. Moreover according to my estimates and according to Di Castelnuovo et al., (2002), beer have a protective function up to a maximum of 300 ml per day, moreover we can highlight the cardio-protective function of alcohol up to a maximum of 150 ml per day. Clearly we note a positive relationship existing between smoking and the probability to suffer from some heart disease, moreover being obese increase the probability to suffer from heart disease. As obtained from my estimates and as underlined by Stampfer et al., (1988), and Colditz et al., (1991), there exist an
1 Ischemic heart diseases, cerebrovascular diseases and other heart diseases are often the result of bad consumption habits, frequently developed in low or middle income neighbourhoods, where individuals prefer to spend less money on healthy foods.
2 Horton, R. (2012). The global burden of disease study 2010. Lancet, 380(9859), 2053-2260. See also the website:
inverse relationship between heavy alcohol drinking (more than 300 ml per day) and body mass index. Moreover I can highlight an inverse relationship between hours of sport per week and obesity. Carbohydrate intake, cheese intake, cold meats and carbonated drinks are also positively related to obesity. As a last step I have tested the role of education and income level in preventing inappropriate lifestyles, my estimates shows that schooling years and household’s economic resources are inversely related with the probability to develop diabetes and to suffer from some heart disease. After having estimated the relationship between risk factors and pathologies, and after having tested the role of education and income level in preventing inappropriate lifestyles I elaborate on possible fiscal policy for making households to have access and to consume more nutritious and less fatty foods. The existing evidence, Mytton et al., (2012); Powell et al., (2009), suggests that small taxes or subsidies are not likely to produce significant changes in BMI or obesity prevalence but that nontrivial pricing intervention may have some measurable effects on weight outcomes. Chapter three ends giving a glance to the literature that explores at the micro level, the price elasticity of demand for food and beverage that harm health. In particular I have seen the rigidity of the demand for junk food and sweetened beverages with respect to price changes. It is therefore interesting to note the role of addiction in the purchasing choices of individuals.
Analyzing the risk factors and their correlation with chronic degenerative diseases and having noticed the rigidity of demand towards goods harmful to health, and therefore the minimal reduction in consumption following a taxation, we recommend to invest the revenue from taxation in food and sport education at home and at school.
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