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Background: An increasing number of countries are implementing taxes on unhealthy foods and drinks to address the growing burden of dietary-related disease, but the cost-effectiveness of combining taxes on unhealthy foods and subsidies on healthy foods is not well understood., Methods and Findings: Using a population model of dietary-related diseases and health care costs and food price elasticities, we simulated the effect of taxes on saturated fat, salt, sugar, and sugar-sweetened beverages and a subsidy on fruits and vegetables, over the lifetime of the Australian population. The sizes of the taxes and subsidy were set such that, when combined as a package, there would be a negligible effect on average weekly expenditure on food (<1% change). We evaluated the cost-effectiveness of the interventions individually, then determined the optimal combination based on maximising net monetary benefit at a threshold of AU$50,000 per disability-adjusted life year (DALY). The simulations suggested that the combination of taxes and subsidy might avert as many as 470,000 DALYs (95% uncertainty interval [UI]: 420,000 to 510,000) in the Australian population of 22 million, with a net cost-saving of AU$3.4 billion (95% UI: AU$2.4 billion to AU$4.6 billion; US$2.3 billion) to the health sector. Of the taxes evaluated, the sugar tax produced the biggest estimates of health gain (270,000 [95% UI: 250,000 to 290,000] DALYs averted), followed by the salt tax (130,000 [95% UI: 120,000 to 140,000] DALYs), the saturated fat tax (97,000 [95% UI: 77,000 to 120,000] DALYs), and the sugar-sweetened beverage tax (12,000 [95% UI: 2,100 to 21,000] DALYs). The fruit and vegetable subsidy (-13,000 [95% UI: -44,000 to 18,000] DALYs) was a cost-effective addition to the package of taxes. However, it did not necessarily lead to a net health benefit for the population when modelled as an intervention on its own, because of the possible adverse cross-price elasticity effects on consumption of other foods (e.g., foods high in saturated fat and salt). The study suggests that taxes and subsidies on foods and beverages can potentially be combined to achieve substantial improvements in population health and cost-savings to the health sector. However, the magnitude of health benefits is sensitive to measures of price elasticity, and further work is needed to incorporate potential benefits or harms associated with changes in other foods and nutrients that are not currently modelled, such as red and processed meats and fibre., Conclusions: With potentially large health benefits for the Australian population and large benefits in reducing health sector spending on the treatment of non-communicable diseases, the formulation of a tax and subsidy package should be given a more prominent role in Australia's public health nutrition strategy., Competing Interests: LJC is a member of the Editorial Board of PLOS Medicine.

Pricing policies such as taxes and subsidies are important tools in preventing and controlling a range of threats to public health. This is particularly so in tobacco and alcohol control efforts and efforts to change dietary patterns and physical activity levels as a means of addressing increases in noncommunicable diseases. To understand the potential impact of pricing policies, it is critical to understand the nature of price elasticities for consumer products. For example, price elasticities are key parameters in models of any food tax or subsidy that aims to quantify health impacts and cost-effectiveness. We detail relevant terms and discuss key issues surrounding price elasticities to inform public health research and intervention studies.

Objective: To develop a new method for estimating the cost to governments of enacting public health legislation., Methods: We adopted a central government perspective in estimating costs. The parliamentary cost of legislative acts and regulations in New Zealand was calculated from the proportion of parliamentary time devoted to law-making (i.e. sitting days in the debating chamber), and the cost of associated policy advice from government agencies was calculated from the proportion of documented policy issues related to law-making. The relative costs of acts and regulations were estimated from the number of pages in the legislation., Findings: We estimated that, between 1999 and 2010, 26.7% of parliamentary resources and 16.7% of policy advice from government agencies were devoted to generating new laws in New Zealand. The mean cost of an act was 2.6 million United States dollars (US$; 95% uncertainty interval, UI: 1.5 to 4.4 million) and the mean cost of a regulation was US$ 382 000 (95% UI: 22 000 to 665 000). For comparison, the average cost of a bill enacted by the 50 state governments in the United States of America between 2008 and 2009 was US$ 980 000., Conclusion: We were able to estimate the cost of new legislation in New Zealand. Our method for estimating this cost seemed to capture the main government costs involved and appears to be generally applicable to other developed countries. Ideally such costs should be included in economic evaluations of public health interventions that involve new legislation.

Background: Recent work in a number of countries has identified growing geographical inequalities in health between deprived and non-deprived neighbourhoods. The health gaps observed cannot be entirely explained by differences in the characteristics of individuals living in those neighbourhoods, which has led to a concerted international public health research effort to determine what contextual features of neighbourhoods matter. This article reports on access to potentially health-promoting community resources across all neighbourhoods in New Zealand. Prevailing international opinion is that access to community resources is worse in deprived neighbourhoods., Methods: Geographical Information Systems were used to calculate geographical access to 16 types of community resources (including recreational amenities, and shopping, educational and health facilities) in 38,350 small census areas across the country. The distribution of these access measures by neighbourhood socioeconomic deprivation was determined., Results: For 15 out of 16 measures of community resources, access was clearly better in more deprived neighbourhoods. For example, the travel time to large supermarkets was approximately 80% greater in the least deprived quintile of neighbourhoods compared with the most deprived quintile., Conclusions: These results challenge the widely held, but largely untested, view that areas of high social disadvantage have poorer access to community resources. Poor locational access to community resources among deprived neighbourhoods in New Zealand does not appear to be an explanation of poorer health in these neighbourhoods. If anything, a pro-equity distribution of community resources may be preventing even wider disparities in neighbourhood inequalities in health.

These policies had minimal impact on health outcomes.[2] For this study, we extended these analyses to determine the impact of age-stratified consistent community-level mask wearing (ie, at all times when outside the home) on numbers of SARS-CoV-2 infections and COVID-19-related deaths. Keywords: COVID-19; Public health; Public policy EN COVID-19 Public health Public policy 77 79 3 07/18/23 20230717 NES 230717 Masks effectively reduce severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission.[1] However, the impact of mask wearing over an extended period on morbidity and mortality at the population level is less clear, particularly given the interplay between mask effectiveness, population immunity, and other public health and social measures. The rise in the numbers of deaths during the third quarter may be related to reduced infection-derived immunity following lower viral transmission earlier in the model run; however, the cumulative infection and death numbers were still lower for these scenarios than with zero mask wearing. [Extracted from the article]

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1745-7939.2009.01164.x Byline: Anna Stevenson (1), Jamie Pearce (2), Tony Blakely (3), Vivienne Ivory (3), Karen Witten (4) Keywords: health; health inequality; neighbourhood; New Zealand Abstract: Abstract Over the past two decades, there has been a resurgence of interest into place-based influences on health. Researchers have identified that various characteristics of neighbourhoods exert an influence on the health outcomes and behaviours of local residents. Understanding the processes linking places to health provides considerable potential for a range of policy interventions. We review the New Zealand-based neighbourhoods and health research. Consideration is given to the types of neighbourhood characteristics, as well the range of health outcomes that have been studied. Finally, we suggest some priorities for further research into the mechanisms underpinning neighbourhood influences on health in New Zealand. Author Affiliation: (1)Community and Public Health, Canterbury District Health Board, Christchurch, New Zealand; (2)Institute of Geography, School of GeoSciences, University of Edinburgh, Edinburgh, UK; (3)Health Inequalities Research Programme, University of Otago, Wellington, New Zealand; (4)Centre for Social and Health Outcomes Research and Evaluation, Massey University, Auckland, New Zealand Article note: Anna Stevenson is a public health physician who works with Christchurch City Council and the Canterbury District Health Board on urban design issues; Jamie Pearce is a reader in Human Geography at the University of Edinburgh, UK, and co-director of the GeoHealth Laboratory, Department of Geography, University of Canterbury; Tony Blakely is research professor of Public Health at the Wellington School of Medicine and Health Sciences, University of Otago and the director of the Health Inequalities Research Programme (HIRP); Vivienne Ivory is a research fellow on the HIRP, Wellington School of Medicine and Health Sciences, University of Otago; Karen Witten is associate professor at the Centre for Social and Health Outcomes Research and Evaluation (SHORE), Massey University, Auckland., E-mail: jamie.pearce@ed.ac.uk; jamie.pearce@canterbury.ac.nz

Background: Although the harm to health from electronic nicotine delivery systems (ENDS) compared to smoked tobacco remains highly uncertain, society and governments still need to know the likely range of the relative harm to inform regulatory policies for ENDS and smoking.Methods: We identified biomarkers with specificity of association with different disease groupings e.g., volatile organic compound (VOCs) for chronic obstructive pulmonary disease; and tobacco-specific N´-nitrosamines (TSNAs) and polycyclic aromatic hydrocarbons (PAHs) for all cancers. We conducted a review of recent studies (post January 2017) that compared these biomarkers between people exclusively using ENDS and those exclusively smoking tobacco. The percentage differences in these biomarkers, weighted by study size and adjusted for acrolein from other sources, were used as a proxy for the assumed percentage difference in disease harm between ENDS and smoking. These relative differences were applied to previously modelled estimates of smoking-related health loss (in health-adjusted life-years; HALYs).Results: The respective relative biomarker levels (ENDS vs smoking) were: 28% for respiratory diseases (five results, three studies); 42% for cancers (five results, four studies); and 35% for cardiovascular (seven results, four studies). When integrated with the HALY impacts by disease, the overall harm to health from ENDS was estimated to be 33% that of smoking.Conclusions: This analysis, suggests that the use of modern ENDS devices (vaping) could be a third as harmful to health as smoking in a high-income country setting. But this estimate is based on a limited number of biomarker studies and is best be considered a likely upper level of ENDS risk given potential biases in our method (i.e., the biomarkers used being correlated with more unaccounted for toxicants in smoking compared to with using ENDS). [ABSTRACT FROM AUTHOR]

Sugar-sweetened beverage (SSB) intake is associated with tooth decay, obesity and diabetes. We aimed to model the health and cost impact of reducing the serving size of all single serve SSB to a maximum of 250 ml in New Zealand. A 250 ml serving size cap was modeled for all instances of single serves (<600 ml) of sugar-sweetened carbonated soft drinks, fruit drinks, carbonated energy drinks, and sports drinks in the New Zealand National Nutrition Survey intake data (2008/09). A multi-state life-table model used the change in energy intake and therefore BMI to predict the resulting health gains in quality-adjusted life-years (QALYs) and health system costs over the remaining life course of the New Zealand population alive in 2011 (N = 4.4 million, 3% discounting). The 'base case' model (no compensation for reduced energy intake) resulted in an average reduction in SSB and energy intake of 23 ml and 44 kJ (11 kcal) per day or 0.22 kg of weight modeled over two years. The total health gain and cost-savings were 82,100 QALYs (95% UI: 65100 to 101,000) and NZ$1.65 billion [b] (95% UI: 1.19 b to 2.24 b, (US$1.10 b)) over the lifespan of the cohort. QALY gains increased to 116,000 when the SSB definition was widened to include fruit juices and sweetened milks. A cap on single serve SSB could be an effective part of a suite of obesity prevention and sugar reduction interventions in high income countries. [ABSTRACT FROM AUTHOR]

Background: Young people with low education have worse health than those with higher education. This paper examined the extent to which employment and income reduced the adverse effects of low education on mental health among people aged 20-35 years.Methods: We used causal mediation analyses to estimate the total causal effect (TCE) of low education on mental health and to decompose the effect into the natural direct effect (NDE) and the natural indirect effect (NIE) through two mediators examined sequentially: employment (labour-force participation/occupation skill level) and income. Three waves of the Household, Income and Labour Dynamics in Australia (HILDA) survey (2012-14) were used to establish a temporal sequence between low education (not completing high school), mediators and mental health [the Mental Health Inventory (MHI-5)] among participants aged 20-35 years. Among those who were employed, we conducted further analyses examining the effect of job characteristics as a mediator of the relationship between low education and mental health.Results: The TCE of low education on the MHI-5 was -3.61 [95% confidence interval (CI) -5.30 to -1.92]. The NIE through labour force status and occupational skill level was -1.09 (95% CI -2.29 to 0.10) and -1.49 (95% CI -2.79 to -0.19) through both labour-force status/occupational skill level and income, corresponding to a percentage mediated of 41%. Among the employed, education had a much smaller effect on the MHI-5.Conclusions: Improving employment opportunities could reduce nearly half of the adverse effects of low education on the mental health of young people. [ABSTRACT FROM AUTHOR]

Background: Disability among adolescents is associated with both poorer mental health (MH) and higher levels of bullying-victimization. Bullying, therefore, conceivably mediates the association between disability and MH. Quantifying this pathway is challenging as the exposure (disability), mediator (bullying) and outcome (MH) are subjective, and subject to dependent measurement error if the same respondent reports on two or more variables.Methods: Utilizing the counterfactual and potential outcomes approaches to causal mediation, we decomposed the total effect of disability on MH into natural indirect effects (through bullying) and natural direct effects (not through bullying) using a sample of 3409 adolescents. As the study included data from multiple informants (teacher, parent, adolescent) on the outcome (MH, as measured on the Strengths and Difficulties Questionnaire) and two informants (adolescent, parent) on the mediator (bullying), we assessed the influence of dependent measurement error.Results: For preferred analysis (using parent-reported bullying and adolescent-reported MH), the total effect was a 2.18 [95% confidence interval (CI): 0.66-3.40] lower MH score for adolescents with a disability, compared with those with no disability (strength of association equivalent to 37% of the standard deviation for MH). Bullying explained 46% of the total effect. Use of adolescent-reported bullying with adolescent-reported MH produced similar results (37% mediation, 95% CI: 12-74%).Conclusions: Disability exerts a detrimental effect on adolescent MH, and a large proportion of this appears to operate through bullying. This finding does not appear to be spurious due to dependent measurement error. [ABSTRACT FROM AUTHOR]

Background: Health-related food taxes and subsidies may promote healthier diets and reduce mortality. Our aim was to estimate the effects of health-related food taxes and subsidies on deaths prevented or postponed (DPP) in New Zealand. Methods: A macrosimulation model based on household expenditure data, demand elasticities and population impact fractions for 18 diet-related diseases was used to estimate effects of five tax and subsidy regimens. We used price elasticity values for 24 major commonly consumed food groups in New Zealand, and food expenditure data from national Household Economic Surveys. Changes in mortality from cardiovascular disease, cancer, diabetes and other diet-related diseases were estimated. Findings: A 20% subsidy on fruit and vegetables would result in 560 (95% uncertainty interval, 400 to 700) DPP each year (1.9% annual all-cause mortality). A 20% tax on major dietary sources of saturated fat would result in 1,500 (950 to 2,100) DPP (5.0%), and a 20% tax on major dietary sources of sodium would result in 2,000 (1300 to 2,700) DPP (6.8%). Combining taxes on saturated fat and sodium with a fruit and vegetable subsidy would result in 2,400 (1,800 to 3,000) DPP (8.1% mortality annually). A tax on major dietary sources of greenhouse gas emissions would generate 1,200 (750 to 1,700) DPP annually (4.0%). Effects were similar or greater for Maori and low-income households in relative terms. Conclusions: Health-related food taxes and subsidies could improve diets and reduce mortality from diet-related disease in New Zealand. Our study adds to the growing evidence base suggesting food pricing policies should improve population health and reduce inequalities, but there is still much work to be done to improve estimation of health impacts. [ABSTRACT FROM AUTHOR]

Background: Given the high importance of dietary sodium (salt) as a global disease risk factor, our objective was to compare the impact of eight sodium reduction interventions, including feasible and more theoretical ones, to assist prioritisation. Methods: Epidemiological modelling and cost-utility analysis were performed using a Markov macro-simulation model. The setting was New Zealand (NZ) (2.3 million citizens, aged 35+ years) which has detailed individual-level administrative cost data. Results: Of the most feasible interventions, the largest health gains were from (in descending order): (i) mandatory 25% reduction in sodium levels in all processed foods; (ii) the package of interventions performed in the United Kingdom (UK); (iii) mandatory 25% reduction in sodium levels in bread, processed meats and sauces; (iv) media campaign (as per a previous UK one); (v) voluntary food labelling as currently used in NZ; (vi) dietary counselling as currently used in NZ. Even larger health gains came from the more theoretical options of a “sinking lid” on the amount of food salt released to the national market to achieve an average adult intake of 2300 mg sodium/day (211,000 QALYs gained, 95% uncertainty interval: 170,000 – 255,000), and from a salt tax. All the interventions produced net cost savings (except counselling – albeit still cost-effective). Cost savings were especially large with the sinking lid (NZ$ 1.1 billion, US$ 0.7 billion). Also the salt tax would raise revenue (up to NZ$ 452 million/year). Health gain per person was greater for Māori (indigenous population) men and women compared to non-Māori. Conclusions: This study substantially expands on the range of previously modelled salt reduction interventions and suggests that some of these might achieve major health gains and major cost savings (particularly the regulatory interventions). They could also reduce ethnic inequalities in health. [ABSTRACT FROM AUTHOR]

Pacific people living in New Zealand have higher mortality rates than New Zealand residents of European/Other ethnicity. The aim of this paper is to see whether Pacific mortality rates vary by natality and duration of residence. We used linked census-mortality information for 25- to 74-year-olds in the 2001 census followed for up to three years. Hierarchical Bayesian modeling provided a means of handling sparse data. Posterior mortality rates were directly age-standardized. We found little evidence of mortality differences between the overseas-born and the New Zealand–born for all-cause, cancer, and cardiovascular disease (CVD) mortality. However, we found evidence for lower all-cause (and possibly cancer and CVD) mortality rates for Pacific migrants resident in New Zealand for less than 25 years relative to those resident for more than 25 years. This result may arise from a combination of processes operating over time, including health selection effects from variations in New Zealand’s immigration policy, the location of Pacific migrants within the social, political, and cultural environment of the host community, and health impacts of the host culture. We could not determine the relative importance of these processes, but identifying the (modifiable) drivers of the inferred long-term decline in health of the overseas-born Pacific population relative to more-recent Pacific migrants is important to Pacific communities and from a national health and policy perspective. [ABSTRACT FROM AUTHOR]

Objective: Global health challenges include non-communicable disease burdens, ensuring food security in the context of rising food prices, and environmental constraints around food production, e.g., greenhouse gas [GHG] emissions. We therefore aimed to consider optimized solutions to the mix of food items in daily diets for a developed country population: New Zealand (NZ). Methods: We conducted scenario development and linear programming to model 16 diets (some with uncertainty). Data inputs included nutrients in foods, food prices, food wastage and food-specific GHG emissions. Findings: This study identified daily dietary patterns that met key nutrient requirements for as little as a median of NZ$ 3.17 per day (US$ 2.41/d) (95% simulation interval [SI] = NZ$ 2.86 to 3.50/d). Diets that included “more familiar meals” for New Zealanders, increased the cost. The optimized diets also had low GHG emission profiles compared with the estimate for the ‘typical NZ diet’ e.g., 1.62 kg CO2e/d for one scenario (95%SI = 1.39 to 1.85 kg CO2e) compared with 10.1 kg CO2e/d, respectively. All of the optimized low-cost and low-GHG dietary patterns had likely health advantages over the current NZ dietary pattern, i.e., lower cardiovascular disease and cancer risk. Conclusions: We identified optimal foods and dietary patterns that would lower the risk of non-communicable diseases at low cost and with low greenhouse gas emission profiles. These results could help guide central and local government decisions around which foods to focus policies on. That is which foods are most suitable for: food taxes (additions and exemptions); healthy food vouchers and subsidies; and for increased use by public institutions involved in food preparation. [ABSTRACT FROM AUTHOR]

A systematic review of simulation studies conducted by Helen Eyles and colleagues examines the association between food pricing strategies and food consumption and health and disease outcomes. [ABSTRACT FROM AUTHOR]

Recent work has identified growing geographical inequalities in health between deprived and nondeprived areas in a number of countries. Despite the plethora of studies monitoring these trends, the explanations for this growing spatial divide remain unclear. This lack of clarity has been a hindrance to the implementation of strategies by policymakers to reduce health inequalities. One explanation for the noted spatial differences in health is that geographical access to a range of community resources, such as health care facilities, supermarkets, and recreational amenities, is lower in deprived areas. However, the evidence base for this explanation is low. In our previous work we noted a strong relationship at the national level between community resource accessibility and social deprivation, with access tending to be better in more deprived neighbourhoods. Other research suggests that the relationship between community resources varies at a subnational scale. Here, we consider whether the relationship of better access to community resources in more deprived areas persists for all regions of New Zealand, urban and rural. Using geographical information systems, we calculate levels of geographical access to sixteen types of community resources in 38350 small census areas across the country and, using an index of deprivation, examine whether access varies between deprived and nondeprived areas of the country. The results suggest that access to community resources in New Zealand is to some extent context specific. In urban areas, access is better in more deprived neighbourhoods, and the same is true of intermediate urban/rural areas although the gradient is considerably more pronounced. However, for rural areas, the relationship between community resource access and deprivation is more mixed, with access to the majority of resources being worse in more deprived areas. Similarly, there are regional variations in the relationship between deprivation and community resource access. These results challenge some aspects of neomaterial interpretations of geographical inequalities in health. [ABSTRACT FROM AUTHOR]

Study objective: To evaluate the New Zealand evidence for three theories of population health change: compression of morbidity, expansion of morbidity, and dynamic equilibrium. Design: Using the Sullivan method, repeated cross sectional survey information on functional limitation prevalence was combined with population mortality data and census information on the utilisation of institutional care to produce health expectancy indices for 1981 and 1996. Setting: The adult population of New Zealand in 1981 and 1996. Participants: 6891 respondents to the 1981 social indicators survey; 8262 respondents to the 1996 household disability survey. Main results: As a proportion of overall life expectancy at age 15 the expectation of non-institutionalised mobility limitations increased from 3.5% to 6% for men, and from 4.5% to 8% for women; the expectation of agility limitation increased from 3% to 7.5% for men and from 4.5% to 8.5% for women, and the expectation of self care limitations increased from 2.0% to 4.5% for men and from 3.0% to 6.0% for women. These changes were primarily attributable to increases in the expectation of moderate functional limitation. Conclusion: The dynamic equilibrium scenario provides the best fit to current New Zealand evidence on changes in population health. Although an aging population is likely to lead to an increase in demand for disability support services, the fiscal impact of this increase may be partially offset by a shift from major to moderate limitations, with a consequential reduction in the average levels of support required. [ABSTRACT FROM AUTHOR]

Presents readers' reactions to articles about public health policy published in the previous issues of the periodical 'Journal of Health Politics, Policy and Law.' Use of age variables in studying population health; Substance and sophistry in the analysis of social inequalities in health.