Ma Guansheng, Meyer Christina L, Jackson-Morris Angela, Chang Suying, Narayan Anuradha, Zhang Man, Wu Daphne, Wang Youfa, Yang Zhenyu, Wang Huijun, Zhao Li, Nugent Rachel
Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China.
Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA.
Lancet Reg Health West Pac. 2023 Dec 1;43:100977. doi: 10.1016/j.lanwpc.2023.100977. eCollection 2024 Feb.
The rapid increase in child and adolescent overweight and obesity (OAO) in China has a significant health and economic impact. This study undertook an investment case analysis to evaluate the health and economic impacts of child and adolescent OAO in China and the potential health and economic returns from implementing specific policies and interventions.
The analysis estimates the reduction in mortality and morbidity from implementing a set of evidence-based interventions across China between 2025 and 2092 using a deterministic Markov cohort model. Modelled interventions were identified by literature review and expert recommendation and include fiscal and regulatory policies, eHealth breastfeeding promotion, school-based interventions, and nutritional counselling by physicians. The study applies a societal costing perspective to model the economic impact on healthcare cost savings, wages, and productivity during adulthood. By projecting and comparing the costs between a status quo scenario and an intervention scenario, the study estimates the return on investment (ROI) for interventions separately and in combination.
Without intervention China will experience 3.3 billion disability-adjusted life years (DALYs) due its current levels of child and adolescent OAO and a lifetime economic impact of CNY 218 trillion (USD 31.6 trillion), or a lifetime CNY 2.5 million loss per affected child or adolescent (USD 350 thousand). National implementation of all five interventions would avert 179.4 million DALYs and result in CNY 13.1 trillion of benefits over the model cohort's lifetime. Implementing fiscal and regulatory policies had the strongest ROI, with benefits accruing at least 10 years after implementation. Scaling up China's current school-based interventions offers China significant health and economic gains, however, the ROI is lower than other modelled interventions.
Effective prevention and treatment of child and adolescent OAO is critical to China's health and economic development. Multiple interventions offer a comprehensive approach to address the various factors that increase risk of child and adolescent OAO. Nonetheless, fiscal and regulatory policies offer the strongest health and economic gains.
Funding was provided by UNICEF China.
中国儿童和青少年超重与肥胖（OAO）情况迅速增加，对健康和经济产生了重大影响。本研究进行了一项投资案例分析，以评估中国儿童和青少年OAO对健康和经济的影响，以及实施特定政策和干预措施可能带来的健康和经济回报。
该分析使用确定性马尔可夫队列模型，估计了2025年至2092年在中国实施一系列循证干预措施后死亡率和发病率的降低情况。通过文献综述和专家推荐确定了模拟干预措施，包括财政和监管政策、电子健康母乳喂养促进、基于学校的干预措施以及医生提供的营养咨询。该研究采用社会成本核算视角，对成年期医疗保健成本节省、工资和生产力方面的经济影响进行建模。通过预测和比较现状情景与干预情景之间的成本，该研究分别和综合估计了干预措施的投资回报率（ROI）。
若不进行干预，由于中国目前儿童和青少年OAO的水平，将经历33亿伤残调整生命年（DALYs），终身经济影响为218万亿人民币（31.6万亿美元），即每个受影响的儿童或青少年终身损失250万人民币（35万美元）。在全国范围内实施所有五项干预措施将避免1.794亿DALYs，并在模型队列的生命周期内带来13.1万亿人民币的收益。实施财政和监管政策的投资回报率最高，收益在实施后至少10年才会显现。扩大中国目前基于学校的干预措施规模可为中国带来显著的健康和经济收益，然而，投资回报率低于其他模拟干预措施。
有效预防和治疗儿童和青少年OAO对中国的健康和经济发展至关重要。多种干预措施提供了一种综合方法，以应对增加儿童和青少年OAO风险的各种因素。尽管如此，财政和监管政策带来的健康和经济收益最大。
由联合国儿童基金会中国办事处提供资金。
