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Kotsopoulos N, Connolly MP. Assessing the Fiscal Burden of Obesity in Canada by Applying a Public Economic Framework. Adv Ther 2024; 41:379-390. [PMID: 37979088 PMCID: PMC10796418 DOI: 10.1007/s12325-023-02718-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Rising obesity prevalence is a health priority for many governments because of its impact on population health and economic consequences. We sought to estimate the broader consequences of obesity in Canada by applying a government perspective framework that captures lost tax revenues and increased government spending on social benefit programs. METHODS An age-specific prevalence-based model was built to quantify the fiscal burden of disease for government attributed to people living with obesity. The model was populated with age-specific wages, employment activity and government benefits received to estimate taxes and transfer costs. A targeted literature search was conducted to identify modifiers of employment status, wages and disability status attributed to people with obesity, and applied to employment and epidemiological projections which enabled us to estimate government costs and tax losses. Government tax revenue and costs attributed to obesity were projected over a 10-year period and discounted at 3%. RESULTS The fiscal burden of obesity in Canada is estimated at CAD$22,974 million (2021). This figure consists of obesity-attributed revenue losses of CAD$9404 million from direct taxes due to decreased employment activity and CAD$2374 million from indirect tax revenue losses due to reduced consumption taxes. Healthcare costs are estimated at CAD$7881 million annually and disability costs of CAD$3686 million annually. This fiscal burden of disease distributed amongst taxpayers in 2021 is estimated to be CAD$752 per capita. We estimate for every 1% reduction in obesity prevalence, CAD$229.7 million net fiscal gains can be achieved annually. CONCLUSIONS Obesity is associated with substantial clinical and economic burden not only to the healthcare system but also to wider government budgets as demonstrated using fiscal analysis. Reductions in obesity prevalence are likely to have positive fiscal gains for government from reduced spending on public benefits and increased tax revenue attributed to employment changes.
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Affiliation(s)
- Nikos Kotsopoulos
- Global Market Access Solutions Sarl, Health Economics Unit, 1162, St-Prex, Switzerland
- University of Athens MBA, University of Athens, Athens, Greece
| | - Mark P Connolly
- Global Market Access Solutions Sarl, Health Economics Unit, 1162, St-Prex, Switzerland.
- University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
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Pekkurnaz D. Causal effect of obesity on the probability of employment in women in Turkey. ECONOMICS AND HUMAN BIOLOGY 2023; 51:101301. [PMID: 37651829 DOI: 10.1016/j.ehb.2023.101301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/11/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
This study aims to investigate the causal effect of obesity on the employment probability of women in Turkey via the instrumental variable approach by using data from the 2018 Turkey and Demographic Health Survey. Obesity prevalence in the area of living and the overweight status of the oldest child, which are the most common types of instruments seen in the literature, are used as instruments. Consistent with the OLS result, the 2SLS estimate indicates that obese women are statistically significantly less likely to be employed when the overweight status of the child is used as an instrument. On the other hand, the statistically significant effect of obesity disappears when the area level obesity prevalence is used as the instrument. In addition, obesity in women decreases the likelihood of employment in the services sector and full-time jobs and employment with social security. Although the results of this study do not indicate the source of the effect found, the presence of a causal relationship for women should not be ignored when the economic burden of obesity for Turkey is considered.
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Affiliation(s)
- Didem Pekkurnaz
- Başkent University, Faculty of Economics and Administrative Sciences, Department of Economics, Bağlıca Campus, Fatih Sultan Mahallesi, Eskişehir Yolu 18. Km, Etimesgut, 06790 Ankara, Turkey.
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Jemna DV, David M, Depret MH, Ancelot L. Physical activity and healthcare utilization in France: evidence from the European Health Interview Survey (EHIS) 2014. BMC Public Health 2022; 22:1355. [PMID: 35840906 PMCID: PMC9288017 DOI: 10.1186/s12889-022-13479-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/18/2022] [Indexed: 12/27/2022] Open
Abstract
Background A growing need and focus on preventing and controlling the diseases and promoting a healthier lifestyle is more evident at global, regional, and national levels. In this respect, it is well-known the positive association between physical activity and population’s health, but also its negative association with the demand of healthcare, which could lead to lower spending on healthcare systems. In France, a lack of physical activity, a high prevalence of sedentary behaviours, and a continuous deterioration of these behaviours are observed since 2006. Therefore, promoting and increasing physical activities could contribute to major societal issues. Within this context, the study aims to analyse how the use of different healthcare services are related to physical activity in a nationally representative sample of French population. Methods The data used was retrieved from the second wave of the EHIS-ESPS 2014. The relationship between physical activity and healthcare utilization, controlled by a set of socioeconomic, demographic, and health behaviour factors, was explored both at the level of the entire population and separately for two age groups (less than 65 years, 65 years and older), employing probit and recursive multivariate probit models. Results Our findings underline that the relation between healthcare utilization and physical activity depends on the type of healthcare services and age group. In this respect, only among adult respondents, we observe a significant negative association between physical activity and prescribed medicines consumption and day hospitalization, while preventive services use is positively related to physical activity. Common to both age groups, the positive association of physical activity with general physician services and non-prescribed medicines reveal that moderately and highly active adults and elders may be more health conscious and therefore may seek referrals to generalist and other prevention measures more frequently than their inactive counterparts. This explanation is also sustained by the negative association between physical activity and overnight hospitalization or home healthcare services. Conclusions This study highlights the double role of physical activity on health as preventive measure and treatment and thus support the implementation of public health policies aimed at increasing the level of physical activity in French population. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13479-0.
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Affiliation(s)
- Dănuț-Vasile Jemna
- Faculty of Economics and Business Administration, "Alexandru Ioan Cuza" University of Iași, Iași, Romania
| | - Mihaela David
- "Gh. Zane" Institute for Economic and Social Research - Romanian Academy, Iași Branch; "Alexandru Ioan Cuza" University of Iași, Iași, Romania.
| | - Marc-Hubert Depret
- Centre de Recherche sur l'Intégration Economique et Financière, Institut des Risques Industriels, Assurantiels et Financiers, University of Poitiers, Poitiers, France
| | - Lydie Ancelot
- Centre de Recherche sur l'Intégration Economique et Financière, Institut des Risques Industriels, Assurantiels et Financiers, University of Poitiers, Poitiers, France
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Li P, Chen X, Stafford F, Ou J. Body shape and stable employment opportunity analysis of China's nonagricultural labor market. SSM Popul Health 2022; 17:101014. [PMID: 35024421 PMCID: PMC8733337 DOI: 10.1016/j.ssmph.2021.101014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/11/2021] [Accepted: 12/20/2021] [Indexed: 10/31/2022] Open
Abstract
Based on the integrated data of the China General Social Survey (CGSS) from 2010 to 2017, this study observes that body shape - being overweight or underweight - is important for labor market outcomes. Body shape significantly affects the employment opportunities of Chinese individuals, and this effect differs by gender and across the occupational hierarchy. Women face both slim premium and obesity penalty effects. Slim women, those with normal and lower but not excessively lower body weight, are more likely to gain long-term employment contracts in the labor market, while the opposite is observed for overweight individuals. The relationship between women's body shape and employment opportunities also varies by occupation. The obesity penalty is more pronounced in occupations with a higher International Socio-Economic Index (ISEI), while the slim premium is more evident in occupations with a low ISEI. The results suggest that the Chinese labor market is highly demanding regarding women's figures, while it is relatively tolerant of men's figures. By mechanism analysis, health capital is found to be the leading cause of the body shape effect. In addition, socialization is also a possible pathway of action. This paper has extended implications for the study of stature and employment stability, enriching the empirical research on labor market discrimination.
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Affiliation(s)
- Ping Li
- Associate Professor of Economics, School of Economics and Management, South China Normal University, Guangzhou, 510006, China
| | - Xiaozhou Chen
- Associate Professor of Economics, School of Business Administration, Guangdong University of Finance, Guangzhou, 510006, China
| | - Frank Stafford
- Professor of Economics, Department of Economics and Institute for Social Research, University of Michigan, Ann arbor, Michigan, 48108, United States
| | - Jinyun Ou
- Ph.D. Candidate, School of Economics and Management, South China Normal University, Guangzhou, 510006, China
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Campbell DD, Green M, Davies N, Demou E, Ward J, Howe LD, Harrison S, Johnston KJA, Strawbridge RJ, Popham F, Smith DJ, Munafò MR, Katikireddi SV. Effects of increased body mass index on employment status: a Mendelian randomisation study. Int J Obes (Lond) 2021; 45:1790-1801. [PMID: 34158612 PMCID: PMC8310793 DOI: 10.1038/s41366-021-00846-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 02/26/2021] [Accepted: 04/27/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The obesity epidemic may have substantial implications for the global workforce, including causal effects on employment, but clear evidence is lacking. Obesity may prevent people from being in paid work through poor health or through social discrimination. We studied genetic variants robustly associated with body mass index (BMI) to investigate its causal effects on employment. DATASET/METHODS White UK ethnicity participants of working age (men 40-64 years, women 40-59 years), with suitable genetic data were selected in the UK Biobank study (N = 230,791). Employment status was categorised in two ways: first, contrasting being in paid employment with any other status; and second, contrasting being in paid employment with sickness/disability, unemployment, early retirement and caring for home/family. Socioeconomic indicators also investigated were hours worked, household income, educational attainment and Townsend deprivation index (TDI). We conducted observational and two-sample Mendelian randomisation (MR) analyses to investigate the effect of increased BMI on employment-related outcomes. RESULTS Regressions showed BMI associated with all the employment-related outcomes investigated. MR analyses provided evidence for higher BMI causing increased risk of sickness/disability (OR 1.08, 95% CI 1.04, 1.11, per 1 Kg/m2 BMI increase) and decreased caring for home/family (OR 0.96, 95% CI 0.93, 0.99), higher TDI (Beta 0.038, 95% CI 0.018, 0.059), and lower household income (OR 0.98, 95% CI 0.96, 0.99). In contrast, MR provided evidence for no causal effect of BMI on unemployment, early retirement, non-employment, hours worked or educational attainment. There was little evidence for causal effects differing by sex or age. Robustness tests yielded consistent results. DISCUSSION BMI appears to exert a causal effect on employment status, largely by affecting an individual's health rather than through increased unemployment arising from social discrimination. The obesity epidemic may be contributing to increased worklessness and therefore could impose a substantial societal burden.
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Affiliation(s)
- Desmond D. Campbell
- grid.8756.c0000 0001 2193 314XMRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Michael Green
- grid.8756.c0000 0001 2193 314XMRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Neil Davies
- grid.5337.20000 0004 1936 7603MRC Integrative Epidemiology Unit at the University of Bristol, Population Health Sciences, University of Bristol, Bristol, UK ,grid.5947.f0000 0001 1516 2393K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Evangelia Demou
- grid.8756.c0000 0001 2193 314XMRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Joey Ward
- grid.8756.c0000 0001 2193 314XMental Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Laura D. Howe
- grid.5337.20000 0004 1936 7603MRC Integrative Epidemiology Unit at the University of Bristol, Population Health Sciences, University of Bristol, Bristol, UK
| | - Sean Harrison
- grid.5337.20000 0004 1936 7603MRC Integrative Epidemiology Unit at the University of Bristol, Population Health Sciences, University of Bristol, Bristol, UK
| | - Keira J. A. Johnston
- grid.8756.c0000 0001 2193 314XMental Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Rona J. Strawbridge
- grid.8756.c0000 0001 2193 314XMental Health & Wellbeing, University of Glasgow, Glasgow, UK ,Health Data Research, Glasgow, UK ,grid.4714.60000 0004 1937 0626Cardiovascular Medicine, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Frank Popham
- grid.8756.c0000 0001 2193 314XMRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Daniel J. Smith
- grid.8756.c0000 0001 2193 314XMental Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Marcus R. Munafò
- grid.5337.20000 0004 1936 7603MRC Integrative Epidemiology Unit at the University of Bristol, Population Health Sciences, University of Bristol, Bristol, UK ,grid.5337.20000 0004 1936 7603School of Psychological Science, University of Bristol, Bristol, UK
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