London School of Hygiene & Tropical Medicine

Proposals designed to prevent non-communicable diseases (NCDs) such as “fat taxes” will have wide-ranging effects on the economy and health but wider research is needed to avoid wasting resources on ineffective measures.

Writing in Science, Professor Richard Smith says that effective prevention of the increasing problem of NCDs will require changes in how we live our lives. 

This will in turn lead to significant economic changes across populations, industries and countries. 

But unless evidence is provided about who and what is positively or negatively affected, it is impossible to know which policies will benefit both economies and health.

He calls for global studies concerning the whole economy and suggests lessons should be learned from infectious diseases such as AIDS where clear demonstration of the overall economic impact played a key role in securing funding initiatives at the highest level.

With increasing numbers of people in the developed and developing world suffering from ill health associated with both genetic and lifestyle factors, the problem is more than just a medical concern.

NCDs affect the economy “profoundly and pervasively” and using the example of Liverpool Football Club manager Bill Shankly who said football was “not just a matter of life and death, it’s more important than that”, Professor Smith claims that for economists so are NCDs.

The target set at the 65th World Health Assembly to reduce premature deaths from NCDs by 25% by 2025 adds to the urgency and there is a growing swell of opinion about the importance of tackling the problem. The School’s Centre for Global Non-Communicable Diseases is just one example of a high-level response to the worldwide call for action.

Purely micro-economic approaches will not work, however, Prof Smith argues. Prices are “pivotal” for economics and this concept provides the logic for the current enthusiasm for the introduction (already implemented in Denmark and Hungary) of a “fat tax” to reduce consumption of foods high in saturated fat by increasing their price through tax.

But Prof Smith sets out the various potential effects of such a mechanism which have not been analysed such as the alternative products consumers might turn to instead and changes in farming practices.

According to the paper, there is a major gap in knowledge about the “macro-economic” big picture perspective which needs to be filled before society-wide NCD prevention can move forward.

He writes: “A food tax will affect the risk of NCDs in an unpredictable manner as it begins to indirectly influence other sectors in the national economy and interface with the rest of the world.

“If the net effect is to increase health, then this should feed positively into the economy itself, by reducing healthcare costs and by improving workforce productivity. However, we do not know that this will be the effect, because we do not consider the broader macro-economic picture.”

Professor Neil Pearce, Director of the School's Centre for Global NCDs, said: "This paper adds to the evidence that prevention and control of NCDs globally will not only require macro-level policies, but will also have macro-level effects."