Given the health benefits of eliminating meat and dairy consumption, I’ve often wondered whether a public health campaign around diet, similar to those performed historically around the world for tobacco and other damaging substances, could result in a net positive for a society. The rationale is that the costs, presumably spent by a government, would be outweighed by the gain from the reduced public health burden. Here I’ve attempted a simple estimate of this. There is already a vast body of research available for the health benefits of a plant based, whole foods diet, and so I haven’t spent too long on this.
90% of all deaths in Australia in 2011 were the result of chronic disease according to the Institute of Health and Wellness. 50% of the Australian population has at least 1 chronic disease, and 20% have 2 or more. Populations with a diet full of plant based food have a lower blood pressure, lower risk of type 2 diabetes, and a lower risk of death from cardiovascular disease (CVD). A plant based diet can even prevent and reverse erectile dysfunction. Diet related issues in 2010 contributed to the burden of disease in the US more than smoking, high blood pressure and high blood sugar.
From 2004-2005 total health expenditure in Australia was $81.1 billion, $52.7 of which is attributable to specific disease categories. 29% of this expenditure was through admitted patient hospital services, 16% of out-of-hospital medical services, 11% for prescription pharmaceuticals and 7% for optometry and dental services. CVD accounted for $5.942 billion alone.
Given such high costs to society from chronic diseases that are treatable through dietary changes, might it be reasonable to assume that a public health campaign focused on diet, similar to the campaign against smoking, could yield significant returns to the government and a tax payer? Several similar campaigns have existed (e.g. Shape Up Australia), though these have lacked the focus and intensity the anti-smoking campaigns had. To determine whether this might be reasonable may take a major study. But we can take a series of assumptions, applying a worst case scenario for each, to estimate the costs and returns of such a campaign.
If we assumed that the only cost to society of chronic disease is the cost to public health, and the only chronic disease related to diet is CVD, then there is a cost of $5.942 billion. The first assumption here isn’t true, as chronic disease leads to decreased productivity and lost time in the workforce. Let’s assume now that only 50% of CVD can be treated through dietary changes (this is not true, and in fact almost all cases of CVD are treatable through diet change – see the end of this piece for a full list of related references). Therefore $2.971 billion of the cost from CVD can be eliminated.
The next step is to ask how much a public health campaign around diet might cost. A campaign that covered Sydney and Melbourne from 1983 to 1987 cost $620,000 ($1,560,700 in 2015 dollars) for the media and a ‘Quit Centre’ in Sydney. The population of Sydney in 1986 was 3,472,000. Assuming, accounting for inflation, that it costs the same to provide similar services per person today it would cost $10,768,800 to implement a national program for 4 years (population of 23,958,000 today, which is 6.9 times higher than the population of Sydney in 1986, so the cost is multiplied by 6.9). Again, this is likely conservative as it assumes there is no benefit from economies of scale in reaching the entire nation compared to just one city.
Now we can ask how effective such a campaign might be. The pilot anti-smoking campaign in Sydney and Melbourne immediately reduced smoking prevalence by 2.6%, and by a further 0.75% each consecutive year. Note that these percentages refer to the drop in smoking prevalence of the entire population, not just the smokers, which were around 38% of the population in Sydney before the campaign. As the percentage of people who don’t eat a plant-based whole food diet in Australia is significantly higher (over 90%), this estimate is even more conservative. We might assume that the dietary campaign would only be 50% as effective as the anti-smoking campaign, which is conservative as smoking is addictive and harder to quit than dietary practices. So we have a campaign that we estimate will reduce poor dietary practices by 1% immediately and an additional 0.375% each year. Going back to our figure of $2.971 billion for treatable CVD, we get an initial benefit of $29.71 million, with an ongoing benefit of $11.14 million per year. After 4 years, this results in a total benefit of $82.36 million for a cost of $10.77 million. This is a return on investment of over 7 times even with the generous assumptions.
The figures for cost and effectiveness of the anti-smoking campaign used here are around the same order as similar programs undertaken in USA from 1989 to 1996. This assumes that the reduction in smoking from the Sydney and Melbourne campaigns are entirely attributable to the campaign, though this assumption is supported by the data.
The estimates presented here are relatively rough, but given the generous assumptions made, it is clear that a detailed study on the costs and benefits of such a program is long overdue, and that it’s time to have a conversation about implementing a public health campaign that advocates for a plant-based, whole food diet.
The road to such a campaign is expected to be long, as Australia’s peak body for health advice and medical research, NHMRC, still recommends meat and dairy consumption as part of a healthy diet despite evidence otherwise. However, given the great expected reduction in Australia’s public health burden and the other benefits of it being significantly better for the environment (the livestock industry is responsible for the most greenhouse gas emissions of any sector) and drastically reducing unnecessary animal suffering, it is a cause worth promoting.
The last two points I have covered previously here.
Thanks to Micaela Karlsen for providing references, working with me and reading early drafts of this work.
References
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Esselstyn CB, Jr., Favaloro RG. “More than coronary artery disease.” [In eng]. Am J Cardiol 82, no. 10B (Nov 26 1998): 5T-9T.
Esselstyn CB, Jr. “Changing the treatment paradigm for coronary artery disease.” [In eng]. Am J Cardiol 82, no. 10B (Nov 26 1998): 2T-4T.
Esselstyn CB, Jr. “Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology).” [In eng]. Am J Cardiol 84, no. 3 (Aug 1 1999): 339-341, A338.
Esselstyn CB, Jr. “In cholesterol lowering, moderation kills.” Cleveland Clinic journal of medicine 67, no. 8 (Aug 2000): 560-564.
Esselstyn CB, Jr. “Resolving the Coronary Artery Disease Epidemic Through Plant-Based Nutrition.” Preventive cardiology 4, no. 4 (Autumn 2001): 171-177.
Esselstyn CB, Jr. “Is the present therapy for coronary artery disease the radical mastectomy of the twenty-first century?” [In eng]. Am J Cardiol 106, no. 6 (Sep 15 2010): 902-904.
Ornish D, Scherwitz LW, Billings JH, et al. “Intensive lifestyle changes for reversal of coronary heart disease.” [In eng]. Jama 280, no. 23 (Dec 16 1998): 2001-2007.