Healthy Nutrition: preventing nutrition-related diseases in Europe

Health economists have been active in the field of health care for decades but have contributed much less tQ the field of health and its promotion. Cohen and Henderson seek to remedy this defect in this book by demonstrating that the techniques of economic evaluation can be applied to show which forms of health promotion are "good value for money" or cost effective, and which forms of health promotion are a waste of scarce economic resources. Such evaluative activities may frustrate the disbeliever and enthuse the advocate by informing the process of policy choice with the best facts available concerning what is given up (costs) and what is gained (enhancement in the length and quality of life). The book is divided into 11 chapters and is complemented with a list of references and author and subject indexes. The first chapter offers definitions of health, prevention and economics. Economics is the science of how people choose to allocate scarce resources amongst competing ends. Illness is a state of physical, social and psychological malfunctioning and prevention policies seek to alter the time profile of such states. The second chapter is the only macro element in the book and explores health-wealth relationships across countries. The authors offer a tentative conclusion that unemployment produces increased ill health and that successful prevention policies could produce new burdens for society. The latter conclusion seems somewhat dated: given the demography of the 1990s, prevention policies which reduce work absence and enable people to defer retirement will produce valuable supplies of scarce labour. In the third chapter the relevance of basic concepts such as supply (seller), demand (buyers), a market (a network of buyers and sellers), market failure and the need for government intervention are explored. The basic characteristics of economic evaluation are set out in chapter 4. Whilst this is comprehensive it is a little thin on the technique of cost utility analysis but this defect is remedied somewhat later (eg, p 98). A series of case studies in primary prevention (ie, measures to prevent the onset of ill health and injury) and secondary prevention (ie, measures to protect presymptomatic disease) are analysed in chapters 5 and 6 respectively. The nature of the common methodological problems encountered in such studies is examined in chapter 7 and a guide to good practice is offered. In chapter 8 the topics ofdemand and consumption are explored. The authors summarise the data on the demand elasticities for alcohol and tobacco pre-1986 comprehensively, citing HM Treasury estimates from 1980 which have been revised subsequently. The subject of demand is extended in chapter 9 where the familiar Grossman model is described. This demand for a health model has been developed by a variety of authors and Cohen and Henderson here seek to offer further innovations, in particular the concept of "utility in anticipation". In the penultimate chapter the gains of prevention policy are described, as is the potential for avoiding losses of productivity in the labour force due to illness. The small outlays on health promotion in the UK are set out. The final chapter examines the contribution of health economics to the promotion of prevention activities in the health field. The authors emphasise the usefulness of economics in providing an explicit framework in which the costs and benefits of competing policies can be appraised. Whilst some of the content of this book shows its age (eg, the discussion of breast cancer screening ignores the Forrest Report and the subsequent debate about the cost-QALYs to be achieved from this intervention), the techniques are set out comprehensively and lucidly to provide a much needed introduction to the economic approach to illness prevention and health promotion. If those in community medicine and other areas ofhealth services research read this volume, they will gain much which will facilitate the cost effective expansion of health promotion policies. Much rubbish has been written about health promotion and illness prevention. Cohen and Henderson demonstrate ably how economics can be used to sift the wheat from the chaff and "confuse" policy making in this important area with facts.