Economic evaluation of nutrition policy Or, there's no such thing as a free lunch

The good news from prevention research is that it appears possible to dramatically improve health in the US by changing identified risk factors. The goal of this paper is to discuss how to evaluate the economic consequences of improvements in nutrition- and exercise-related health. Cost-benefit analysis and the related tools of cost-effectiveness analysis and cost-utility analysis are proposed as preferred methods. The decision rule is simply if the sum of the potential gains to all those affected by a policy intervention exceed the sum of costs, there is a potential gain in societal welfare. By this standard, preventive interventions can be worthwhile even when they do not reduce lifetime medical expenditures or increase lifetime earnings, that is, even when the intervention is not a 'free lunch.' The distinction between the internal costs for an individual patient versus the external costs an individuals illness imposes on other is an important conceptual issue. Practical issues include determining whether a poor health habit causes the costs and other results being attributed to it, and the completeness of thr analysis. In principle, the analysis should examine all of the effects and resource costs of the intervention, including changes in morbidity, mortality, the quality of life, allocations of patient time and caregiving by others, as well as traditional health sector costs and changes in productivity. Improvements in nutrition- and exercise-related health may also have important implications for public sector finances of programs, including Medicare and Social Security. (C) 1999 Published by Elsevier Science Ltd, All rights reserved.