Nutrition and Coronary Heart Disease
5 DISCUSSION
Having presented the results in section 4 above, it is important to recognise some of the
issues that this project has raised. The following discussion explores these issues by
recognising the parameters of a Cost Effectiveness Analysis. The discussion includes
an examination of the different types of work undertaken by the SWSAHS Health
Promotion Unit, issues in effectiveness and evidence in the public health field, portfolio
theory and equity. This section provides a contextual framework to interpret the results
of this analysis more carefully.
Healthy Public Policy
Healthy public policy is an important part of the work of the SWSAHS (SWSAHS
1997). Healthy public policy can be divided into three categories: First, there is the
provision of information (not necessarily education). Second, there is regulation of
price and third, healthy public policy can aim to increase the availability of certain
foods (Rayner 1996).
Healthy public policy can have a large number of outcome measures. Examples include
changes in the availability of certain foods, inclination to buy certain foods, policy
statements, regulations, legislation and public opinion. Such outcome measures pose
three main problems for an economic analysis. First, an economic analysis requires a
direct link between the intermediate objective and the final objective. Second, the
outcome measure has to be quantifiable. Third, the major objective of an economic
analysis is to compare the costs of a program with its benefits. More specifically, these
costs and benefits are compared at the margin. Undertaking a marginal analysis for
healthy public policy would be very difficult. For example, quantifying the marginal
costs and benefits of lobbying local government officials would be conceptually
difficult.
This leaves the economist with a problem; the economic evaluation is now limited to
the analysis of only a small sub-group of all possible interventions. Namely, only those
interventions that have a quantifiable outcome measure.
The ‘healthy public policy’ outcomes listed above may be neither measurable, nor have
a direct link to our final objective. Nevertheless, ‘healthy public policy’ is undeniably
CHERE Project Report 11 - November 1999
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