Economic evaluation of potential fiscal strategies to improve Indigenous nutrition and health in remote communities of Australia. (#89)
The health status of Indigenous Australians is much lower than that of the non-Indigenous population, especially in life expectancy, diabetes and heart disease rates. Governments and numerous other stakeholders are committed to finding acceptable and sustainable ways to reduce these inequalities. There is growing evidence that taxes and discounts on food and beverages have the potential to positively influence consumption patterns, and thus improve population health outcomes.
To evaluate the impact on diet and lifetime health outcomes for remote Indigenous Australians and determine the cost-effectiveness of fiscal measures in community food stores.
Six price discount strategies (of 20%) on fruits, vegetables and reduced-calorie beverages and a 20% tax on sweetened beverages were modelled. Baseline population diet was determined from a 12 months sample of complete food supply data gathered in three remote Indigenous communities. Weight of the daily diet was assumed constant following the introduction of discounts. Published price elasticity data was applied to the Indigenous population.
Dietary change was converted to change in energy, salt intake, and Body Mass Index (BMI) over a 12 month period. Improved lifetime health outcomes, modelled for the entire remote Indigenous Australian population, were converted to disability adjusted life years (DALYs) using a proportional multistate lifetable model populated with diet-related disease risks and Indigenous rates of disease.
BMI changes were small; the changes in salt intake were larger. The incremental cost per DALY ranged from dominant (the tax strategy), very cost-effective ($AU21,000 [dominated to $480,000] the discount on water and diet beverages) to cost-ineffective ($AU69,000 [$50,000 to $91,000] the discount on vegetables), applying a $AU50,000 /DALY threshold.
Selective price discounts and taxes offer to improve Indigenous health. Verification by trial-based research is needed.