Health and nutritional aspects of sustainable diet strategies and their association with environmental impacts: a global modelling analysis with country-level detail

Region-specific nutritious, environmentally friendly, and affordable diets in India

The premature cancer mortality rate has been declining in Canada, but there has been considerable variation in the rate of decline across cancer sites. I analyze the effect that pharmaceutical innovation had on premature cancer mortality in Canada during the period 2000–2011, by investigating whether the cancer sites that experienced more pharmaceutical innovation had larger declines in the premature mortality rate, controlling for changes in the incidence rate. Premature mortality before age 75 is significantly inversely related to the cumulative number of drugs registered at least 10 years earlier. Since mean utilization of drugs that have been marketed for less than 10 years is only one-sixth as great as mean utilization of drugs that have been marketed for at least a decade, it is not surprising that premature mortality is strongly inversely related only to the cumulative number of drugs that had been registered at least ten years earlier. Premature mortality before age 65 and 55 is also strongly inversely related to the cumulative number of drugs that had been registered at least ten years earlier. None of the estimates of the effect of incidence on mortality are statistically significant. Controlling for the cumulative number of drugs, the cumulative number of chemical subgroups does not have a statistically significant effect on premature mortality. This suggests that drugs (chemical substances) within the same class (chemical subgroup) are not therapeutically equivalent. During the period 2000–2011, the premature (before age 75) cancer mortality rate declined by about 9 %. The estimates imply that, in the absence of pharmaceutical innovation during the period 1985–1996, the premature cancer mortality rate would have increased about 12 % during the period 2000–2011. A substantial decline in the “competing risk” of death from cardiovascular disease could account for this. The estimates imply that pharmaceutical innovation during the period 1985–1996 reduced the number of years of potential life lost to cancer before age 75 in 2011 by 105,366. The cost per life-year before age 75 gained from previous pharmaceutical innovation is estimated to have been 2730 USD. Most of the previously-registered drugs were off-patent by 2011, but evidence suggests that, even if these drugs had been sold at branded rather than generic prices, the cost per life-year gained would have been below 11,000 USD, a figure well below even the lowest estimates of the value of a life-year gained. The largest reductions in premature mortality occur at least a decade after drugs are registered, when their utilization increases significantly. This suggests that, if Canada is to obtain substantial additional reductions in premature cancer mortality in the future (a decade or more from now) at a modest cost, pharmaceutical innovation (registration of new drugs) is needed today.Electronic supplementary materialThe online version of this article (doi:10.1007/s10754-015-9172-2) contains supplementary material, which is available to authorized users.

The premature cancer mortality rate has been declining in Switzerland, but there has been considerable variation in the rate of decline across cancer sites (e.g., breast or digestive organs). I analyze the effect that pharmaceutical innovation had on premature cancer mortality in Switzerland during the period 1995-2012 by investigating whether the cancer sites that experienced more pharmaceutical innovation had larger declines in premature mortality, controlling for the number of people diagnosed and mean age at diagnosis. Premature cancer mortality before ages 75 and 65 is significantly inversely related to the cumulative number of drugs registered 5, 10, and 15 years earlier. The number of drugs registered during 1980-1997 explains 63% of the variation across cancer sites in the 1995-2012 log change in the premature (before age 75) mortality rate. Controlling for the cumulative number of drugs, the cumulative number of chemical subgroups does not have a statistically significant effect on premature mortality. This suggests that drugs (chemical substances) within the same class (chemical subgroup) are not "therapeutically equivalent". Over 17,000 life-years before age 75 were gained in 2012 due to drugs registered during 1990-2007. The number of life-years before age 75 gained in 2012 from drugs registered during two earlier periods (1985-2002 and 1980-1997) were more than twice as great. Since mean utilization of new drugs is much lower than mean utilization of older drugs, more recent drug registrations may have a smaller effect on premature mortality than earlier drug registrations even if the average quality of newer drugs is higher. Estimates of the cost per life-year gained before ages 75 and 65 in 2012 from drugs registered during 1990-2007 are $21,228 and $28,673, respectively. These figures are below even the lowest estimates from the value-of-life literature of the value of a quality-adjusted life-year. The estimates indicate that the cost per life-year before age 75 gained from drugs registered during earlier periods (1985-2002 and 1980-1997) were considerably lower: $5299 and $3218, respectively. The largest reductions in premature mortality occur at least a decade after drugs are registered, when their utilization increases significantly. This suggests that if Switzerland is to obtain substantial additional reductions in premature cancer mortality in the future (a decade or more from now) at a modest cost, pharmaceutical innovation (registration of new drugs) is needed today.

ObjectiveTo analyse the health and environmental implications of adopting national food based dietary guidelines (FBDGs) at a national level and compared with global health and environmental targets.DesignModelling study.Setting85 countries.ParticipantsPopulation of...

Cancer mortality declined in Belgium during the period 2004-2012, but there was considerable variation in the rate of decline across cancer sites (breast, lung, etc.). I analyze the effect that pharmaceutical innovation had on cancer mortality in Belgium, by investigating whether the cancer sites that experienced more pharmaceutical innovation had larger subsequent declines in mortality, controlling for changes in cancer incidence. The measures of mortality analyzed - premature (before ages 75 and 65) mortality rates and mean age at death - are not subject to lead-time bias. Premature cancer mortality rates are significantly inversely related to the cumulative number of drugs registered 15-23 years earlier. Since mean utilization of drugs that have been marketed for less than 10 years is less than one fourth as great as mean utilization of drugs that have been marketed for at least a decade, it is not surprising that premature mortality is strongly inversely related only to the cumulative number of drugs that had been registered at least 10 years earlier. Drugs registered during the period 1987-1995 are estimated to have reduced the premature cancer mortality rate in 2012 by 20%. Mean age at death from cancer increased by 1.17 years between 2004 and 2012. The estimates indicate that drugs registered during the period 1987-1995 increased mean age at death from cancer in 2012 by 1.52 years. The estimates also suggest that drugs (chemical substances) within the same class (chemical subgroup) are not "therapeutically equivalent," i.e. they do not have essentially the same effect in the treatment of a disease or condition. The estimates imply that the drugs registered during 1987-1995 reduced the number of life-years lost to cancer at all ages in 2012 by 41,207. The estimated cost per-life-year gained in 2012 from cancer drugs registered in Belgium during the period 1987-1995 was €1311. This estimate is well below even the lowest estimates from other studies of the value of a life-year saved. The largest reductions in premature mortality occur 15-23 years after drugs are registered, when their utilization increases significantly. This suggests that, if Belgium is to obtain substantial additional reductions in premature cancer mortality in the future (15 or more years from now) at a modest cost, pharmaceutical innovation (registration of new drugs) is needed today.

Achieving historic reductions in global cardiovascular disease (CVD) mortality will require attention to detail in 4 areas: a clear understanding of current trends in CVD mortality, an appreciation of what has influenced positive trends in CVD mortality, a knowledge of which interventions are cost-effective, and an ability to scale the interventions. Globally, CVD mortality has increased,1 but this statistic belies significant successes that have already occurred. Although CVD mortality overall has increased, the reasons require a devil is in the details look at various trends that give us this summary statistic.2 First, the world population is aging in part because of our successes in managing many of the challenges of previous centuries, including improved control of infectious diseases and increased food supplies to the starving. Second, the overall world population is growing. Third, we have recently developed and implemented successful solutions to control more recent afflictions, such as HIV/AIDS. Article see p 541 A better statistic for evaluating success than total mortality is age-adjusted mortality where we have also seen tremendous reductions in age-adjusted CVD mortality. Recent estimates suggest that age-standardized death rates because of ischemic heart disease dropped from over 200 per 100 000 to 300 per 100 000 to nearly 100 per 100 000 over the same time frame. In comparison, less dramatic declines occurred in most other countries and even increases in age-adjusted ischemic heart disease mortality occurred in some Latin American and many Eastern European countries, such as Russia. With such varying experiences in age-adjusted mortality rates, …

SummaryBackgroundAdoption of healthy and sustainable diets could be essential for safe-guarding the Earth's natural resources and reducing diet-related mortality, but their adoption could be hampered if such diets proved to be more expensive and unaffordable for some populations. Therefore, we aimed to estimate the costs of healthy and sustainable diets around the world.MethodsIn this modelling study, we used regionally comparable food prices from the International Comparison Program for 150 countries. We paired those prices with estimates of food demand for different dietary patterns that, in modelling studies, have been associated with reductions in premature mortality and environmental resource demand, including nutritionally balanced flexitarian, pescatarian, vegetarian, and vegan diets. We used estimates of food waste and projections of food demand and prices to specify food system and socioeconomic change scenarios up to 2050. In the full cost accounting, we estimated diet-related health-care costs by pairing a comparative risk assessment of dietary risks with cost-of-illness estimates, and we estimated climate change costs by pairing the diet scenarios with greenhouse gas emission footprints and estimates of the social cost of carbon.FindingsCompared with the cost of current diets, the healthy and sustainable dietary patterns were, depending on the pattern, up to 22–34% lower in cost in upper-middle-income to high-income countries on average (when considering statistical means), but at least 18–29% more expensive in lower-middle-income to low-income countries. Reductions in food waste, a favourable socioeconomic development scenario, and a fuller cost accounting that included the diet-related costs of climate change and health care in the cost of diets increased the affordability of the dietary patterns in our future projections. When these measures were combined, the healthy and sustainable dietary patterns were up to 25–29% lower in cost in low-income to lower-middle-income countries, and up to 37% lower in cost on average, for the year 2050. Variants of vegetarian and vegan dietary patterns were generally most affordable, and pescatarian diets were least affordable.InterpretationIn high-income and upper-middle-income countries, dietary change interventions that incentivise adoption of healthy and sustainable diets can help consumers in those countries reduce costs while, at the same time, contribute to fulfilling national climate change commitments and reduce public health spending. In low-income and lower-middle-income countries, healthy and sustainable diets are substantially less costly than western diets and can also be cost-competitive in the medium-to-long term, subject to beneficial socioeconomic development and reductions in food waste. A fuller accounting of the costs of diets would make healthy and sustainable diets the least costly option in most countries in the future.FundingGlobal Panel on Agriculture and Food Systems for Nutrition and Wellcome Trust.

Current global health policy goals include a 25% reduction in premature mortality from noncommunicable diseases by 2025. In this 2-part review, we provide an overview of the current epidemiological data on cardiovascular diseases (CVD), its risk factors, and describe strategies aimed at reducing its burden. In part 1, we examine the global epidemiology of cardiac conditions that have the greatest impact on CVD mortality; the predominant risk factors; and the impact of upstream, societal health determinants (eg, environmental factors, health policy, and health systems) on CVD. Although age-standardized mortality from CVD has decreased in many regions of the world, the absolute number of deaths continues to increase, with the majority now occurring in middle- and low-income countries. It is evident that multiple factors are causally related to CVD, including traditional individual level risk factors (mainly tobacco use, lipids, and elevated blood pressure) and societal level health determinants (eg, health systems, health policies, and barriers to CVD prevention and care). Both individual and societal risk factors vary considerably between different regions of the world and economic settings. However, reliable data to estimate CVD burden are lacking in many regions of the world, which hampers the establishment of nationwide prevention and management strategies. A 25% reduction in premature CVD mortality globally is feasible but will require better implementation of evidence-based policies (particularly tobacco control) and integrated health systems strategies that improve CVD prevention and management. In addition, there is a need for better health information to monitor progress and guide health policy decisions.

The environmental impact of Swedish diets was assessed for six indicators (greenhouse gas [GHG] emissions, cropland use, nitrogen application, phosphorus application, consumptive water use and extinction rate), using self-reported food intake within two population-based cohorts of men and women, 56–96 years of age. The dietary environmental impact was assessed in relation to per capita planetary boundaries, overall and by population subgroups, addressing the relative importance of specific foods and food groups. The total average dietary impact exceeded the planetary boundaries by 1.6 to 4-fold for five of the six environmental indicators; consumptive water use did not exceed the boundaries. Comparing the highest with lowest quintiles of the population impact showed >2.5-fold differences across all environmental indicators. Of the diet's total average environmental impact, animal-based, plant-based and discretionary foods accounted for 28–83%, 8–40% and 9–37%, respectively, across the six indicators. Animal-based foods dominated the impact on GHG emissions, cropland use and nitrogen and phosphorus application, while plant-based and discretionary foods contributed more to consumptive water use and extinction rate. Environmental impact was driven predominantly by consumption of red meat, dairy, fresh fruit and coffee. The findings show major challenges in affluent countries that have to be addressed to achieving sustainable food production systems and diets. They provide guidance on critical food groups, environmental indicators and population subgroups to prioritize in future efforts to reduce the environmental impact.

Premature mortality projection for cardiovascular diseases to 2030: a sub-national evaluation towards the SDG 3.4 goals in China.

BackgroundCardiovascular diseases (CVD) are the underlying cause 1.6 million deaths per year in the Americas, accounting for 30% of total mortality and 38% of by non-communicable deaths diseases (NCDs). A 25% reduction in premature mortality due four main NCDs was targeted by the 2011 High-level Meeting of the General Assembly on the Prevention and Control of NCDs. While overall CVD mortality fell in the Americas during the past decade, trends in premature CVD mortality during the same period have not been described, particularly in the countries of Latin America and the Caribbean.MethodsThis is a population-based trend-series study based on a total of 6,133,666 deaths to describe the trends and characteristics of premature mortality due to CVD and to estimates of the average annual percentage of change during the period 2000–2010 in the Americas.FindingsPremature mortality due to CVD in the Americas fell by 21% in the period 2000–2010 with a -2.5% average annual rate of change in the last 5 year—a statistically significant reduction of mortality—. Mortality from ischemic diseases, declined by 25% - 24% among men and 26% among women. Cerebrovascular diseases declined by 27% -26% among men and 28% among women. Guyana, Trinidad and Tobago, the Dominican Republic, Bahamas, and Brazil had CVD premature mortality rates over 200 per 100,000 population, while the average for the Region was 132.7. US and Canada will meet the 25% reduction target before 2025. Mexico, Costa Rica, Venezuela, Dominican Republic, Panama, Guyana, and El Salvador did not significantly reduce premature mortality among men and Guyana, the Dominican Republic, and Panama did not achieve the required annual reduction in women.ConclusionsTrends in premature mortality due to CVD observed in last decade in the Americas would indicate that if these trends continue, the Region as a whole and a majority of its countries will be able to reach the goal of a 25% relative reduction in premature mortality even before 2025.

At the UN climate change conference in Paris in November 2015, Norway committed itself to a 40% reduction in greenhouse gas (GHG) emissions by 2030 compared to 1990 levels. Agriculture accounts for 8% of Norway’s total GHG emissions. If GHGs from drained and cultivated wetland (categorized under land use, land use change and forestry) are included, the share is 13%; this for a sector that accounts for roughly 0.3% of GDP. As is the case in most countries, agriculture is currently exempt from emission reduction measures, including the European Union’s Emissions Trading System (ETS), in which Norway participates. But the country has recently signaled its intention to include agriculture in future emission reduction efforts. Consideration is being given to how best to achieve GHG reductions in the sector. A recent report by the Norwegian Green Tax Commission, established by the government to evaluate policy options for achieving emission reductions, (Government of Norway, 2015) emphasizes the importance of including agriculture. The Commission suggests that agricultural emissions should be taxed at the same rate as for other sectors. It also recommends that reductions in the production and consumption of red meat should be specifically targeted, through cuts in production grants to farmers and the imposition of consumption taxes. Unsurprisingly, this proposed policy shift is extremely controversial and faces resistance, particularly from the farmers’ unions. Farmers argue that the maintenance of domestic agricultural production is crucial for achieving national food security objectives, in addition to pursuing other aims such as the maintenance of economic activity in rural areas and landscape preservation. Food security, which has been a key policy objective since the end of the Second World War, has been interpreted in Norway as requiring high levels of selfsufficiency in basic agricultural commodities. To achieve this, substantial subsidies are provided to farmers and domestic prices of many commodities are kept at high levels by restricting imports. The Organization for Economic Cooperation and Development (OECD) estimates that the total financial support provided to Norwegian agriculture in 2015 was equivalent to 62% of the value of gross farm receipts, which made Norway (along with Switzerland) a leader in the amount of support provided to agriculture by the 50 OECD member and non-member countries monitored by the Organization (OECD, 2016). In this paper we analyze policy options for achieving a 40% reduction in agricultural GHG emissions, consistent with the economy-wide target, while imposing the restriction that national food production measured in calories should be maintained (the food security target). This is consistent with the way that the Norwegian government identifies the country’s food security objective. In section 2 we outline the current situation with respect to GHG emissions in Norwegian agriculture. In section 3 we illustrate the policy issues involved by considering two product aggregates that are intensive in the use of land for crop production (grainland) and grassland, respectively. The aggregates are based on data for the main commodities in Norwegian agriculture relating to GHG emissions, land use, caloric content, subsidies, and costs per unit of production. We show that even though the opportunity set (i.e., the production combinations that are possible within technical constraints) is narrow, a 40% cut in emissions is achievable by substituting from ruminant products that are intensive in the use of grassland to products based on grainland. We also show that the emissions reduction both reduces government budgetary costs and land use, i.e., ruminant products are characterized by relatively high subsidies and land use. Two-dimensional analysis ignores the fact that per unit emissions from dairy production are low compared to other ruminant products (i.e., beef and sheep production). Both in terms of production value and agricultural employment, dairy farming is the most important component of Norwegian agriculture. Consequently, milk production deserves to be separated from ruminant meat production. Finally in section 4, we present a detailed analysis 3 of policy options derived from a disaggregated model that includes all the major products in Norwegian agriculture. In the model-based analysis, we examine first the imposition of a carbon tax, while maintaining existing agricultural support policies and import protection, and achieving the food security (production of calories) target. Since the imposition of a carbon tax in agriculture presents both technical and political challenges, we then examine an alternative approach of changing the existing structure of agricultural support to approximate the same result. We show that it is possible to change current subsidy rates to mimic the carbon tax and calorie target solution. The explanation for this is that ruminant products not only generate high emissions per produced calorie, but they are also the most highly subsidized products. Meat from ruminants is relatively unimportant in achieving Norway’s food security objective of calorie availability.

The current Dutch diet fails to meet existing nutritional guidelines and exceeds the environmental boundaries as defined by the EAT-Lancet Commission. The purpose of this study is to model planet-based diets for the Netherlands for 2030 and 2050 that are in line with national dietary recommendations and within the planetary boundaries, as input for future Food-System Based Dietary Guidelines. Future Dutch planet-based diets were modelled using mathematical optimisation (Optimeal 3.0) with the most recent 2019–2021 food consumption survey for males and females (18–50 years) and the environmental impact database for Dutch foods (2024). Environmental impacts were adjusted to align with the planetary boundaries and incorporate forecasted improvements. Constraints were applied on nutrients and environmental impacts (greenhouse gas emissions in kg CO2eq/y, blue water use in m3/y, cropland use in hectares, phosphorus application and surplus nitrogen in kg/y). The ReCiPe 2016 endpoint indicator method was applied to calculate biodiversity loss related to diets (extinctions/ million species year). The optimised diets resulted in a significant reduction in meat, eggs, fats/oils, potatoes/tubers, and sugar/confectionery, and a significant increase in legumes, nuts/seeds, vegetables, fish, and meat replacers. In the optimised diets, 64% of total protein is plant-based substantial higher than the 43% in the current diet. These dietary changes led to a 65% lower impact on species richness loss and a diet within five planetary boundaries. A healthy and sustainable diet within the boundaries of one planet is possible, if we manage to reduce food waste, shift to more sustainable production methods, and change our diets. This study shows the urgent need for policymakers to take big steps in the five years leading up to 2030. The results of this study could contribute to more sustainable dietary guidelines and eating habits in the Netherlands and could be an example for other countries.

Dietary changes are required to mitigate the climatic impact of food consumption. Food consumption databases can support the development of sustainable food based dietary guidelines (SFBDG) when linked to environmental indicators. An improved knowledge base is crucial to the transition to sustainable diets, and multiple environmental indicators should be considered to ensure this transition is evidence based and accounts for trade-offs. The current study aimed to quantify the environmental impact of daily diets across population groups in Ireland. Nationally representative food consumption surveys for Irish children (NCFSII; 2017–2018), teenagers (NTFSII; 2019–2020), and adults (NANS; 2008–2010) were used in this analysis. Blue water use (L) and greenhouse gas emissions (GHGe; kgCO2eq) were assigned at food level to all surveys. Cropland (m2), nitrogen (kgN/t), and phosphorous use (kgP/t) were assigned at the agricultural level for adults. Multiple linear regressions, Spearman correlations, and ANCOVAs with Bonferroni corrections were conducted. Higher environmental impact diets were significantly associated with demographic factors such as age, education status, residential location, and sex, but these associations were not consistent across population groups. The median greenhouse gas emissions were 2.77, 2.93, and 4.31 kgCO2eq, and freshwater use per day was 88, 144, and 307 L for children, teenagers, and adults, respectively. The environmental impact of the Irish population exceeded the planetary boundary for GHGe by at least 148% for all population groups, however the boundary for blue water use was not exceeded. Meat and meat alternatives (27–44%); eggs, dairy, and dairy alternatives (15–21%); and starchy staples (10–20%) were the main contributors to GHGe. For blue water use, the highest contributors were meat and meat alternatives in children; savouries, snacks, nuts, and seeds in teenagers; and eggs, dairy, and dairy alternatives in adults (29–52%). In adults, cropland use, nitrogen use, and phosphorous use exceeded planetary boundaries by 277–382%. Meat, dairy, and grains were the main contributors to cropland, nitrogen, and phosphorous use (79–88%). The quantified environmental impact of Irish diets provides a baseline analysis, against which it will be possible to track progress towards sustainable diets, and the basis for the development of Sustainable Food Based Dietary Guidelines in Ireland.

Background The Sustainable Development Goal 3.4 has a target of 1/3 reduction in premature mortality (30-69 years) from chronic noncommunicable diseases. Although cancer is a chronic disease, it comprises more than 100 different conditions, with different risk factors and prognosis. This study aimed to calculate current and predicted premature mortality by 2030 for Brazil and regions, compare with SDG 3.4 target and identify regional progress and future needs. Methods Mortality data were extracted from the National Mortality Information System of Brazil (SIM) and subsequently corrected for ill-defined causes. Crude and age-standardized mortality rates per 100,000 inhabitants were calculated. NordPred package by software R was used to calculate predictions up to 2030 and compared with the goal of 1/3 reduction of premature deaths. Results Comparison of observed (2011-2015) and predicted (2016-2030) mortality rates show a 12.0% reduction in the likelihood of death among men and 4.6% among women nationally. Although predicted rates for 2026-2030 are lower than those observed in 2011-2015 predicted number of deaths increases by 75,341 for men and 90,513 for women. Lung cancer mortality rates are predicted to decrease more among men than women, while colorectal cancer mortality will increase for both sexes, in all regions (except in the Southeast). Conclusions The profile of premature cancer mortality is diverse in Brazil. Nationally, only male lung cancer will be close to reaching SDG 3.4 target, endorsing government's long-term efforts to reduce tobacco consumption. The increase in colorectal cancer mortality reflects the epidemiological transition. Despite progress in cervical cancer control, it will continue to be a major challenge. Our results provide a baseline for public policies for both prevention and access to treatment to reduce premature mortality in Brazil. Differences in mortality patterns highlight the need to adapt cancer prevention policies regionally. Key messages Cancer premature mortality decrease in Brazil is expected to occur, but far from the SDG 3.4 target – including preventable cancers as cervical cancer. An increase is expected to occur in colorectal premature cancer mortality rates and strategies to face it need to be developed regionally.