294 Diet and Health
looming as a serious concern. The growth of health expenditure is sometimes
higher than the growth of gross domestic product (GDP). Table 13.9 gives a break-
down of the direct and indirect costs for a number of key diet-related diseases in
the US; these costs are immense, even for such a rich society.
Health ministries, it appears, are locked in a model which tends to be curative
rather than preventative. The UK health care system, for instance, costs £68 bil-
lion for around 60 million people, costs that are anticipated to rise to between
£154 billion ($231 billion) and £184 billion ($276 billion) by 2022–2023 in
2002 prices.^78 In other words, at constant prices, UK health care costs are dou-
bling.
In the context of diet-related disease, the direct and indirect financial tolls of
ill health could offer opportunities for positive policy intervention through a
health-enhancing food supply chain. An estimate for the UK by the Oxford Uni-
versity British Heart Foundation Health Promotion Research Group has calcu-
lated that coronary heart disease (CHD) – constituting about half of all cases of
cardiovascular disease – costs the UK £10 billion per annum. These costs are made
up of £1.6 billion in direct costs (primarily to the taxpayer through the costs of
treatment by the NHS) and £8.4 billion in indirect costs to industry, and to soci-
ety as a whole, through loss of productivity due to death and disability.^79 (This is
probably an underestimate of the direct costs to the UK’s National Health Service
as these costs do not include the cancer treatment costs.)
A report chaired in 2002 by Derek Wanless, a former head of the NatWest
Bank, for the Chancellor of the Exchequer produced not dissimilar calculations.^80
Table 13.9 Economic costs of diet- and exercise-related health problems, USDisease Direct costs US$ billion
(medical expenditures)Indirect costs US$ billion
(productivity losses)Total costs
US$ billion
Heart disease 97.9 77.4 175.3
Stroke 28.3 15.0 43.3
Arthritis 20.9 62.9 83.8
Osteoporosis n.a. 14.9 14.9
Breast cancer 8.3 7.8 16.1
Colon cancer 8.1 n.a. 8.1
Prostate cancer 5.9 n.a. 5.9
Gall bladder
disease6.7 0.6 7.3Diabetes 45.0 55.0 100.0
Obesity 55.7 51.4 107.1
Total = 561.8Note: Costs are expressed in constant 1998 dollars, using the Consumer Price Index.
Source: National Institutes of Health (1998) and Wolf and Colditz (1998)^77