This chapter shows how stronger action on key cancer risk factors would benefit individuals, health systems, the environment and safety. The chapter presents results from OECD Strategic Public Health Planning (SPHeP) for Non-Communicable Diseases (NCDs) model, which was used to quantify the impact of achieving international policy targets for tobacco use, harmful alcohol use, diet, physical activity, overweight and air pollution. It also highlights the societal co-benefits of achieving targets on diet and harmful alcohol use, for the environment and safety, respectively.
Tackling the Impact of Cancer on Health, the Economy and Society
OECD Health Policy Studies
Abstract
Stronger action on key cancer risk factors would benefit health, health systems, the environment and safety
Around 40% of all cancer cases can be prevented by adopting healthier lifestyles and protection from harmful exposures, prevention should be a corner stone of the battle against cancer.
Most of the key cancer risk factors remain prevalent in the OECD and EU: 16% of adults smokes daily; the average per capita consumption of alcohol is 8.6 litres of pure alcohol per year; only 15% of adults in the OECD eats at least five portions of fruit and vegetables daily; in most OECD countries over half of the population is either overweight or obese; only 40% of adults meets the WHO physical activity recommendations; and almost all OECD countries have air pollution levels above the WHO guideline of 5μg/m3.
Analysis using the OECD SPHeP NCDs model estimates that meeting international policy targets on major cancer risk factors would prevent around 8% of all cancer cases, avert 12% of premature deaths due to cancer, and reduce the burden of cancer on health expenditure by 9%.
Tobacco accounts for 40‑60% of the total impact of action on risk factors across the different outcomes. This shows that, despite progress made, action on tobacco smoking remains a fundamental element of any cancer prevention strategy.
However, it is essential that policy makers go beyond tobacco control, and develop cancer prevention strategies that effectively target a wider set of risk factors. This includes more ambitious targets, as well as stronger policy action to achieve these targets. The current targets on obesity and physical activity are less ambitious than those for tobacco. Similarly, the timeline to achieve the air pollution target is much longer than for other targets, which means that the health benefits are delayed. Moreover, it appears that few countries will actually achieve these targets.
Action to improve diets would also benefit the environment. The food system accounts for about one‑third of all human-caused greenhouse gas (GHG) emissions. Adhering to a healthier diet with less meat and more fruit, vegetables and whole grains is estimated to reduce GHG emissions by 304 Mt of CO2‑equivalent. This is the amount of GHG associated with more than 72 million gasoline‑powered passenger vehicles, or the number of cars in Germany and Spain combined.
Harmful alcohol use has a direct impact on societal safety, as it can lead to road traffic accidents and violence due to its effects on cognitive function, co‑ordination, and behaviour. It is estimated that achieving the policy target on reducing harmful alcohol use could prevent 10% of premature deaths due to road traffic accidents and homicides.
A wide range of effective policies exist to address the major risk factors of cancer, varying in degree of intrusiveness. The least intrusive policies increase the choices available to people or decrease the cost of certain choices. For example, improving cycling and walking infrastructure can increase physical activity and reduce air pollution. Policies can also modify preferences through persuasion or provision of information; or by increasing the price of certain choices. Finally, there is the option to regulate, up to forbidding, certain options. This can be selective or partial, such as forbidding to smoke or the sale of alcohol to underage people.
As technological advances made cancer treatable, the discovery of carcinogens (substances capable of causing cancer) also made it preventable. For example, the human papilloma virus (HPV) was discovered in 1907, and its link to cervical cancer was first reported in 1974 (Lippman and Hawk, 2009[1]). The relation between tobacco smoking and lung cancer – though long suspected – was unequivocally established by the United States Surgeon General report in 1964 (Lippman and Hawk, 2009[1]). Since its inception in 1965, the International Agency for Research on Cancer (IARC) has identified 127 substances that are carcinogenic to humans, with another 95 that are probably carcinogenic (Box 5.1) (IARC, 2023[2]).
The International Agency for Research on Cancer (IARC) is a global authority on evaluating preventable causes of cancer in humans. IARC undertakes comprehensive reviews with subject experts and classifies risk factors based on the levels of evidence. The different classes are:
Group 1: Carcinogenic to humans. There is sufficient evidence of carcinogenicity in humans.
Group 2A: Probably carcinogenic to humans. There is limited evidence of carcinogenicity in humans and sufficient evidence of carcinogenicity in experimental animals.
Group 2B: Possibly carcinogenic to humans. There is limited evidence of carcinogenicity in humans and less than sufficient evidence of carcinogenicity in experimental animals.
Group 3: Not classifiable as carcinogenic to humans. Inadequate evidence of carcinogenicity and inadequate or limited evidence of carcinogenicity in experimental animals.
Importantly, this grouping is based only on the level of evidence, not the effect size. Exposure to a group 1 carcinogen does not necessarily result in a greater cancer risk than a group 2A one. Similarly, carcinogens in group 1 all result in different levels of increased cancer risk – what they have in common is that there is convincing evidence that they do increase the cancer risk.
Source : Minozzi, S. et al. (2015[3]), “European Code against Cancer 4th Edition: Process of reviewing the scientific evidence and revising the recommendations”, https://doi.org/10.1016/j.canep.2015.08.014; IARC (2019[4]), IARC Monographs on the Identification of Carcinogenic Hazards to Humans Questions and Answers, https://monographs.iarc.who.int/wp-content/uploads/2018/07/IARCMonographs-QA.pdf.
Around 40% of cancers can be prevented (European Commission, 2021[5]). In the OECD, 46% of cancer deaths are attributable to risk factors, and 47% of cancer deaths in the EU (IHME, 2019[6]). Therefore, addressing cancer risk factors to prevent cancer should be a corner stone of the battle against cancer. By investing in prevention, individuals are saved the physical, emotional, and financial tolls associated with cancer, leading to healthier, happier lives. Additionally, preventing cancer will alleviate the strain on healthcare systems by reducing the demand for medical services. Furthermore, healthier societies are more productive, and benefit the economy. Overall, prioritising prevention aligns with principles of sustainability, efficiency, and social responsibility, ultimately contributing to stronger, more resilient societies.
This chapter focuses on six major behavioural risk factors that should be considered in any cancer prevention strategy: tobacco use, harmful alcohol use, diet, air pollution (referring to ambient air PM2.5 pollution), overweight and obesity, and low physical activity (HPV is discussed separately in the next chapter, and other cancer risk factors are discussed in Box 1.2 in Chapter 2). Progress on addressing these risk factors over the past decade has been mixed. Tobacco smoking is the leading cause of cancer, and between 2011 and 2021, almost all countries saw a decrease in smoking prevalence (OECD, 2023[7]). However, tobacco use remains common in the OECD, with 16% of adults smoking daily in 2021. Contrary to tobacco smoking, alcohol consumption has changed little over the past decade. The average per capita consumption in the OECD has gone from 8.9 litres of pure alcohol in 2011 to 8.6 in 2021; and in around 40% of countries the consumption of alcohol increased (OECD, 2023[7]).
Other cancer risk factors also remain prevalent in the OECD (Table 5.1). On average, only 15% of adults in the OECD eats at least five portions of fruit and vegetables daily, ranging from 2% to 33%. Overweight and obesity have been increasing, and in most OECD countries, over half of the population is now either overweight or obese. Only 40% of adults in the OECD meets the WHO recommended 150 minutes of physical activity per week, ranging across countries from 5% to 76%. Despite some progress, in 2020 all OECD countries except Finland had air pollution levels above the WHO guideline of 5μg/m3, with five‑fold variation across countries (OECD, 2024[8]).
Daily tobacco smoking rates among population aged 15 and over, 2021 (or nearest year); Alcohol consumption in litres per capita among population aged 15 and over, 2021 (or nearest year); Self-reported overweight and obese adults (BMI>25), 2021 (or nearest year); Proportion of adults reporting spending at least 150 min per week on physical activity, 2021 or most recent (2019 for EU countries); Daily consumption of five or more portions of fruit and vegetables among adults, 2019 (or nearest year); Mean annual population exposure to fine particulates (PM2.5), 2020
Note: For each risk factor, the best performance is coloured green, the worst in red, and points in between are coloured proportionally. Grey indicates missing data.
Source: OECD (2023[7]), Health at a Glance 2023: OECD Indicators, https://www.doi.org10.1787/7a7afb35-en/; OECD (2024[8]), OECD Data Explorer: Exposure to air pollution ; OECD (2024[9]), Beating Cancer Inequalities in the EU: Spotlight on Cancer Prevention and Early Detection https://www.doi.org/10.1787/14fdc89a-en.
Scaling up action to tackle tobacco and harmful alcohol use, unhealthy diets, low physical activity, overweight and air pollution can make a crucial contribution in curbing the growing burden of cancer on individuals and health systems. Various international policy targets have been set to encourage countries to take action on these risk factors. Such targets were used in the OECD SPHeP NCDs model to evaluate the potential impact of scaling up action on risk factors on cancer (Table 5.2). The policy targets are based on Europe’s Beating Cancer Plan (European Commission, 2021[10]; European Commission, 2021[11]; European Commission, 2021[12]), the European Code Against Cancer (IARC, 2016[13]), the WHO Global Action Plan on NCDs (WHO-GAP) (WHO, 2021[14]) (WHO, 2013[15]) (WHO, 2022[16]), other WHO action plans (WHO, 2018[17]; WHO, 2024[18]), and national dietary guidelines (Annex Box 5.A.1), among others.
Note: For more details on these policy targets, please see Annex 5.A.
Source: OECD analysis of sources listed in table.
Tobacco remains a fundamental element of cancer prevention…
It is estimated that meeting the policy targets on all risk factors would prevent around 8% of all cancer cases, avert 12% of premature deaths due to cancer, and lower the burden of cancer on health expenditure by 9%. Tobacco accounts for 40‑60% of the total impact of action on risk factors across the different outcomes, which shows that, despite progress made, action on tobacco remains a fundamental element of any cancer prevention strategy (Figure 5.1).
Cancer cases prevented (thousands and as a percentage of total), premature cancer deaths avoided (thousands and as a percentage of total), and cancer health expenditure saved (EUR PPP billions and as a percentage of total burden of cancer on health expenditure) if policy targets on key cancer risk factors were achieved, total for OECD countries, per year, average over 2023‑50
Note: For country-level results, please see Annex 5.A.
Source: OECD SPHeP NCDs model, 2024.
If the policy targets on tobacco were achieved, it would prevent 151 000 cases of cancer per year in the OECD, corresponding to 2.7% of all the cancer cases in the same region (67 000 and 3.4% in the EU). Tobacco primarily affects lung cancer cases (Figure 5.2). As lung cancer has a high case fatality rate, the impact of tobacco on cancer cases translates to a greater impact on premature mortality than other risk factors. Achieving the policy target on tobacco would prevent 56 000 premature deaths per year– 6.1% of total premature mortality due to cancer (Figure 5.1) (28 000 and 7.8% in the EU). It would also save health systems EUR PPP 13.3 billion each year in cancer health expenditure – 3.0% of total burden of cancer on health expenditure – more than the total annual health budget of Hungary.
Cancer cases prevented by cancer type if policy targets on key cancer risk factors were achieved, total for OECD countries, per year, average over 2023‑50
Note: Graph only shows the number of cancer cases prevented, and not the small increase in other types of cancers as people live longer and are more likely to get other cancers. The total number shown here is therefore higher than the absolute impact on cancer cases presented above. Digestive includes liver, oesophageal, pancreatic, and stomach cancer; head and neck includes lip and oral cavity, larynx, other pharynx, and nasopharynx cancer; and other includes prostate, cervical cancer and malignant skin melanoma.
Source: OECD SPHeP NCDs model, 2024.
Countries globally are getting closer to reaching the target of a 30% relative reduction in current tobacco use by 2025, with the projected relative reduction being at 24.9% in 2022 (WHO, 2024[21]). However, progress is uneven across countries and regions of the world. Across the 51 countries included in this report, 20 were deemed on track to achieve a 30% relative reduction, 27 were likely to achieve a decrease in prevalence but less than 30%, and 3 were unlikely to experience a significant change in prevalence (Figure 5.3).
Assessment of country progress towards the 30% tobacco reduction target over 2010‑25
Source: WHO (2024[21]) Global report on trends in prevalence of tobacco use 2000‑30.
…but it is crucial that tobacco control policies are complemented with action on a wider set of risk factors
However, it is essential that policy makers go beyond tobacco control, and develop cancer prevention strategies that effectively target a wider set of risk factors. This includes more ambitious targets on physical activity and obesity. The results presented here are based on the policy target set for each risk factor, and the relatively small impact from addressing obesity and physical activity is in part a reflection of the ambition of the target. While reaching the target on tobacco (a 30% relative reduction in tobacco use by 2025 versus 2010, and that less than 5% of the population using tobacco by 2040) would see a considerable impact on tobacco smoking rates, the target on obesity (to reduce current levels of obesity down to those observed in 2010) would do little to tackle high obesity levels.
The air pollution target would have seen greater impact if its timeline was shorter. For most other risk factors, the scenarios reach their target value by 2025 or 2030. For air pollution, the current policy targets aims to achieve a level of 10 µg/m³ by 2030 and the WHO Global Air Quality Guideline of 5 µg/m³ by 2050 (European Parliament, 2024[22]), which is reflected in the analyses as a linear decrease over time to reach the two targets. Moreover, under the current EU proposal, the 2030 deadline to achieve the intermediary target of 10 µg/m³ can be postponed by ten years under certain circumstances, which would further delay the health benefits.
Stronger action is also needed to achieve these targets. It is estimated that, of OECD, G20 and EU countries, only Estonia and Latvia have a 20% or greater chance of reaching the obesity target for women under a business-as-usual situation. No country in the OECD, G20 or EU has a greater than 5% chance of reaching the target for men in absence of stronger policy action (World Obesity Federation, 2020[23]). The WHO Global Status Report on Physical Activity 2022 found that, if current physical activity trends continue, the global target of a 15% relative reduction in physical inactivity by 2030 will not be met (WHO, 2022[24]). And while the average PM2.5 exposure level fell from 17.5 to 11.6 µg/m³ between 2000 and 2020 in OECD countries, this is still well above the final target of 5 µg/m³ by 2050, or the 10 µg/m³ by 2030 (or 2040 under certain circumstances) target for EU Member States (OECD, 2024[8]).
In addition to reducing the cancer burden, action on risk factors also benefits other NCDs. All of these risk factors are linked to many other NCDs, including cardiovascular disease, diabetes, COPD, dementia and depression. Stepping up efforts to tackle risk factors would therefore have an additional impact on health, healthcare cost and the economy through other NCDs. Moreover, action on harmful alcohol use and diet would provide societal benefits to safety and the environment (see sections below).
In addition to reducing the burden of cancer and other NCDs, action on risk factors such as harmful alcohol use and diet can produce wider societal benefits. Policies on diet affect the environment through a change in the greenhouse gas (GHG) emissions associated with the food system, and alcohol policies can improve safety by reducing road traffic accidents and violence. These societal co-benefits make an even stronger case for action.
Healthier diets would reduce greenhouse gas emissions by the equivalent of 72 million cars in the OECD
There are strong links between dietary patterns and the environment. About one‑third of all anthropogenic (human-caused) GHG) emissions are linked to food systems (Crippa et al., 2021[25]). This includes land-use, production (farming and harvesting), processing, transporting and distribution, packaging, cooking and disposing of waste. To reflect the relationship between diet and the environment, the OECD SPHeP NCDs model links the dietary factors to GHG emissions, using data from the WHO Diet Impact Assessment model (WHO, 2023[26]) (see Annex 5.C for more details on the methodology).
If everyone in the OECD were to adhere to the policy targets for the selected dietary risk factors, this is estimated to reduce GHG emissions by 304 Mt of carbon dioxide (CO2) equivalent per year (56 in the EU) (Figure 5.4). This is the amount of GHG associated with more than 72 million gasoline‑powered passenger vehicles (13 million in the EU) (EPA, 2024[27]), or the number of cars in Germany and Spain combined.
Change in total GHG emissions, Mt of CO2‑eq per year, average over 2023‑50
Source: OECD SPHeP NCDs model, 2024, and WHO (2023[26]), The Diet Impact Assessment model: a tool for analyzing the health, environmental and affordability implications of dietary change, https://iris.who.int/handle/10665/373835.
As meat has one of the largest footprints when it comes to GHG emissions, countries with a higher baseline consumption of meat generally see a greater impact on per capita GHG emissions from meeting the diet policy targets (Figure 5.5). However, other factors also influence the relative impact: Argentina’s baseline consumption of meat is average, but a high proportion of meat consumption is beef – for which GHG emissions are five times higher per kilogram than for pork (WHO, 2023[26]). In addition, Argentina has relatively high emissions per kilo of beef due to local production inputs and methods. As a result, the per capita impact in Argentina is much higher than for other countries. On the other hand, many Central and Eastern EU member states predominantly eat pork rather than beef, and the impact of reducing meat consumption is therefore small.
Change in per capita GHG emissions, kgCO2‑eq per year, average over 2023‑50
Note: Differences between countries are influenced by baseline consumption of target food groups, mix of animal products consumed, and the country-specific emission intensity of the food groups.
Source: OECD SPHeP NCDs model, 2024, and WHO (2023[26]), The Diet Impact Assessment model: a tool for analysing the health, environmental and affordability implications of dietary change, https://iris.who.int/handle/10665/373835.
In countries where meat, and in particular beef, consumption is low, the additional GHG emissions from increased fruit, vegetables and whole grain consumption can outweigh the reduction related to meat. In this case, GHG emissions can increase under the diet policy target. However, it is important to note that the scenario assumes no substitution, where any increase in consumption is on top of current dietary intake. For whole grain, an increase in consumption is likely to come from substituting processed grain, rather than additional grain consumption to meet the whole grain target. In that case, the amount of raw products needed will not be substantially affected, and the impact on GHG emissions would in fact be minimal.
Action on harmful alcohol consumption would prevent 10% of premature deaths due to road traffic accidents and homicides
Harmful alcohol use has a direct impact on societal safety, as it can lead to road traffic accidents and violence due to its effects on cognitive function, co‑ordination, and behaviour. When individuals consume alcohol, it impairs their ability to make rational decisions, slows reaction times, and impairs motor skills, all of which are critical for safe driving. Similarly, alcohol can lower inhibitions and increase impulsivity, making individuals more prone to engage in confrontations and escalate conflicts. In some cases, alcohol-induced aggression can lead to physical altercations, assaults, and even homicides.
Alcohol plays a significant role in fatal road traffic accidents. On average in the OECD, around one in three deaths from road traffic accidents can be attributed to alcohol use (Figure 5.6). This ranges from less than 1% in Saudi Arabia to 55% among male fatalities in Luxembourg in 2016. The proportion of road traffic crash deaths involving alcohol was higher in males than in females all countries.
Proportion of road traffic crash deaths attributable to alcohol among men and women aged 15+ in 2016
Source: WHO (2016[28]) Alcohol-attributable fractions (15+), road traffic crash deaths (%) 2016, www.who.int/data/gho/data/indicators/indicator-details/GHO/alcohol-related-road-traffic-crashes-per-100-000-population.
Achieving the policy target of reducing harmful alcohol consumption with 20% by 2030 versus 2010 is estimated to prevent 9 246 premature deaths due to road traffic accidents per year in the OECD (2065 in the EU). This is 10.4% of the total premature mortality from road traffic accidents (10.9% in the EU) (Figure 5.7). Countries with higher baseline rates of road traffic accidents see greater absolute reductions in premature mortality rate.
Impact of achieving the harmful alcohol use policy target on premature mortality from road traffic accidents, in deaths per 100 000 population and as a percentage of total premature mortality from road traffic accidents, per year, average over 2023‑50
Source: OECD SPHeP NCDs model, 2024.
Alcohol also plays a detrimental role in many non-traffic related injuries and violent behaviour. In a systematic review of alcohol consumption and causes of fatal injuries in Canada Mexico and the United States, alcohol played a role in almost one in three homicides, a quarter of firearm injuries, a third of fire injuries, one in three drownings and more than a third of fall injuries among other injuries (Alpert et al., 2022[29]).
Achieving the policy target on harmful alcohol use is estimated to prevent 5 645 premature deaths due to interpersonal violence each year in the OECD, 10.0% of the total premature mortality from this cause (309 and 9.8% in the EU) (Figure 5.8). There is strong variation across countries, driven by baseline differences in homicide rates, with the number of homicide deaths prevented per 100 000 population ranging from less than 0.01 in Slovenia to 2.1 in Colombia.
Impact of achieving the harmful alcohol use policy target on premature mortality from interpersonal violence, in deaths per 100 000 population and as a percentage of total premature mortality from interpersonal violence, per year, average over 2023‑50
Source: OECD SPHeP NCDs model, 2024.
A wide range of effective policies exist to address the major risk factors of cancer (Table 5.3). The least intrusive policy options increase the choices available to people or decrease the cost of certain choices. Positive changes to the environment such as improving cycling and walking infrastructure can help increase physical activity, reduce air pollution and decrease overweight and obesity levels. Other examples of increasing choice include non-alcoholic alternatives at social venues (Box 5.2), or subsidising healthy food options such as fruit and vegetables. Interventions to improve the choices available can also be used to address existing structural (often overlapping) inequities, such as poverty and gender (Ginsburg et al., 2023[30]).
Note: This table aims to provide examples of different policies across risk factors, and is not exhaustive. Policies with an * are part of the WHO NCD Best Buys to tackle NCDs. However, this does not imply that the other policies are not cost-effective and/or feasible.
Source: Sassi, F. and J. Hurst (2008[31]), “The Prevention of Lifestyle‑Related Chronic Diseases: an Economic Framework”, https://doi.org/10.1787/243180781313; WHO (2003[32]), WHO Framework Convention on Tobacco Control (WHO FCTC), https://iris.who.int/handle/10665/42811; European Commission (2021[33]), European Commission (2021), Pathway to a Healthy Planet for All – EU Action Plan:’Towards Zero Pollution for Air, Water and Soil’ communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions, https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=COM%3A2021%3A400%3AFIN; OECD (2021[34]), Preventing Harmful Alcohol Use, https://doi.org/10.1787/6e4b4ffb-en; WHO (2018[17]), Global action plan on physical activity 2018‑30, https://iris.who.int/handle/10665/272722; OECD (2019[35]), The Heavy Burden of Obesity: The Economics of Prevention, https://doi.org/10.1787/67450d67-en; WHO (2015[36]), Fiscal policies for diet and prevention of noncommunicable diseases: technical meeting report, https://iris.who.int/handle/10665/250131; Gelius, P. et al. (2020[37]), “What are effective policies for promoting physical activity? A systematic review of reviews”, https://doi.org/10.1016/j.pmedr.2020.101095; OECD/WHO (2023[38]). Step Up! Tackling the Burden of Insufficient Physical Activity in Europe, https://doi.org/10.1787/500a9601-en; WHO (2023[39]), More ways, to save more lives, for less money: World Health Assembly adopts more Best Buys to tackle noncommunicable diseases, https://www.who.int/news/item/26-05-2023-more-ways--to-save-more-lives--for-less-money----world-health-assembly-adopts-more-best-buys--to-tackle-noncommunicable-diseases.
In France, article L. 3323‑1 of the public health code requires that bars hosting happy hour drink deals also include zero‑alcohol drink options in the deal. The deals should be equivalent, such that if during a happy hour there are two alcoholic drinks for the price of one, there should also be two non-alcoholic drinks for the price of one. Additionally, non-alcoholic drinks should be on display and easily seen in the bar, with the display of at least ten bottles or containers of non-alcoholic drinks (Republique Francaise, 2009[40]).
In Australia all licenced premises must provide cold drinking water on request, though there are regional variations in terms of exact rules, with five of six States stipulating it must be offered free rather than at a reasonable cost. Western Australia also states that the water needs to be easily accessible in areas away from the queues for alcoholic drinks (Tasmanian Government, 2019[41]; Queensland Government, 2024[42]; Government of Southern Australia Customer and Business Services, 2023[43]; Government of New South Wales, 2024[44]; Government of Victoria, 2023[45]; Government of Western Australia, 2024[46]).
The next policy lever involves actions that modify preferences based on characteristics of choice options other than price, such as through persuasion, provision of information. Labelling and health warnings on tobacco, alcohol and food products can inform and persuade people to make healthier choices (Box 5.3). Providing education, for example through physical education and classes on food preparation, or through public health campaigns, can also help modify choice towards healthy behaviours. Regulation of advertising, for alcohol, tobacco or food, can reduce the exposure to persuasive messages promoting less healthy choices. It is important to note that, when developing policies that affect industries, countries need to ensure the transparency and integrity of lobbying and other influence practices (Box 5.4).
Nutri-score is a front-of-pack (FOP) label consisting of five colours, ranging from green to red, to help consumers make more informed choices about what they eat (Figure 5.9). In addition to informing consumers, FOP labels can also incentivise food companies to reformulate their products (OECD, 2022[47]; Kloss et al., 2015[48]).
Source: Santé Publique France (2024[49]), Nutri-score, www.santepubliquefrance.fr/determinants-de-sante/nutrition-et-activite-physique/articles/nutri-score.
Nutri-score was introduced initially in France in 2017, where a randomised control trial showed that it increased purchases of the highest nutrition categories (Dubois et al., 2021[50]). It is implemented by companies on a voluntary basis, and between 2018 and 2023 the market share of food companies that adhere to the Nutri-score increased from 24% to 62% (in sales volume) (Ministère du travail, 2021[51]; OECD, 2022[47]). Since its introduction in France, the logo has also been adopted by Belgium, Switzerland, Germany, Spain, the Netherlands and Luxembourg (Santé Publique France, 2024[49]).
OECD analysis of the Nutri-score scheme estimates that it could prevent nearly 2 million cases of NCDs between 2023 and 2050 across EU countries, as well as lower annual healthcare spending by 0.05% (Devaux et al., 2024[52]).
Lobbying groups and influencers represent valid interests and provide policy makers with important insights and data on various issues, leading to more informed and better policies. However, policy making is not always inclusive. Sometimes, financially and politically powerful groups dominate, sidelining those with fewer resources. Additionally, policies can be skewed by biased or deceitful information and manipulated public opinion, resulting in policies that only benefit special interest groups and not society as a whole.
The OECD Recommendation of the Council on Transparency and Integrity in Lobbying and Influence provides a set of recommendations to strengthen transparency and openness of lobbying and influence activities in public decision-making processes, with the aim to avoid making policy choices in the interests of the more financially and politically powerful.
Source: OECD (2024), Recommendation of the Council on Transparency and Integrity in Lobbying and Influence; https://legalinstruments.oecd.org/en/instruments/OECD-LEGAL-0379.
Increasing the price of selected options, typically through increased taxation, is more intrusive but can help move individuals away from less healthy options. Examples include taxation on tobacco, alcohol, food and drinks high in sugar, saturated fats and salt, and highly polluting vehicles. There are also non-taxation fiscal measures, such as minimum unit pricing for alcohol, and higher congestion charges or parking fees for polluting vehicles (Box 5.5).
There are various financial policies to discourage the purchase of polluting vehicles, and steer buyers towards less polluting options (Samos, Mellios and Tsalikidis, 2019[53]). In the Netherlands, CO2‑efficient cars have been encouraged by (partial) exemptions from registration tax and annual circulation tax, while diesel cars are taxed at a higher rate than petrol cars, for registration tax as well as in the annual circulation taxes. In France, buyers of efficient vehicles are rewarded with an up-front bonus subsidy, while buyers of high-emitting vehicles have to pay a malus.
Financial incentives can also be used to discourage the use of polluting vehicles. London has implemented an Ultra Low Emission Zone (ULEZ) which covers all London boroughs. Vehicles that do not meet the ULEZ emissions standards need to pay a GBP 12.50 (EUR 15) daily charge to drive within the zone (Transport for London, n.d.[54]). In Paris, a new policy was implemented in 2024 where heavier and higher polluting cars have to pay much higher parking charges within the city (Ville de Paris, 2024[55]).
The final policy lever involves banning selected options. Bans can be employed as selective or partial, such as restricting the times or days alcohol can be sold, or imposing a minimum age at which tobacco products can be legally sold (Box 5.6). Bans can also be complete, such as banning outright the use of trans-fats in the food supply chain or banning highly polluting vehicles from the roads. Although these regulatory measures are typically less expensive than other policy types, enforcement costs can be substantial and bans also run the risk of incentivising illicit activities (Sassi and Hurst, 2008[31]).
The idea of a tobacco-free generation first took hold in 2010, when researchers at the National Cancer Centre in Singapore suggested that minimum age legislation for tobacco sales could be re‑written so that sales are denied to: “a person below the age of 18 years or a citizen born on or after 1 January 2000”, effectively phasing out tobacco use in the next generations (Khoo, 2010[56]).
In December 2022, New Zealand became the first country in the world to introduce legislation on a tobacco-free generation, as part of a larger strategy on smoking (Hefler, 2023[57]). The policy would see the legal age to purchase tobacco increase yearly, so that it will never be legal to sell combustible tobacco products to people born after 2008. However, in November 2023, the new Coalition Government announced that they intended to repeal the legislation, referring to the illicit tobacco market and tax revenue shortages.
In the United Kingdom, a bill is under way to ensure that children turning 15 in 2024 or younger will never be legally sold tobacco, by increasing the legal age of sale by one year, every year (UK Government, 2024[58]). Other countries have also started talking about raising smoke‑free generations, including Australia, France, Mexico and Portugal. (World Economic Forum, 2023[59]) (Hefler, 2023[57])
References
[29] Alpert, H. et al. (2022), “Alcohol Consumption and 15 Causes of Fatal Injuries: A Systematic Review and Meta-Analysis”, American Journal of Preventive Medicine, Vol. 63/2, pp. 286-300, https://doi.org/10.1016/j.amepre.2022.03.025.
[19] Council of the EU (2024), Air Quality: Council and Parliament strike deal to strengthen standards in the EU, https://www.consilium.europa.eu/en/press/press-releases/2024/02/20/air-quality-council-and-parliament-strike-deal-to-strengthen-standards-in-the-eu/ (accessed on 23 April 2024).
[25] Crippa, M. et al. (2021), “Food systems are responsible for a third of global anthropogenic GHG emissions”, Nature Food, Vol. 2/3, pp. 198-209, https://doi.org/10.1038/s43016-021-00225-9.
[52] Devaux, M. et al. (2024), “Establishing an EU‐wide front‐of‐pack nutrition label: Review of options and model‐based evaluation”, Obesity Reviews, https://doi.org/10.1111/obr.13719.
[50] Dubois, P. et al. (2021), “Effects of front-of-pack labels on the nutritional quality of supermarket food purchases: evidence from a large-scale randomized controlled trial”, Journal of the Academy of Marketing Science, Vol. 49/1, pp. 119-138, https://doi.org/10.1007/s11747-020-00723-5.
[61] EAT-Lancet Commission (2019), Food Planet Health: Healthy Diets From Sustainable Food Systems - Summary Report, https://eatforum.org/content/uploads/2019/07/EAT-Lancet_Commission_Summary_Report.pdf.
[74] EFSA (2021), Food consumption data, https://www.efsa.europa.eu/fr/data-report/food-consumption-data (accessed on 1 April 2022).
[27] EPA (2024), Greenhouse Gas Equivalencies Calculator, https://www.epa.gov/energy/greenhouse-gas-equivalencies-calculator#results (accessed on 6 May 2024).
[65] European Commission (2023), Food-Based Dietary Guidelines in Europe, https://knowledge4policy.ec.europa.eu/health-promotion-knowledge-gateway/topic/food-based-dietary-guidelines-europe_en (accessed on 6 September 2023).
[5] European Commission (2021), Europe’s Beating Cancer Plan, https://ec.europa.eu/health/sites/default/files/non_communicable_diseases/docs/eu_cancer-plan_en.pdf.
[12] European Commission (2021), Europe’s Beating Cancer Plan, https://ec.europa.eu/commission/presscorner/detail/en/ip_21_342 (accessed on 10 March 2022).
[10] European Commission (2021), Europe’s Beating Cancer Plan - Communication from the commission to the European Parliament and the Council.
[11] European Commission (2021), Factsheet - Europe’s Beating Cancer Plan, https://ec.europa.eu/commission/presscorner/detail/en/fs_20_341 (accessed on 18 February 2022).
[33] European Commission (2021), Pathway to a Healthy Planet for All - EU Action Plan: ’Towards Zero Pollution for Air, Water and Soil’ communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions, https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=COM%3A2021%3A400%3AFIN.
[22] European Parliament (2024), Air pollution: Deal with Council to improve air quality, https://www.europarl.europa.eu/news/en/press-room/20240219IPR17816/air-pollution-deal-with-council-to-improve-air-quality (accessed on 26 February 2024).
[64] European Parliament (2023), Texts adopted - Ambient air quality and cleaner air for Europe, https://www.europarl.europa.eu/doceo/document/TA-9-2023-0318_EN.html (accessed on 21 September 2023).
[75] FAO (2022), Food Balance Sheets, https://www.fao.org/economic/the-statistics-division-ess/publications-studies/publications/food-balance-sheets/en/ (accessed on 21 November 2022).
[71] FAO (2016), Food-based dietary guidelines - Republic of Korea, https://www.fao.org/nutrition/education/food-dietary-guidelines/regions/countries/republic-of-korea/en/ (accessed on 6 September 2023).
[72] GBD 2019 Risk Factors Collaborators (2020), “Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019”, The Lancet, Vol. 396/10258, pp. 1223-1249, https://doi.org/10.1016/S0140-6736(20)30752-2.
[37] Gelius, P. et al. (2020), “What are effective policies for promoting physical activity? A systematic review of reviews”, Preventive Medicine Reports, Vol. 18, p. 101095, https://doi.org/10.1016/j.pmedr.2020.101095.
[30] Ginsburg, O. et al. (2023), “Women, power, and cancer: a Lancet Commission”, The Lancet, Vol. 402/10417, pp. 2113-2166, https://doi.org/10.1016/s0140-6736(23)01701-4.
[44] Government of New South Wales (2024), Liquor and Gaming - Patron Rights, Cancer Epidemiology, https://www.liquorandgaming.nsw.gov.au/community-and-stakeholders/licensed-venues/patron-rights (accessed on 30 April 2024).
[43] Government of Southern Australia Customer and Business Services (2023), Liquor Licence Self-Assessment Compliance Audit Checklist, https://www.cbs.sa.gov.au/__data/assets/pdf_file/0010/908551/Self-assessment-checklist-liquor.pdf (accessed on 30 April 2024).
[45] Government of Victoria (2023), Free water for patrons, https://www.vic.gov.au/free-water-licensed-premises (accessed on 30 April 2024).
[46] Government of Western Australia (2024), Liquor licensing, https://www.dlgsc.wa.gov.au/racing-gaming-and-liquor/liquor/liquor-licensing/free-drinking-water-policy (accessed on 30 April 2024).
[68] Health Canada (2019), Canada’s Dietary Guidelines, https://food-guide.canada.ca/sites/default/files/artifact-pdf/CDG-EN-2018.pdf (accessed on 6 September 2023).
[57] Hefler, M. (2023), “Short-term dollars at what cost? Repealing New Zealand’s Smokefree Aotearoa 2025 plan would sacrifice lives and longer-term economic gain”, https://tobaccocontrol.bmj.com/content/early/2023/12/05/tc-2023-058535.info.
[2] IARC (2023), Agents Classified by the IARC Monographs, Volumes 1–134, International Agency for Research on Cancer, https://monographs.iarc.who.int/agents-classified-by-the-iarc/.
[4] IARC (2019), IARC Monographs on the Identification of Carcinogenic Hazards to Humans Questions and Answers, International Agency for Research on Cancer, https://monographs.iarc.who.int/wp-content/uploads/2018/07/IARCMonographs-QA.pdf.
[13] IARC (2016), European Code Against Cancer, International Agency for Research on Cancer, https://cancer-code-europe.iarc.fr/index.php/en/ (accessed on 18 February 2022).
[6] IHME (2019), GBD Results Tool, Institute For Health Metrics and Evaluation, http://ghdx.healthdata.org/gbd-results-tool (accessed on 25 October 2018).
[56] Khoo, D. (2010), “Phasing-out tobacco: proposal to deny access to tobacco for those born from 2000”, Tobacco Control, Vol. 19, pp. 355-360, https://tobaccocontrol.bmj.com/content/19/5/355.
[48] Kloss, L. et al. (2015), “Sodium intake and its reduction by food reformulation in the European Union — A review”, NFS Journal, Vol. 1, pp. 9-19, https://doi.org/10.1016/j.nfs.2015.03.001.
[1] Lippman, S. and E. Hawk (2009), “Cancer prevention: From 1727 to milestones of the past 100 years”, Cancer Research, Vol. 69/13, pp. 5269-5284, https://doi.org/10.1158/0008-5472.CAN-09-1750.
[51] Ministère du travail, D. (2021), Nutri-score assessment report after three-year of nutri-score implementation, https://sante.gouv.fr/IMG/pdf/nutri-score_follow-up_report_3_years_26juillet2021.pdf (accessed on 26 April 2024).
[70] Ministry of Agriculture, F. (2016), Dietary guidelines for Japanese, https://www.maff.go.jp/j/syokuiku/attach/pdf/shishinn-10.pdf (accessed on 6 September 2023).
[69] Ministry of Health (2020), Eating and Activity Guidelines for New Zealand Adults, http://www.health.govt.nz (accessed on 6 September 2023).
[3] Minozzi, S. et al. (2015), “European Code against Cancer 4th Edition: Process of reviewing the scientific evidence and revising the recommendations”, Cancer Epidemiology, Vol. 39, pp. S11-S19, https://doi.org/10.1016/j.canep.2015.08.014.
[66] National Health and Medical Research Council (2013), Australian Dietary Guidelines, https://www.health.gov.au/sites/default/files/australian-dietary-guidelines.pdf (accessed on 6 September 2023).
[9] OECD (2024), Beating Cancer Inequalities in the EU: Spotlight on Cancer Prevention and Early Detection, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/14fdc89a-en.
[8] OECD (2024), Exposure to air pollution, https://data-explorer.oecd.org/vis?df[ds]=DisseminateFinalDMZ&df[id]=DSD_AIR_POL%40DF_AIR_POLL&df[ag]=OECD.ENV.EPI&df[vs]=1.0&dq=SAU%2BZAF%2BARG%2BBRA%2BBGR%2BCHN%2BHRV%2BCYP%2BIND%2BIDN%2BMLT%2BPER%2BROU%2BAUT%2BAUS%2BBEL%2BCAN%2BCHL%2BCOL%2BCRI%2BCZE%2B.
[7] OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/7a7afb35-en.
[47] OECD (2022), Healthy Eating and Active Lifestyles: Best Practices in Public Health, OECD Publishing, Paris, https://doi.org/10.1787/40f65568-en.
[34] OECD (2021), Preventing Harmful Alcohol Use, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/6e4b4ffb-en.
[35] OECD (2019), The Heavy Burden of Obesity: The Economics of Prevention, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/67450d67-en.
[38] OECD/WHO (2023), Step Up! Tackling the Burden of Insufficient Physical Activity in Europe, OECD Publishing, Paris, https://doi.org/10.1787/500a9601-en.
[73] Poore, J. and T. Nemecek (2018), “Reducing food’s environmental impacts through producers and consumers”, Science, Vol. 360/6392, pp. 987-992, https://doi.org/10.1126/science.aaq0216.
[42] Queensland Government (2024), Patron and staff safety on licensed premises, https://www.business.qld.gov.au/industries/hospitality-tourism-sport/liquor-gaming/liquor/compliance/patron-staff-safety (accessed on 30 April 2024).
[40] Republique Francaise (2009), Article L3323-1 Code de la santé publique, https://www.legifrance.gouv.fr/codes/article_lc/LEGIARTI000020896932.
[53] Samos, Z., G. Mellios and N. Tsalikidis (2019), The impact of vehicle taxations system on vehicle emissions, European Environment Agency.
[49] Santé Publique France (2024), Nutri-score, https://www.santepubliquefrance.fr/determinants-de-sante/nutrition-et-activite-physique/articles/nutri-score (accessed on 26 April 2024).
[31] Sassi, F. and J. Hurst (2008), “The Prevention of Lifestyle-Related Chronic Diseases: an Economic Framework”, OECD Health Working Papers, No. 32, OECD Publishing, Paris, https://doi.org/10.1787/243180781313.
[41] Tasmanian Government (2019), Guide to Tasmanian Liquor Licensing laws for licence holders, https://www.treasury.tas.gov.au/Documents/Guideforlicenceholders.pdf.
[54] Transport for London (n.d.), Ultra Low Emission Zone, https://tfl.gov.uk/modes/driving/ultra-low-emission-zone (accessed on 7 May 2024).
[67] U.S. Department of Agriculture and U.S. Department of Health and Human Services (2020), Dietary Guidelines for Americans, 2020-2025, https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf (accessed on 6 September 2023).
[58] UK Government (2024), Creating a smokefree generation and tackling youth vaping: what you need to know, https://healthmedia.blog.gov.uk/2024/04/15/creating-a-smokefree-generation-and-tackling-youth-vaping-what-you-need-to-know/ (accessed on 7 May 2024).
[55] Ville de Paris (2024), Les résultats de la votation sur la tarification des SUV, https://www.paris.fr/pages/plus-ou-moins-de-suv-les-parisiens-et-parisiennes-sont-invites-a-voter-le-4-fevrier-25381 (accessed on 29 April 2024).
[18] WHO (2024), Global Alcohol Action Plan 2022-2030, World Health Organization, https://iris.who.int/handle/10665/376939.
[21] WHO (2024), WHO global report on trends in prevalence of tobacco use 2000–2030, World Health Organization, https://iris.who.int/handle/10665/375711.
[39] WHO (2023), More ways, to save more lives, for less money: World Health Assembly adopts more Best Buys to tackle noncommunicable diseases, World Health Organization, https://www.who.int/news/item/26-05-2023-more-ways--to-save-more-lives--for-less-money----world-health-assembly-adopts-more-best-buys--to-tackle-noncommunicable-diseases.
[26] WHO (2023), The Diet Impact Assessment model: a tool for analyzing the health, environmental and affordability implications of dietary change, World Health Organization Regional Office for Europe, https://iris.who.int/handle/10665/373835.
[63] WHO (2022), Follow-up to the political declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases, World Health Organization, https://doi.org/10.1016/S0140-6736(20)31761-X.
[24] WHO (2022), Global Status report on physical activity 2022, World Health Organization, https://iris.who.int/handle/10665/363607.
[16] WHO (2022), Seventy-fifth World Health Assembly - Resolutions and decisions annexes, https://apps.who.int/gb/ebwha/pdf_files/WHA75-REC1/A75_REC1_Interactive_en.pdf#page=1.
[62] WHO (2022), WHO manual on sugar-sweetened beverage taxation policies to promote healthy diets, World Health Organization, https://iris.who.int/handle/10665/365285.
[60] WHO (2021), Global alcohol action plan: Second draft, unedited, https://www.who.int/publications/m/item/global-alcohol-action-plan-second-draft-unedited.
[20] WHO (2021), WHO global air quality guidelines: particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide, World Health Organization, https://apps.who.int/iris/handle/10665/345329.
[14] WHO (2021), WHO NCD Accountability Framework for NCD Implementation Roadmap, World Health Organization, https://www.who.int/publications/m/item/who-ncd-accountability-framework-for-ncd-implementation-roadmap (accessed on 31 March 2023).
[17] WHO (2018), Global action plan on physical activity 2018-2030, World Health Organization, https://iris.who.int/handle/10665/272722.
[28] WHO (2016), Alcohol-attributable fractions (15+), road traffic crash deaths (%), World Health Organization, https://www.who.int/data/gho/data/indicators/indicator-details/GHO/alcohol-related-road-traffic-crashes-per-100-000-population (accessed on 18 April 2024).
[36] WHO (2015), Fiscal policies for diet and prevention of noncommunicable diseases: technical meeting report, World Health Organization, https://iris.who.int/handle/10665/250131.
[15] WHO (2013), Global action plan for the prevention and control of noncommunicable diseases 2013-2020, World Health Organization, https://iris.who.int/handle/10665/94384.
[32] WHO (2003), WHO Framework Convention on Tobacco Control (WHO FCTC), World Health Organization, https://iris.who.int/handle/10665/42811.
[59] World Economic Forum (2023), “Smoking bans: These countries are tackling tobacco use”, World Economic Forum, https://www.weforum.org/agenda/2023/11/smoking-tobacco-ban-portugal-new-zealand-mexico-uk/.
[23] World Obesity Federation (2020), Obesity: missing the 2025 global targets Trends, Costs and Country Reports March 2020, https://data.worldobesity.org/publications/WOF-Missing-the-2025-Global-Targets-Report-FINAL-WEB.pdf.
Note: All scenarios assume a linear change starting 2023, going from current level to the target level in the target year, after which they remain at target level.
Source: OECD analysis of European Commission (2021[12]), Europe’s Beating Cancer Plan, https://ec.europa.eu/commission/presscorner/detail/en/ip_21_342; WHO (2013[15]), Global action plan for the prevention and control of noncommunicable diseases 2013‑20, https://iris.who.int/handle/10665/94384; WHO (2018[17]), Global action plan on physical activity 2018‑30, https://iris.who.int/handle/10665/272722; WHO (2022[16]), Seventy-fifth World Health Assembly – Resolutions and decisions annexes, https://apps.who.int/gb/ebwha/pdf_files/WHA75-REC1/A75_REC1_Interactive_en.pdf#page=1, WHO (2021[60]), Global alcohol action plan: Second draft, unedited, www.who.int/publications/m/item/global-alcohol-action-plan-second-draft-unedited; EAT-Lancet Commission (2019[61]), Food Planet Health: Healthy Diets From Sustainable Food Systems – Summary Report, https://eatforum.org/content/uploads/2019/07/EAT-Lancet_Commission_Summary_Report.pdf; WHO (2021[20]), WHO global air quality guidelines: particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide, https://apps.who.int/iris/handle/10665/345329; WHO (2022[62]), WHO manual on sugar-sweetened beverage taxation policies to promote healthy diets, https://iris.who.int/handle/10665/365285; WHO (2022[63]), Follow-up to the political declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases, https://doi.org/10.1016/S0140-6736(20)31761-X; (European Parliament (2023[64]), Texts adopted – Ambient air quality and cleaner air for Europe, www.europarl.europa.eu/doceo/document/TA-9-2023-0318_EN.html.
For diet, there are few international policy targets. Instead, national dietary guidelines were reviewed from European countries, the United States, Canada, Australia, New Zealand, Japan and Korea.
Fruit and vegetables: Where guidelines provide specific, quantitative targets, the most common recommendation is to consume 250 grammes per day of both fruit and vegetables (i.e. 500 grammes per day in total). While this adds up to more than the WHO recommendation of eating 400 grammes per day of fruit and vegetables, many countries have recommendations even higher than 250 grammes per day.
Whole grains: Few countries have quantitative targets on whole grains, but those that do are closely aligned: Denmark, Sweden, Norway and the United States all recommend between 75 and 85 grammes per day.
Red meat and processed meat: The countries that include specific recommendations on red meat intake generally recommend limiting intake to 500 grammes per week (about 70 grammes per day). Often the recommendation covers both red and processed meat. France and Switzerland have separate recommendations on processed meat, limiting intake to 150 grammes and 100‑120 grammes per week respectively (around 18 grammes per day on average). Therefore, for the policy targets the 70 grammes of red meats per day was split into 18 grammes of processed meat, and the remaining 52 grammes for other red meats.
Source: OECD analysis of European Commission (2023[65]), Food-Based Dietary Guidelines in Europe, https://knowledge4policy.ec.europa.eu/health-promotion-knowledge-gateway/topic/food-based-dietary-guidelines-europe_en; National Health and Medical Research Council (2013[66]), Australian Dietary Guidelines, www.health.gov.au/sites/default/files/australian-dietary-guidelines.pdf; U.S. Department of Agriculture and U.S. Department of Health and Human Service (2020[67]) Dietary Guidelines for Americans, 2020‑25, www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf; Health Canada (2019[68]), Canada’s Dietary Guidelines, https://food-guide.canada.ca/sites/default/files/artifact-pdf/CDG-EN-2018.pdf; Ministry of Health (2020[69]), Eating and Activity Guidelines for New Zealand Adults, www.health.govt.nz; Ministry of Agriculture (2016[70]), Dietary guidelines for Japanese, www.maff.go.jp/j/syokuiku/attach/pdf/shishinn-10.pdf; FAO (2016[71]), Food-based dietary guidelines - Republic of Korea, www.fao.org/nutrition/education/food-dietary-guidelines/regions/countries/republic-of-korea/en/.
Source: OECD SPHeP NCDs model, 2024.
Source: OECD SPHeP NCDs model, 2024.
Source: OECD SPHeP NCDs model, 2024.
The OECD SPHeP NCDs model contains six dietary risk factors that are linked to cancer: fruit, vegetables, whole grains, sodium, red meat and processed meat (GBD 2019 Risk Factors Collaborators, 2020[72]). Changes in five of these (excluding sodium) were linked to changes in greenhouse gas (GHG) emissions. The environmental footprint for each food group was derived from the WHO Diet Impact Assessment model, which is a tool for analysing environmental implications of dietary changes (WHO, 2023[26]).
As environmental impacts of specific food products are highly variable across producers (Poore and Nemecek, 2018[73]), the environmental impacts of specific food products differ across countries. The impacts shown in this report therefore reflect both the difference between the baseline and target consumption in a country, as well as the relative environmental footprint of food consumed in that county. Moreover, the environmental impact combines all food groups covered in the OECD SPHeP NCDs model (red meat, processed meat, fruit, vegetables, whole grains), and assumed that there is no change in other dietary groups, e.g. there was no replacement or substitution.
To compare and aggregate emissions of different GHGs, a carbon dioxide equivalent (CO2‑eq) is used. This measure converts the amount of other GHGs to the equivalent amount of carbon dioxide with the same global warming potential. The lifecycle assessment approach was used to calculate the GHG emissions of food products across all stages of a food item’s life cycle – including farming, processing, packaging and transport.
While the dietary risk factors in the OECD SPHeP NCDs model include “red meat” or “processed meat” as a group, different animal products are associated with different emission intensities. For example, a kilogram of beef results in ten times more GHG emissions than a kilogram of pork. Analysis of the European Food Safety Agency (EFSA) Comprehensive European Food Consumption Database (EFSA, 2021[74]) shows that the relative proportion of meat intake from various animals varies significantly across countries, and across the fresh and processed meat categories. Therefore, the two meat intake variables are combined into one overall meat consumption quantity, which is split into red meat categories based on country-specific supply data from the FAO Food Balance Sheets (FAO, 2022[75]) for bovine meat (beef), pig meat (pork) and mutton and goat meat (including lamb).
Note that this necessitates the assumption that all processed meat also falls into these red meat categories. While processed meat is defined only by its processing method and not by type of animal (“meat preserved by smoking, curing, salting, or addition of chemical preservatives”), analysis across 22 countries included in the EFSA Database shows that approximately 90% of processed meat consumed was indeed red meat (beef or pork).
It is important to note that the changes in total emissions are based on the change in per capita emissions, applied to the baseline population. This means that the results are not affected by the slight increase in population size associated with a lower cancer mortality.