The World is Fat: How the Obesity Epidemic is Affecting the Global Economy
With more than 2.1 bil...
Obesity falls just behind war and terrorism in terms of how much it costs the global economy: $2 trillion annually, to be exact.
With more than 2.1 billion people – nearly 30 percent of the global population and nearly two and a half times the number of adults and children who are undernourished – obesity has become a critical global issue.
Apart from the social and health impacts, obesity is an economic crisis, too. Today, the toll of obesity on health systems alone is between 2 and 7 percent of all health care spending in developed economies, and that does not include the cost of treating associated diseases such as Type 2 diabetes and heart disease.
A recent study conducted by the McKinsey Global Institute sought to find out what the impact of obesity really is on the world’s economy and what the most effective measures are for combating the disease.
A Global Epidemic
Over the last decade, no country in the world managed to trim its obesity prevalence. America’s waistline continues to expand and leads the countries with the highest obesity rates at a whopping 34.9 percent, but it isn’t the only country with an obesity problem.
The report found that Saudi Arabia, the United Arab Emirates, Mexico and South Africa rounded out the top five heaviest nations in the world. In China’s largest metropolises, more than half of the population was also found to be overweight.
“It seems that many of the emerging markets that are on this phenomenally fast growth trajectory are on an even faster obesity trajectory,” said Richard Dobbs, head of the McKinsey Global Institute and one of the authors of the study, in an interview with NPR.
Obesity was once a problem only for relatively prosperous developed economies, but as incomes rise in the emerging world, the problem is spreading. Today, roughly 60 percent of the world’s obese people are in developing countries.
And if current trends continue, the report predicts that 41 percent of adults in the world will be overweight by the year 2030.
The Impact on Health Care Costs
The estimate annual medical cost of obesity in the U.S. alone was $147 billion in 2008, and the medical costs for people who are obese were $1,429 higher than those of normal weight, the CDC reported. The McKinsey Institute found that the global cost for obesity is even higher, estimating that obesity costs the world more than $2 trillion every year, roughly the same economic impact as smoking or an armed conflict.
A large chunk of that number is due to “productivity costs,” as people who are obese often work less, needing to take more time off due to illness.
The McKinsey Institute report assessed the productivity lost to obesity using the standard measurement of disability-adjusted life years, or DALYs, which measure the number of years that are lost or rendered economically unproductive due to the disease.
The number of DALYs lost to obesity today is three times as high in developed economies as it is in emerging markets. But that gap is slowly narrowing. The rise in the number of DALYs per 100,000 lost because of obesity decreased in developed economies between 1990 and 2010 but soared by 90 percent in emerging economies.
Obese individuals also suffer from shortened life spans, and obesity is responsible for around 5 percent of global deaths. According to the World Health Organization, about 3.4 million adults die every year because they are overweight or obese.
However, as health care systems improve, many people who are overweight or obese are living longer lives. The catch though, is that they are costing the systems that much more.
As obese individuals tend to get sick more often and are prone to a number of diseases linked to their weight, their overall quality of life is significantly reduced, leading to many more trips to the doctor’s office or hospital.
Solutions to Tackle Obesity
The McKinsey study found that “no single solution creates sufficient impact to reverse obesity: Only a comprehensive, systemic program of multiple interventions is likely to be effective.”
By reviewing around 500 obesity-reduction research trials around the world, the McKinsey Institute report identified 74 interventions to address obesity in 18 areas. These included subsidized school meals, calorie and nutrition labeling, restrictions on advertising of high calorie food and drinks and public health campaigns.
According to Dobbs, an effective program to combat obesity would likely need to be “a combination of top-down corporate and government interventions, together with bottom-up community led ones,” though the study’s authors note that there is still much to be learned on how to combat obesity.
“Rather than wait for perfect proof of what works, we should experiment with solutions, especially in the many areas where interventions are low risk,” the study concluded. “We have enough knowledge to do more.”
Driving sustainability in medical device production
Environmental protection and stewardship are rapidly rising to the top of the corporate agenda and medical device businesses are no exception. The healthcare sectors of the United States, Australia, Canada, and England combined emit an estimated 748 million metric tons of greenhouse gases each year, an output greater than the carbon emissions of all but six nations worldwide. In order to curb this situation various European standards have been introduced.
The Waste Electrical and Electronic Equipment (WEEE); Restriction on Hazardous Substances (RoHS); Registration, Evaluation, and Authorisation of Chemicals (REACH) and the Energy Using Products (EuP) regulations have all significantly altered manufacturing processes, specific labelling, compliance with disposal restrictions, and creation of instructions for end-of-life management and recycling.
At the moment many medical devices are currently exempt from these regulations but several directives, including RoHS and WEEE, are in the process of being reviewed and could be applicable in future. This is especially relevant for devices that are ‘connected’ and have a digital monitoring component which then brings them under the regulatory purview of authorities that govern devices with electronic components.
Safety, Usability and Sustainability
While medical device manufacturers have been working to respond to increasing demand for environmental sustainability from the market, they also have to contend with a key element of their mission: to ensure safety and usability to healthcare workers and patients. Parenteral and other invasive devices are strictly regulated to help reduce the risk of Healthcare Acquired Infection which typically runs as high as 5% and 8% in most developed countries, according to the European Centre for Disease Prevention and Control. As a result, they typically contain disposable single-use plastic elements.
At the same time, many hospitals and purchasing organisations have started to recognise that sustainable purchasing practices play a pivotal role in reducing costs over time. Many GPOs have appointed and empowered Senior Directors of Environmentally Preferred Sourcing who are successfully implementing the sustainable purchasing business case. In addition global pharmaceutical companies are increasingly creating senior positions with sustainability objectives as key to the role.
Medical device disposal is a particularly burning issue; generally carried out through incineration in the EU, it typically releases nitrous oxide, as well as known carcinogens including polychlorinated biphenyls, furans and dioxins. Some of the strategies trialled by manufacturers to reduce waste matter destined to incineration include sterilisation and reprocessing.
Sterilisation, however, falls short on the environmental front, and may consume more energy and produce more emissions than incineration itself. In the United States for example, 50% of all sterile medical devices are sterilised with ethylene oxide but since this method releases harmful emissions, the US Food and Drug Administration is now encouraging the development of new methods or technologies. Many other established sterilisation methods use glutaraldehyde that is not only harmful to the environment but also tends to be regulated by strict usage and disposal rules such as COSSH guidelines.
Focus on Recycling
The outlook on recycling is changing significantly thanks to new research and technologies enabling, for example, monomer extraction. Recycled polymers can be broken down to their constituent monomers promoting an almost limitless recyclability of some polymers. In addition to this, Polyvinyl chloride (PVC), renewable polyethylene and polyethylene terephthalate (PET) can be recycled several times without losing critical properties.
Reducing the impact of packaging can also significantly reduce the materials that need to be dealt with through either waste or recycling. Packaging manufacturers are decreasing packaging volume by favouring sealed trays instead of pouches, laser-etching instructions directly on to the tray where regulation permits it, or reducing the number of components required overall. In addition to this, for recycling plans to be successful it important to have a full understanding of the practices surrounding device use and to establish, where possible, closed loop recycling systems that recover the waste materials from hospitals or patients and bring them back into the recycling process.
Sustainable Manufacturing: Technology and Research
Greater employment of fast degrading plastics or material from other sources is a key strategy to reduce harmful pollutants both at production and disposal stage. Bio-based materials can in fact offset the carbon emitted during processing as the monomer source grows, and a growing range of sources for bio based monomers -such as wood pulp or sugar cane- is available. However, when assessing the most suitable material for a part, the entire lifecycle of the product needs to be considered. For example: bio-degradable polymers can contaminate a recycling stream and emit methane when incinerated.
The use of environmentally friendly materials should also be supported by an increase in clean renewable energy sources. Lower energy consumption means fewer carbon emissions but also financial savings, making this an appealing measure for manufacturers. New technologies are proving a major gamechanger on this front, helping manufacturers marry their environmental stewardship with cost savings and efficiency. 3D printing, for example, can help develop optimum product moulds more quickly, refining production parameters to minimise raw materials volumes and maximising output productivity.
Similarly, ‘digital twin’ production software uses inline sensors to create a virtual, real-time mirror of the production environment to enable inline refinements. The objective is to achieve “zero defect”, waste-free manufacturing. In addition to this, LEAN manufacturing methodologies are already helping to optimise inventory management and reduce overproduction.
Sustainability by Design
It is increasingly clear that effective environmental sustainability in the medical device sector cannot exist without a full view of the product life cycle from concept development, material selection, design and engineering to manufacturing, packaging, transportation, sales, use, and end-of-life disposal. These evaluations are typically made for factors such as manufacturing efficiency, time to market, or safety and regulatory compliance, packaging and transportation costs, but should be extended to energy efficiency and environmental impact by means such as life cycle analysis.
In addition to this, with devices rapidly becoming more digitally connected, developers need to be aware that the costs of disposable electronics would simply not be viable, or indeed acceptable in the light of electronics disposal regulations. Design therefore should focus on creating a simple, repeatable interface between the two component sections so as not to impair the functionality or efficacy. As reducing waste and harmful emissions continues to exert businesses and governments globally, the medical devices industry cannot stand by. The environmental but also commercial implications of inaction are too serious and the array of solutions now available is exciting and diverse.