Review Article

The Preventable Risk Integrated ModEl and Its Use to Estimate the Health Impact of Public Health Policy Scenarios

Table 2

Published results using the PRIME and earlier versions.

ScenarioPopulation of interestChanges to lifestyle parametersBaseline health burden (annual deaths, unless specified otherwise)1Primary scenario results (change in deaths per year)Secondary scenario resultsReference

Impact of 17.5% tax on foods containing saturated fatUK, 2003Total energy intake: +2.2%
Saturated fat: −0.13% energy (absolute)
Salt: +5.2%
Fruit and vegetables: −1.2%
CVD: 232,722CVD: +2,500 to +3,500Tax scenario based on nutrient profile model including saturated fat, salt, and sugar, annual deaths: −2,100 to −2,500[53]

Impact of 32.5% tax on unhealthy foods combined with 17.5% subsidy on fruit and vegetablesUK, 2005Total energy intake: +0.35%
Saturated fat: +0.84%
Salt: −0.45%
Fruitand vegetables: +10.95%
TOTAL: 198,552
CHD: 100,936
Stroke: 57,646
Cancer: 39,970
TOTAL: −3,689 to −6,435
CHD: −1,584 to −1,776
Stroke: −1,507 to −1,532
Cancer: −597 to −3,127
Percentage of weekly income lost to tax: lowest income quintile—0.86 (0.70, 1.01)
Highest income quintile—0.09 (0.07, 0.10)
[54]

Population achieves government recommendations for healthy dietUK, 2007Fruit and vegetables: 347 → 440 g/d
Fibre: 15.4 → 18.0 g/d
Total fat: 37.2 → 33.0% energy
Saturated fat: 14.1 → 10.0% energy
Salt: 8.9 → 6.0 g/d
TOTAL: 193,947
CHD: 91,458
Stroke: 53,186
Cancer: 49,303
TOTAL: −33,157 (−29,055, −37,246)
CHD: −20,800 (−17,845, −24,069)
Stroke: −5,876 (−3,856, −7,364)
Cancer: −6,481 (−4,487, −8,353)
Percentage of dietary related deaths averted in four countries of UK:
England: 13.8%
Scotland: 18.3%
Wales: 15.0%
Northern Ireland: 18.9%
[20]

Geographic inequality in dietary quality between Scotland and England is removedScotland, 2007–09Fruit and vegetables: 308 → 351 g/d
Fibre: 15.0 → 15.1 g/d
Total fat: 98.1 → 94.6 g/d
Saturated fat: 37.8 → 35.7 g/d
MUFA: 36.3 → 35.3 g/d
PUFA: 17.5 → 17.3 g/d
Dietary cholesterol: 268 → 265 mg/d
Salt: 7.5 → 7.0 g/d
TOTAL: 70,753
CHD: 28,029
Stroke: 15,999
Cancer: 26,725
TOTAL: −6,353 (−5,217, −7,957)
CHD: −3,575 (−2,896, −4,437)
Stroke: −1,299 (−615, −2,051)
Cancer: −1,479 (−1,170, −1,848)
Percentage of mortality gap between Scotland and England closed by removing dietary inequalities: 40% (33%, 51%) [56]

Population achieves diet with 50% less livestock products, balanced by increase in plant commoditiesUK, 2008Fruit and vegetables: 290 → 473 g/d
Fibre: 13.5 → 17.7 g/d
Total fat: 86.1 → 81.5 g/d
Saturated fat: 33.8 → 29.7 g/d
MUFA: 31.5 → 29.7 g/d
PUFA: 15.2 → 16.7 g/d
Dietary cholesterol: 227 → 153 mg/d
Salt: 6.2 → 6.0 g/d
TOTAL: 191,368
CVD: 141,240
Cancer: 50,128
TOTAL: −36,910 (−30,236, −43,616)
CVD: −28,674 (−22,001, −34,766)
Cancer: −8,236 (−5,798, −10,232)
19% reduction in UK agriculture GHG emissions and 42% reduction in land use.[55, 57]

Impact of a £2.72/tonne CO2e/100 g greenhouse gas tax on foods UK, 2010Fruit and vegetables: 344 → 344 g/d
Fibre: 13.1 → 13.1 g/d
Total fat: 84.2 → 82.4 g/d
Saturated fat: 32.5 → 31.6 g/d
MUFA: 31.0 → 30.3 g/d
PUFA: 15.3 → 15.2 g/d
Dietary cholesterol: 230 → 223 mg/d
Salt: 6.3 → 6.2 g/d
TOTAL: 179,615
CVD: 129,908
Cancer: 49,707
TOTAL: −1,207 (−1,003, −1,431)
CVD: −961 (−723, −1,211)
Cancer: −448 (−279, −613)
Annual reduction in GHG emissions: 18,683 ktCO2e (14,665, 22,889)
Annual revenue generated from tax: £2,023 m (£1,980 m, £2,064 m)
[22]

Population achieving optimal level of alcohol consumption to reduce alcohol-related chronic diseaseEngland, 2006Mean alcohol consumption in drinkers: 13.1 → 5.0 g/d
Percentage of nondrinkers in population: 29.0% → 29.0%
TOTAL: 170,617
CVD: 125,767
Cancer: 33,304
Liver cirrhosis: 5,783
TOTAL: −4,579 (−2,544, −6,590)
CVD: +843 (−1,085, +2,645)
Cancer: −2,668 (−2,103, −3,210)
Liver cirrhosis: −2,828 (−2,508, −3,072)
Impact of moving all nondrinkers into current alcohol consumption distribution on annual deaths: +3,160 (−436, +6,409)[13]

Impact of 10% tax on sugar-sweetened beveragesIreland, 2007Total energy intake: −2.1 kcal/d (−1.7, −2.6)Number of people with BMI ≥ 30: 495,300Number of people with BMI ≥ 30: −6,170 (−4,240, −8,060)Percentage reduction in obesity by subgroups
Low consumers: −0.5% (−0.3%, −0.6%)
Regular consumers: −3.3% (−2.3%, −4.4%)
Low income: −0.6% (−0.4%, −0.8%)
High income: −0.7% (−0.5%, −1.0%)
[52]

Impact of 20% tax on sugar-sweetened beveragesUK, 2010Total energy intake: −4.0 kcal/d (−5.2, −2.7)Number of people with BMI ≥ 30: 13,877,000Number of people with BMI ≥ 30: −180,400 (−247,100, −109,500)Percentage reduction in obesity by subgroups
Lowest income: −1.3% (−2.0%, −0.3%)
Highest income: −2.1% (−2.9%, −1.3%)
16–29: −7.6% (−8.6%, −6.4%)
30–49: −1.3% (−1.7%, −0.8%)
50+: +0.2% (−0.2%, +0.5%)
[51]

Population achieves government recommendations for healthy dietCanada, 2004Fruit and vegetables: 460 → 963 g/d
Fibre: 19 → 36 g/d
MUFA: 12.7 → 14.4% energy
PUFA: 5.5 → 6.0% energy
Saturated fat: 10.2 → 10.0% energy
Salt: 9.0 → 5.8 g/d
TOTAL: 85,527TOTAL: −30,540 (−24,953, −34,989)
CVD: −24,711 (−19,432, −28,713)
Cancer: −5,829 (−3,985, −7,368)
[50]

Population increases fruit consumption by one portion per dayUK, 2011, adults aged 50 and overFruit and vegetables: 344 → 440 g/d (with 70% compliance)CVD: 95,153CVD: −8,500 (−6,200, −10,800)Impact of extending to population aged 30 and over, annual deaths: −8,800 (−6,500, −11,100)[40]

Only includes deaths from diseases where risk factors that are changed in the scenario are associated with mortality (e.g., diet-related cancers include colorectal cancer, mouth, larynx and pharynx cancer, stomach cancer, and lung cancer; alcohol-related CVD includes CHD, stroke, and hypertensive disease).