Essais sur l'économie de l'obésité, de la nutrition et l'activité physique

Une alimentation saine et activité physique (AP) régulière sont des facteurs déterminants des trajectoires de santé au cours de la vie. Ces facteurs influencent la santé par leur capacité à améliorer la composition corporelle, la santé musculo-squelettique et les performances physiques et cognitives des individus, ainsi qu’à prévenir les maladies métaboliques telles que l’obésité, le diabète et les maladies cardiovasculaires. Bien que les bienfaits de la nutrition et de l’AP pour la santé soient souvent étudiés séparément, il apparaît de plus en plus évident que leur intégration présente des avantages par rapport aux stratégies se focalisant uniquement sur l’un ou sur l’autre. Cette thèse vise à fournir un examen empirique des causes et conséquences des investissements individuels de santé. Plus précisément, elle se focalise sur l’étude des déterminants des choix alimentaires ainsi que sur la compréhension de l’impact de l’activité physique sur la santé des individus. Le fil conducteur de ce travail est la mise en avant du rôle crucial joué par l’interaction des agents économiques avec leur environnement dans leur choix de santé.Healthy nutrition and physical activity are key lifestyle factors that determine health trajectories during life.They modulate lifelong health through their ability to improve body composition, musculoskeletal health, and physical and cognitive performance, as well as to prevent metabolic diseases including obesity, diabetes mellitus, and cardiovascular disease across the lifespan. While the health benefits of nutrition and PA are of-ten studied singularly, it has become more and more evident that the integration of nutrition and PA has the potential to produce greater benefits when compared to strategies focusing solely on one or the other. This thesis aims to provide an empirical examination of the causes and consequences of health investments. More specifically, it focuses on exploring determinants of diet choices and on understanding the effects of physical activity on health outcomes. The common link across each chapter relies on recognizing the importance of the interaction of economic agents and their environment

Into the Far West? Investigating Health Policy-Makers' Willingness to Adopt Decrementally Cost-Effective Innovations Using a DCE Approach

In a context of increasingly limited resources, a number of strategies, such as the adoption of decrementally cost-effective interventions (d-CEIs), which are both less clinically effective and less costly, could offer potential levers at enhancing both efficiency and equity in healthcare systems. These interventions are located in the SouthWest (S-W) quadrant of the cost-effectiveness plane, and have yet received little attention from researchers or HTA agencies as they are often perceived as per se "unethical" or "unacceptable", hence the reference sometimes made to the S-W quadrant as the 'Far West'. The purpose of our paper is to investigate policy-makers' willingness to adopt d-CEIs using a choice experiment. We use a two-stage pairwise DCE survey to elicit (i) preferences for d-CEIs' attributes in forced choices and (ii) adoption preferences, i.e. the determinants of d-CEIs' adoption (unforced choices). We investigate the effect (and trade-offs) between three attributes: health loss (very small to significant), reversibility defined as the possibility to switch back to usual care (from possible to hardly possible) and cost-savings (from 5% to 15% of a fixed budget). Such trade-offs are contextualized by using two sensitivity attributes: disease severity (low and moderate) and savings uncertainty (low and high). Our final sample consists of 180 respondents with 46.7% originating from France and the remaining respondents from other EU countries. All attributes' levels have a significant effect in the two decision stages. The "health loss" attribute dominates in the first stage followed by "reversibility": we calculate that decision-makers would require 28.3% increase of budget savings to be indifferent between a scenario of small versus significant health losses and 14.5% budget savings to be indifferent between a scenario of possible and hardly possible reversibility. In contrast, the "reversibility" attribute dominates in the second stage suggesting that anticipated regret may play a role in adoption decisions

Into the Far West? Investigating Health Policy-Makers' Willingness to Adopt Decrementally Cost-Effective Innovations Using a DCE Approach

In a context of increasingly limited resources, a number of strategies, such as the adoption of decrementally cost-effective interventions (d-CEIs), which are both less clinically effective and less costly, could offer potential levers at enhancing both efficiency and equity in healthcare systems. These interventions are located in the SouthWest (S-W) quadrant of the cost-effectiveness plane, and have yet received little attention from researchers or HTA agencies as they are often perceived as per se "unethical" or "unacceptable", hence the reference sometimes made to the S-W quadrant as the 'Far West'. The purpose of our paper is to investigate policy-makers' willingness to adopt d-CEIs using a choice experiment. We use a two-stage pairwise DCE survey to elicit (i) preferences for d-CEIs' attributes in forced choices and (ii) adoption preferences, i.e. the determinants of d-CEIs' adoption (unforced choices). We investigate the effect (and trade-offs) between three attributes: health loss (very small to significant), reversibility defined as the possibility to switch back to usual care (from possible to hardly possible) and cost-savings (from 5% to 15% of a fixed budget). Such trade-offs are contextualized by using two sensitivity attributes: disease severity (low and moderate) and savings uncertainty (low and high). Our final sample consists of 180 respondents with 46.7% originating from France and the remaining respondents from other EU countries. All attributes' levels have a significant effect in the two decision stages. The "health loss" attribute dominates in the first stage followed by "reversibility": we calculate that decision-makers would require 28.3% increase of budget savings to be indifferent between a scenario of small versus significant health losses and 14.5% budget savings to be indifferent between a scenario of possible and hardly possible reversibility. In contrast, the "reversibility" attribute dominates in the second stage suggesting that anticipated regret may play a role in adoption decisions