Download An Emphasis on Obesity Reduction Programs

Impacts of Impact Reporting: An
Emphasis on Obesity Reduction
Programs
Presentation By
David W. Hughes
Professor, Department of Applied Economics & Statistics
Clemson Institute for Economic and Community
Development, Clemson Extension Service, Clemson
University
www.clemson.edu/public/ciecd/
Presentation Outline
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Obesity Situation
Overview of Impact as a Concept
Application to Obesity: Key Concepts
Apply in a Logic Model Context
Obesity Situation
Obesity Situation
(CDC, www.cdc.gov/obesity/index.html)
• Well known national epidemic
• American society has become 'obesogenic,' characterized by
environments that promote increased food intake, non-healthful foods,
and physical inactivity.
• Body Mass Index >= 30
– (adult’s weight in kilograms divided by the square of his or her height in
meters)
– (5 feet, 9 inches min 203 pounds)
• Overall rate 26.7% (2009)
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Non-Hispanic blacks (36.8%),
Hispanics (30.7%),
< high school (32.9%)
aged 50--59 years (31.1%
60--69 years (30.9%)
Increase from 2006-08 rate of 25.6%
• 16.9% of children and adolescents aged 2–19 years are obese
Contributing Factors and Impacts
(www.cdc.gov/obesity/causes)
• Due to energy imbalance.
– eating too many calories and insufficient physical activity.
• genes, metabolism, behavior, built environment,
culture, and socioeconomic status all play roles.
• Health Impacts:
• Coronary heart disease, Type 2 diabetes, Cancers, Hypertension,
Stroke, Liver- Gallbladder disease, Osteoarthritis, respiratory and
Gynecological problems,.
• Economic Impacts:
– 9.1 % U.S. medical expenditures (1998)
– Also value of lost wages.
Overview of Impact as a Concept
Overview of Related Economic
Concepts
• Economic Impact Analysis:
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Usually policy impact or industry contribution
Mostly for economic development or agriculture
Multiplier based, turn over of $ in a given economy.
See Hughes, 2003.www.choicesmagazine.org
• Cost-Benefit Analysis
– Economists usually evaluate based on producer
surplus (extra profits) plus consumer surplus (extra
benefits beyond price paid).
– Can look at program cost vs. net cost avoided or net
benefits generated
Overview of Impact: Case Study
• Programmatic effectiveness:
– Can apply quantitative analysis examining a
dependent variable as explained by a set of causal
variables
– Causal variables
• The program (policy instrument to economist)
• Other variables attempting to control for “external factors”
– Approach is problematic concerning evaluating
extension programmatic activities for obesity
reduction (errors in variables issue)
Case Study Approach
• careful study of some social unit (as a corporation
or division within a corporation) that attempts to
determine what factors led to its success or
failure (wordnet.princeton.edu)
• in-depth investigation/study of a single individual,
group, incident, or community.
(en.wikipedia.org/wiki/Case_study)
• Does not using samples and following a rigid
protocol (strict set of rules) to examine limited
number of variables
Case Study Approach More
(Barkley cherokee.agecon.clemson.edu/case_study_research.pdf)
• “evaluation” of programmatic efforts with the
goal of identifying potential explanations for their
successes or failures.
• Exploratory and descriptive case studies,
examine the development and characteristics of
phenomena
– Objective: constructing hypotheses concerning cause–
effect relationships.
• Tests for causal relationships by comparing
generalizations from case studies’ findings with
the underlying theory
Application to Obesity: Key
Concepts
Literature on Smoking Cessation to
Applicable to Obesity Reduction Effort
• Time value of money because benefits of
cessation continued into the future.
• Rational consumer and time-inconsistent
behavior very pertinent.
• Tendency to use gross, not net, benefits.
• Advertising, product development
controversial roles.
• Government policy controversial (cheap food
= obesity argument).
Time Value of Money Key Concept
– Value of a stream of money overtime.
– Money saved (earned) in the future less valuable
than current money saved (earned).
– Invest $100 today to receive $105 one year from
today.
– Discounting of future savings or earnings the
flipside.
– Over several years, can add up annual savings
using discounting ($100 this year, $95.2 next year,
$90.7 following, etc).
What are Actual Cost-Benefits?
• Is over-eating by adults a rational decision?
– I.e., do they weigh the costs (health) vs. benefits (satisfaction) in a
rational way.
– As forward-looking consumers, overeaters trade off the happiness
gains from overeating against the costs of doing so.
– If so, what is the justification for public $s on education and
intervention?
• time-inconsistent behavior
– tend to realize immediate rewards and avoid immediate costs in a way
that does not maximize their long run well-being.
– Will loose 10 pounds next year by exercise and eating right then; when
the time comes to make the choice, no follow through. Inconsistent,
because the behavior I anticipated did not fit my actual future actions.
– eight of ten smokers in America wish to quit but most of the intentions
are not actualized, which indicates time-inconsistent smoking
preferences (Gruber and Koszegi, 2002).
Are Benefits “Net” or Gross?
• Gross benefits– aren’t benefits because do not
account for alternatives.
• Gross Benefits:
• calculate all costs (usually in a year) due to
diabetics, other obesity related health cost, count
as benefit from obesity reduction program.
• Net Benefits:
• comparing the lifetime costs and savings of
cohorts of 20-year-old obese to cohorts of “nonobese” of the same age.
Applying Concepts in a Logic
Model Framework
Logic Model Output Focus
Inputs
Outputs
Activities
Situation
What
we
invest
What
we
do
Outcomes
Participation
Short
Term
Medium
Term
Who we
reach
What the
short
term
results
are
Learning
Assumptions
Extension reporting focuses on outputs
Long
Term
What the What the
medium
long
term
term results
results
are
are
Conditions
Actions
External Factors
Logic Model Outcomes Focus
Inputs
Outputs
Activities
Situation
What
we
invest
What
we
do
Outcomes
Participation
Short
Term
Medium
Term
Who we
reach
What the
short
term
results
are
Learning
Assumptions
Case study allows focused on outcomes
Long
Term
What the What the
medium
long
term
term results
results
are
are
Conditions
Actions
External Factors
Impacts from measuring outputs
(Barefoot)
• Measuring outcomes implies measuring a
change in behavior
• Imparted knowledge does not mandate
behavior change
• Look at program outputs as the mechanism
for knowledge adoption and behavior change.
Evaluating Impacts: A Hypothetical
Example Focusing on Outcomes
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•
(O'Neill, 2008, Feb., JOE)
Net Benefits over time
Use the time value of money
Use net benefit approach
annual health cost:
– $13,243 with diabetes
– $2,560 without
– $10,683 savings
• Assume 20% of 1,000 program participants push back onset by 6
years.
• At 5% interest rate, present value of cost savings for one individual
would be $56,001
• $56,001 X 200 = $11,200,200
Do Extension Obesity Reduction Efforts
Have an Impact?
• Definite Maybe
• State Reports for 2007
• Noise in the data:
– Nutrition, Food Safety and Healthy Lifestyles
– Youth/Adult Obesity
– Not possible in many cases to filter out spending on other objectives
(such as food safety)
• Correlated per capita spending & FTEs per capita (2007) on
changes in obesity rates 2007-08.
• Data available for 47 States
– Spending:
-0.01935
– FTE (Non-research):
– Total FTE:
-0.15061
-0.04702.
A Call for More, Better Case Studies
• Opportunity Cost:
– Reporting takes time and other resources
– In it for the impact, not the reporting.
• Case Study
– Linking inputs to outputs to outcomes
– Historic Asset Mapping
• Use focus groups, surveys, other (?), to determine the
current and past programmatic landscape (extension and
other wise).
• Similar tools to determine impact of current program.
• Convert to monetary, other impacts using principles such as
net benefits, time value of money.
Supporting Case Studies in an Era of
Budget Challenges
• Partner with research colleagues
• Write case studies into grants, contracts
• Use case study results to:
– Publicize results, especially in the political process
(this program saved state government
$11,000,000 in medical spending)
– Improve future programmatic efforts.
Questions, Comments?
Thank You for Your Attention