Economic Evaluation of a School-Based Program for the Prevention of Childhood Obesity


Principal Investigator:

Veugelers, Paul J. (University of Alberta)


Ohinmaa, Arto E. (University of Alberta); Johnson, Jeffrey A. (University of Alberta).
Our previous research had identified the Annapolis Valley Health Promoting Schools project as very effective in preventing childhood obesity. If public health decision makers have better knowledge of program costs in relation to avoided health care costs due to prevented childhood obesity and its long-term complications, they will be more inclined to the broader implementation of the successful program. Our aim is to compare the prevention program costs with avoided health care costs due to obesity and its long-term complications. We propose data collection on program costs and students' health behaviour and body weights in schools with a program costs, prevented obesity, and avoided health care costs. A program that is effective in preventing childhood obesity, and cost saving may become a key instrument in curbing the obesity epidemic in Canada.

A. What program are we going to study?

The applicants are currently evaluating the effectiveness of the Annapolis Valley Health Promoting Schools (AVHPS) program that has been implemented in 22 schools in the Annapolis Valley Regional School Board in Nova Scotia. The project teams up education, health, recreation, and food industry sectors. It includes the development of healthy policies, practices, supportive environments, strong community leadership, partnerships, and personal skill development through education. Program practices include daily physical education, daily healthy and affordable lunches, no access to fast food or soft drinks at schools, education of health and nutrition, and access to after school physical activity facilities and programs. The AVHPS program is funded by the government of Nova Scotia. The applicants already secured funding to investigate whether the new policy is effective in the prevention of childhood obesity. Preliminary results are indicative of changes towards a healthier diet, more physical activity and less overweight in the program schools.

B. What is the potential impact of the program on healthy living at a population level?

Recognizing that of similar importance to policy decision makers are the questions of both the effectiveness and cost-effectiveness of such programs. To allow judgement of cost-effectiveness and to support decisions for broader implementation of successful programs, we propose an economic evaluation. The emerging need for economic evaluation of obesity prevention programs was highlighted in the recent CIHR-INMD workshop on Cost Effectiveness of Interventions for Preventions of Obesity held in Toronto in April 2008. 
The answer to the question of cost-effectiveness will be critical to broader implementation of similar school-based prevention programs across the country. The proposed research represents the first formal economic evaluation of school-based overweight prevention programs in Canada. The two existing US-based economic evaluations are of limited value for Canadian settings because of system differences. The proposed research may contribute to establishing a school-based program that is 1) effective in preventing overweight; 2) portable to other settings; and 3) proven to reduce future health care costs. A program with these three essential properties may become a key instrument towards the goal of curbing the overweight epidemic.

C. Why does this project require rapid consideration?

1. The principal applicant is currently evaluating the effectiveness of the AVHPS program through funding by CIHI/CPHI. This research includes data collection on diet, physical activity, and body weight of students in the 22 schools where the intervention is being implemented. The last data collection round is scheduled for the school year of 2009/2010. For the proposed economic evaluation of the program, additional data will need to be collected in control schools at the same time as the last wave of data collection in the intervention schools. As data collection in schools requires a number of steps of approval (1. the Health Research Ethics Board; 2. the Nova Scotia Department of Education; 3. the school boards involved; 4. schools; and 5. parents), preparations for this process have to start early in the school year 2008/2009.
2. The proposed evaluation requires cost data to be collected from all intervention and control schools. This additional data collection would have to take place throughout the 2009/2010 school year. This work requires detailed preparation and a subsequent array of permission steps (see above).
3. Results from the effectiveness evaluation of the AVHPS program are expected to be available by 2010. So as to be able to make a much stronger point on the program's effectiveness and to support policy make decisions on further funding for the AVHPS program and other school-based prevention programs, concurrent availability of cost-effectiveness data would be highly desirable.