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ACTIONS FOR POLICY AND IMPLEMENTATION

• Investment in health promotion, such as nutrition care, is worthwhile, and primary care is an ideal setting in to ensure return on investment.
• Nutrition care is effective in the short term at improving health outcomes but requires upfront investment beyond usual care to ensure sustainable integration into primary care services.
• Nutrition care should be considered in primary care planning by governments and health care commissions.

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RESEARCH CONTEXT

Having a poor diet accelerates the development of three of the five most common causes of death in Australia. Guidelines for healthy eating exist, yet few Australians eat in line with those guidelines. Promoting healthy eating in primary care is seen as a ‘smart buy’ by the World Health Organization, because of the frequency that individuals interact with this setting. In primary care, nutrition care refers to any action by a health professional that aims to support individuals to improve their diet.  

Researchers from the Healthy Primary Care team at Griffith University have explored the cost-effectiveness of nutrition care in primary care settings. Data on cost-effectiveness was collated based on the differences in cost and effect between nutrition advice and/or counselling compared to usual care. The results were interpreted using the cost-effectiveness plane (Figure 1).

Figure 1: Cost-effectiveness plane and quadrant descriptions

The review included nine studies and showed that over time periods of 3-24 months, a person who is eating healthier may have fewer visits to health professionals, reduced medications, and feel more productive and able to better contribute to society. Eight of the nine studies reported that nutrition care was more effective and more costly than usual care (potentially cost-effective). Being more costly than usual care is not surprising due to the increased costs of labour and intervention materials. What was surprising was that costs fell below recommended thresholds for investment (Willingness-To-Pay thresholds) in six of nine studies, indicating that nutrition care in primary care settings may be worthy of investment. Cost-effective strategies included: incorporating nutrition care in usual consultations, investing in technology that supports positive dietary behaviours between consultations, and funding for dietitians working in primary care.  

The benefits of eating healthier can take time to emerge and are widespread in nature. Benefits are felt by multiple parties, including governments, general businesses, health insurance and services, individual people through lower health care spending (via taxes), and improved quality of life and economic productivity. However, widespread benefits mean that the upfront cost of supporting patients to eat healthily is not directly returned to one investor. Still, the cost of not investing in regular support for healthy eating will be felt mostly by individuals through poorer health outcomes and increased use of health services.

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