1

CIn Work|ng aper: opu|at|on-based Approaches to keduc|ng

Non-commun|cab|e D|seases and In[ur|es: a kev|ew of the Lv|dence

ne|en Saxen|an
November 29, 2013


1he key rlsk facLors for nCus and ln[urles can be clusLered lnLo behavloral and envlronmenLal rlsk facLors,
whlch are poLenLlally modlflable, non-modlflable rlsk facLors such as someone's age and genes, and
physlologlcal rlsk facLors (llgure 1). 1he focus of Lhls worklng paper ls on modlflable behavloral and
envlronmenLal rlsk facLors LhaL can be addressed aL a populaLlon-wlde level Lhrough broad publlc
pollcles. 1hese rlsk facLors are prlnclpally causes of !"#$% nCus, wlLh Lhe excepLlon of household alr
polluLlon from Lhe use of solld fuels such as flrewood, dung, and oLher agrlculLural resldues, as well as
charcoal and coal. Pousehold alr polluLlon causes slgnlflcanL dlsease burden ln chlldren (lower
resplraLory LracL lnfecLlons prlmarlly) ln addlLlon Lo causlng adulL chronlc dlsease. CovernmenLs can
adopL speclflc populaLlon-wlde measures Lo reduce Lhe growlng Lra[ecLory of burden of nCus and
ln[urles ln low- and mlddle-lncome counLrles.
I|gure 1 ke|at|onsh|ps among key r|sk factors for ma[or NCDs and |n[ur|es



a
leLal orlglns llnked Lo Lhe moLher's healLh and nuLrlLlon LhaL ralse Lhe rlsk of nCus laLer ln llfe are noL
modlflable from Lhe affecLed lndlvldual's polnL of vlew, buL maLernal healLh and nuLrlLlon can be
lmproved over Llme and Lhls rlsk facLor can be reduced.
b
MedlcaLlons are avallable LhaL can reduce Lhe level of rlsk from Lhese rlsk facLors.
c
ulabeLes ls boLh a condlLlon and an lmporLanL rlsk facLor for oLher condlLlons.
Source: AdapLed from llgure 23-4 ln earson 1, !amlson u, 1re[o-CuLlerrez !, 1993.
2



1he loss ln llfe expecLancy from some of Lhese rlsk facLors ls large (1able 1). Smokers ln Lhe unlLed SLaLes
are esLlmaLed Lo lose over 10 years of llfe expecLancy compared Lo non-smokers, afLer conLrolllng for
age, educaLlonal levels, adlposlLy, and alcohol consumpLlon (1able 1). SLopplng smoklng before Lhe age
of 40 can dramaLlcally cuL Lhe rlsk (!ha , 8amasundaraheLLlge C, Landman v eL al., 2013). Chlnese
women llvlng ln moderaLely polluLed clLles lose an esLlmaLed 4 years of llfe expecLancy compared Lo
women ln clLles wlLh good alr quallLy (Wen M, Cu u, 2012). 1hls dlfferenLlal, lnLeresLlngly, ls much
reduced for men. 1he reducLlon ln llfe expecLancy from obeslLy has also been esLlmaLed by body mass
lndex (8Ml). lor Lhose morbldly obese (8Ml of 40-30 kg/m
2
), Lhe loss of llfe expecLancy approaches LhaL
of a smoker (rospecLlve SLudles CollaboraLlon, WhlLlock C, LewlngLon S, eL al., 2009). Whlle obeslLy
ofLen recelves much aLLenLlon as a rlsk facLor, poor dleLary quallLy and physlcal lnacLlvlLy are rlsk facLors
for obeslLy as well as rlsk facLors ln and of Lhemselves for hearL aLLacks, sLrokes, and cancers.

1ab|e 1. L|fe Lxpectancy Losses from Smok|ng, A|r o||ut|on, and Cbes|ty: I|nd|ngs from Se|ected
Stud|es
8lsk
lacLor
Llfe LxpecLancy uecllne opulaLlon noLes SLudy
Smoklng Smokers lose aL leasL 10 years
of llfe expecLancy compared Lo
nonsmokers. CessaLlon can
greaLly reduce Lhe rlsks.
CessaLlon before Lhe age of 40,
for example, ls esLlmaLed Lo
decrease Lhe rlsk of deaLh
assoclaLed wlLh conLlnued
smoklng by abouL 90.
u.S. adulLs Pazard raLes
ad[usLed for age,
educaLlonal
levels, adlposlLy,
and alcohol
consumpLlon
!ha ,
8amasundaraheLLlge
C, Landsman v eL al.,
2013.
Alr
polluLlon
Comparlng clLles ln Chlna wlLh
good alr quallLy versus
moderaLely polluLed clLles, Lhe
auLhors flnd losses ln llfe
expecLancy of almosL 4 years
for women aL age 63, and
almosL 1 year for men aL LhaL
age.
Clder
Chlnese
adulLs
ConLrolled for
soclodemographlc
facLors.
Wen M, Cu u, 2012.
CbeslLy lor boLh sexes, aL age 60, llfe
expecLancy decllne of 1-2 years
for 8Ml 27-30, 2-4 years for
8Ml 30-33, and 8-10 years for
8Ml 40-30 (measured ln
kg/m
2
).
37
prospecLlve
sLudles of
900,000
adulLs
ConLrolled for
age, sex, smoklng
sLaLus, and sLudy
rospecLlve SLudles
CollaboraLlon,
WhlLlock C,
LewlngLon S, eL al.,
2009.



3


We have classlfled Lhe populaLlon-wlde lnsLrumenLs LhaL governmenLs can use Lo alLer ma[or rlsk facLors
for nCus and ln[urles and Lo prevenL ln[urles lnLo four groups: (1) LaxaLlon/subsldles, (2)
regulaLlon/leglslaLlon, (3) measures Lo lnfluence Lhe bullL envlronmenL (and how people respond Lo lL)
and lnfluence behavlors ln Lhe home, schools, and workplace, and (4) empowermenL of consumers wlLh
beLLer lnformaLlon. Some of Lhese lnsLrumenLs have mulLlple purposes beyond healLh, such as
addresslng cllmaLe change or generaLlng revenue.
WPC ldenLlfled and cosLed an essenLlal package of besL buy" populaLlon-wlde lnLervenLlons LhaL
address Lobacco use, harmful use of alcohol, and poor dleLary quallLy and physlcal lnacLlvlLy (1able 2).
1hese besL buy" lnLervenLlons rely on Lhree Lypes of lnsLrumenLs: LaxaLlon, regulaLlon/leglslaLlon, and
lnformaLlon. 1he slngle mosL lmporLanL lnLervenLlon ln Lhls package ls Lobacco LaxaLlon. SLeadlly
phaslng ln lncreaslng Lobacco Laxes would averL mllllons of ulsablllLy-Ad[usLed Llfe ?ears (uAL?s) due Lo
Lobacco use. lor all low- and mlddle-lncome counLrles, Lhe besL buy" lnLervenLlons are esLlmaLed Lo
cosL abouL $2 bllllon annually (uS$2011). 1hey are all recommended on Lhe basls of Lhelr cosL-
effecLlveness, lmpacL on healLh ouLcomes, feaslblllLy, and low lmplemenLaLlon cosLs. 1he Commlsslon
on lnvesLlng ln PealLh fully endorses Lhls essenLlal package. 1he dlscusslon LhaL follows dlscusses Lhese
lnLervenLlons and oLher prlorlLy measures avallable Lo governmenLs Lo reduce nCus and ln[urles. 1he
dlscusslon ls organlzed by Lype of measure, raLher Lhan by rlsk facLor.
1ab|e 2. Lssent|a| ackage of "8est buy" opu|at|on-8ased Intervent|ons for NCD k|sk Iactors
Government
Instrument
Spec|f|c Intervent|ons
1axat|on Large Lobacco Lax lncreases (reachlng over Llme aL leasL 70 exclse Lax ln flnal
consumer prlce)
Large alcohol Lax lncreases (excepL ln Lhe few counLrles wlLh very low lncldence of
harmful alcohol use).
kegu|at|on]|eg|s|at|on Smoke-free lndoor workplaces and publlc places, bans on Lobacco adverLlslng and
promoLlon. Warnlngs abouL Lobacco's harm.
8esLrlcLlons/bans on alcohol markeLlng, resLrlcLlons on reLall sales.
8egulaLlon Lo reduce salL conLenL ln processed foods, Lrans faLs bans or volunLary
reducLlons.
8etter |nformat|on PealLh lnformaLlon abouL Lobacco.
Mass medla campalgns abouL salL reducLlon.
ubllc awareness program abouL dleL and physlcal acLlvlLy.
Source: WPC. Scallng up AcLlon AgalnsL noncommunlcable ulseases: Pow Much Wlll lL CosL? 2011.
1axat|on and Subs|d|es
1axes on alcohol, Lobacco, and fuel have long been a ma[or source of revenue generaLlon worldwlde.
lncreaslngly, LaxaLlon ls recognlzed as a powerful lever Lo reduce rlsks from exposure Lo or consumpLlon
of unhealLhy producLs. Subsldles can lncrease Lhe rlsks of nCus and ln[urles (e.g. peLroleum and coal
subsldles LhaL resulL ln lncreased alr polluLlon) or, less commonly, reduce Lhe rlsks of nCus and ln[urles
(subsldles for healLhy school lunches, subsldles for healLhy foods or nuLrlenLs ln food voucher programs).
1able 3 esLlmaLes Lhe share of Cu from Lobacco and alcohol Laxes ln selecLed counLrles. 1hese shares
vary wldely by counLry. 1obacco Lax revenue as a share of Cu ls Llny ln Chana (0.02) buL closer Lo 2
4

ln 8ulgarla. Alcohol Laxes are very small ln nlgerla, where Lax revenue ls domlnaLed by oll revenue, buL
over 1 of Cu ln 8wanda and 1halland. 1here ls conslderable scope for lncreaslng Lhe use of alcohol
and Lobacco Laxes Lo boLh reduce consumpLlon and lncrease overall revenue.
1ab|e 3. 1obacco and A|coho| 1axes as a ercentage of GD |n se|ected countr|es
1obacco A|coho|
Armenla 0.34 0.33
8ulgarla 1.81 0.40
Chlle 0.60 0.38
Colombla 0.11 0.67
Chana 0.02 0.19
!ordan 0.92 0.19
kenya 0.39 0.68
kyrgyzsLan 0.16 0.37
MaurlLlus 0.29 0.86
nlgerla 0.07 0.09
eru 0.04 0.32
hlllpplnes 0.13 0.13
oland 1.17 0.46
8usslan lederaLlon 0.32 0.38
8wanda 0.14 1.01
1halland 0.62 1.03
ukralne 1.01 0.32
noLes: 1obacco esLlmaLes refer Lo 2012, exclse Laxes only.
Source: WPC for Lax revenue, World 8ank for Cu.
Alcohol esLlmaLes refer Lo 2012, exclse Laxes only.

Lconom|c rat|ona|e for taxat|on. lrom an economlc sLandpolnL, Lhe case for governmenL lnLervenLlon
Lo Lax commodlLles such as Lobacco, alcohol, fuels, and unhealLhy food and beverages resLs on Lhe ldea
of markeL fallures. Such consumpLlon generaLes negaLlve exLernallLles, and, ln some cases, consumers
are noL fully lnformed of Lhe consequences of consumpLlon. 1obacco ls addlcLlve, and many Lobacco
users are noL fully cognlzanL of Lhe addlcLlve naLure of lLs consumpLlon and lLs healLh consequences,
especlally youLh (!ohnsLon v, LlberaLo S, 1homas u, 2012). lurLhermore, Lobacco consumers also
lmpose cosLs on oLhers Lhrough second hand smoke and Lhrough socleLal healLh care cosLs.
1he economlc raLlonale for LaxaLlon of alcohol ls slmllar. Alcohol use affecLs Lhe drlnker's healLh buL
also Lhe healLh of oLhers, someLlmes causlng vlolenL ln[urles Lo oLhers, or affecLlng feLal developmenL
when pregnanL women consume lL. Large socloeconomlc cosLs lnclude healLh care expendlLures, Lhe Loll
on famllles and communlLles, reduced workers' producLlvlLy, and Lhe lnvolvemenL of Lhe legal sysLem.
1he consumpLlon of gasollne and oLher fossll fuels also generaLes negaLlve exLernallLles-noL [usL from
Lhe healLh consequences of polluLanLs, buL also Lrafflc-relaLed ln[urles, cllmaLe change, and Lrafflc
congesLlon.
3

A raLlonale for Laxlng unhealLhy foods and beverages ls suggesLed by Lhe evldence LhaL some consumers
have dlfflculLy maklng raLlonal dleLary cholces because Lhey do noL undersLand Lhe close llnks beLween
poor dleL and healLh, or are Llme lnconslsLenL (havlng a preference for shorL Lerm graLlflcaLlon over
longer Lerm well belng). lurLhermore, under lnsurance, lndlvlduals do noL bear Lhe full cosLs of Lhelr
dleLary cholces. CbeslLy was recenLly esLlmaLed as accounLlng for close Lo 21 of healLh care cosLs ln
Lhe unlLed SLaLes (Cawley !, Meyerhoefer C, 2012).
A full beneflL cosL analysls (8CA) of reduclng alcohol, Lobacco, or unhealLhy food and beverage
consumpLlon uslng Laxes would quanLlfy Lhe &'()(*+' -&)&.+%s from Lhe Lax ln Lerms of: (1) reducLlons
ln healLh cosLs (medlcal care) and ln welfare cosLs (e.g. reduced crlme from lowerlng alcohol use), (2)
reducLlons ln labor and producLlvlLy losses from reduced lll healLh, and (3) reducLlons ln paln, sufferlng,
and loss of llfe Lo Lhe user and oLhers, as approprlaLe (e.g. from second hand smoke). Cn Lhe '(/%/ /+"&,
Lhe 8CA would lnclude: (1) Lhe cosLs of lmplemenLlng Lhe Lax, (2) Lhe [ob losses and oLher damage Lo
lndusLry, and (3) Lhe deadwelghL loss," l.e., Lhe consumer loss from Lhe Lax LhaL ls noL Lransferred Lo
Lhe governmenL ln Lhe form of Lax revenue. 8CAs may also be used Lo ldenLlfy Lhe dlsLrlbuLlonal
consequences of proposed Lax changes. Such analyses are more complex Lo carry ouL Lhan cosL-
effecLlveness analyses buL generaLe lnformaLlon LhaL can be compared across secLors. 1o daLe, almosL
all economlc analyses of nCu and ln[ury lnLervenLlons have used cosL-effecLlveness analyses.
Wu8 1993 summarlzed Lhe evldence on Lobacco LaxaLlon aL Lhe Llme as follows: a 10 prlce lncrease ln
Lobacco would be expecLed Lo reduce consumpLlon by abouL 4 ln Lhe populaLlon overall and by
slgnlflcanLly more ln adolescenLs. now Lhere are more Lhan 100 sLudles, lncludlng evldence from low-
and mlddle-lncome counLrles, showlng how Lobacco exclse Laxes can boLh generaLe rellable Lax revenue
as well as reduce Lobacco use (Chaloupka l, ?urekll A, long C, 2012). ln Lhe hlllpplnes, for example, a
10 lncrease ln prlce ls esLlmaLed Lo reduce consumpLlon by abouL 3 (Culmbo S, Casorla A, Mlguel-
8aqullod M, Medalla l, xu x, Chaloupka l, 2012). 1he evldence ls sLronger Loday Lhan ln 1993 Lo show
LhaL lncreaslng Lobacco Laxes ls llkely Lo be Lhe slngle mosL lmporLanL measure LhaL governmenLs can
Lake Lo address nCus. Lxclse and oLher Laxes make up abouL 63 of Lhe average prlce of clgareLLes ln
hlgh lncome counLrles, falllng Lo 31 ln upper-mlddle lncome counLrles, 47 ln lower-mlddle lncome
counLrles, and 41 ln low lncome counLrles (Chaloupka l, ?urekll A, long C, 2012). WPC recommends
LhaL Lhe Lobacco exclse Lax make up aL leasL 70 of Lhe flnal reLall prlce. 1ax lncreases would generaLe
slgnlflcanL flscal revenues for governmenLs. A recenL sLudy esLlmaLed LhaL for Chlna, lndla, Lhe
hlllpplnes, 1halland, and vleLnam, Laxes LhaL resulLed ln a 30 prlce lncrease would reduce Lhe number
of currenL and fuLure smokers by almosL 67 mllllon, would decrease Lobacco deaLhs by 27 mllllon, and
would generaLe over $24 bllllon ln addlLlonal revenue annually. 1hese revenue lncreases averaged 0.3
of Cu (!ha , 8enu !, Ll u eL al., 2012). lncreases ln Lobacco Laxes noL only lmprove healLh, Lhey also
lmprove governmenL's flscal balances.
1obacco Laxes dlsproporLlonaLely affecL Lhe poor, because of Lhelr lower dlsposable lncome. 1herefore
some economlsLs and oLhers have argued agalnsL Lobacco Laxes on Lhe grounds LhaL such Laxes are
regresslve. 8uL looklng aL Lhe full consequences of Lobacco LaxaLlon, boLh shorL and long Lerm, lL ls clear
LhaL Lhe healLh beneflLs also dlsproporLlonaLely accrue Lo Lhe poor. ln addlLlon, sLopplng or reduclng Lhe
use of Lobacco can provlde slgnlflcanL beneflLs ln Lerms of flnanclal proLecLlon: nCus laLer ln llfe
aLLrlbuLed Lo Lobacco could bankrupL a poor famlly Lhrough medlcal ouLlays and loss ln lncome.
As wlLh Lobacco, consumers respond Lo alcohol prlce changes. 1he cheaper Lhe alcohol ls, Lhe more lL ls
consumed and Lhe greaLer Lhe relaLed harm. llnland cuL lLs alcohol Laxes by 33 ln 2004, when
nelghborlng LsLonla [olned Lhe Luropean unlon. 1he llnnlsh governmenL feared LhaL, wlLhouL Lax cuLs,
cheaper alcohol would be lmporLed from nelghborlng LsLonla, reduclng Lax revenue from alcohol sales
ln llnland and causlng unemploymenL ln lLs domesLlc alcohol producLlon secLor. 1he Lax cuLs led Lo a
6

large fall ln Lhe prlce of alcohol, afLer whlch alcohol consumpLlon lncreased 12 and overall alcohol-
relaLed morLallLy lncreased by 16 among men and 31 among women (PerLLua k, Makela ,
MarLlkalnen , 2008).
1ax lncreases are a hlghly cosL effecLlve measure Lo reduce LoLal alcohol consumpLlon and Lhe number
of eplsodes of heavy drlnklng, especlally ln young people. 1he analysls on alcohol ln Lhe ulsease ConLrol
rlorlLles ln ueveloplng CounLrles sLudy (2
nd
edlLlon) concluded LhaL LaxaLlon was Lhe slngle mosL cosL-
effecLlve populaLlon-level sLraLegy Lo reduce Lhe harmful use of alcohol ln Lurope and CenLral Asla, LaLln
Amerlca and Lhe Carlbbean, and Sub-Saharan Afrlca, all reglons wlLh a slgnlflcanL prevalence of hlgh-rlsk
drlnklng (8ehm !, Chlsholm u, 8oom 8, Lopez A, 2006). Powever, some economlc sLudles argue LhaL
populaLlon level alcohol Laxes lmpose a subsLanLlal efflclency cosL because mosL harmful drlnklng ls
llmlLed Lo a small segmenL of Lhe populaLlon.
1here ls much less experlence wlLh Laxes on unhealLhy food and beverages (oLher Lhan alcohol). 1he
rlsk of nCus ls reduced by Lhe promoLlon of a dleL LhaL lncludes flsh and seafood, whole gralns, frulLs
and vegeLables, nuLs, vegeLable olls, and moderaLe dalry lnLake, whlle llmlLlng sLarches, reflned gralns,
sugars, processed meaLs, lndusLrlally process Lrans faLs, and salL (Mozaffarlan u, Afshln A, 8enowlLz n eL
al., 2012). Several counLrles have lnLroduced, or are conslderlng lnLroduclng, Laxes on unhealLhy food
and drlnk.
uenmark lnLroduced Lhe flrsL faL Lax," l.e. a Lax on saLuraLed faLs (Laxed per kg of saLuraLed faL ln meaL,
cheese, buLLer, and oLher foods), wlLh Lhe alm of decreaslng consumpLlon of saLuraLed faLs by 4 ln
2011 (Smed, 2012). Powever, Lhe Lax was crlLlclzed for Lhe hlgh admlnlsLraLlve cosLs of lmplemenLaLlon
(born prlmarlly by Lhe food lndusLry) and for how lL spurred consumers Lo shop for food ln oLher
counLrles. 1he Lax on saLuraLed faLs was laLer revoked aL Lhe end of 2012, and aL Lhe same Llme, Lhe
uanlsh governmenL announced lL was cancelllng plans for a sugar Lax (SLafford, 2012).
1ab|e 4. D|etary nab|ts to keduce the k|sk of NCDs
Lat L|m|t
llsh and seafood SLarches, reflned gralns, sugars
Whole gralns Sugar sweeLened beverages
lrulLs rocessed meaLs
vegeLables lndusLrlally rocessed 1ransfaLs
nuLs SalL
vegeLable Clls
ModeraLe ualry
Sources: Mozaffarlan u, Appel L, van Porn L, 2011, Mozaffarlan u, Afshln A, 8enowlLz n eL al., 2012.

ln laLe 2011, Pungary lncreased a Lax on cerLaln sofL drlnks, energy drlnks, pre-packed sweeLened
producLs, salLy snacks, and condlmenLs. lrance lnLroduced a Lax on sugar-sweeLened and arLlflclally
sweeLened beverages ln 2012. llnland relnLroduced Laxes on sweeLs and lncreased Laxes on sofL drlnks
ln 2011 (LPA, 2012). llnland's Sugar 1ax Worklng Croup, ln lLs llnal 8eporL Lo Lhe MlnlsLry of llnance,
noLed LhaL changes ln consumpLlon from Lhe exclse duLles of sweeLs are dlfflculL Lo forecasL (Sugar 1ax
Worklng Croup, 2013). WlLh lncreased Laxes, some of Lhe decrease ln consumpLlon of sugar-conLalnlng
producLs could be replaced wlLh oLher unhealLhy producLs such as salLy snacks (Sugar 1ax Worklng
Croup, 2013. A sLudy of sofL drlnk LaxaLlon ln lreland esLlmaLed a 10 decrease ln consumpLlon for each
10 lncrease ln prlce (8ahl 8, 8lrd 8, Walker M, 2003). A recenL revlew of Lhe evldence found LhaL
modellng Lhe lmpacL of food and beverage Laxes on dleL and healLh ouLcomes ls greaLly llmlLed by Lhe
7

daLa avallable. 1axes would llkely need Lo be slzeable (aL leasL 20) Lo slgnlflcanLly change behavlors.
1axes would need Lo be carefully deslgned, conslderlng subsLlLuLlon effecLs from unLaxed foods (MyLLon
C, Clarke u, 8ayner M, 2012). ollcy would need Lo be gulded by research on Lhe effecL of such Laxes
and Lhelr feaslblllLy ln dlfferenL counLrles and dlfferenL culLural conLexLs.
Whlle Lhere ls less avallable evldence and experlence on LaxaLlon of unhealLhy foods and beverages Lhan
on Lobacco and alcohol, cross-cuLLlng lessons are emerglng from LaxaLlon of all of Lhese commodlLles.
1axes need Lo be evaluaLed ln Lerms of efflclency, equlLy, and slmpllclLy (mlnlmlzlng boLh publlc
admlnlsLraLlon cosLs and prlvaLe compllance cosLs). 1ax avoldance (Lhrough loopholes) and Lax evaslon
(Lhrough smuggllng) need Lo be consldered. lor speclflc commodlLles, exclse Laxes are generally easler
Lo admlnlsLer Lhan sales Laxes. 1axes and prlce lncreases need Lo be slgnlflcanL Lo make Lhe needed
changes ln consumpLlon and need Lo be ad[usLed regularly for lnflaLlon. 1ax deslgn needs Lo conslder
Lhe range of relevanL producLs and Lhe changes ln consumpLlon LhaL consumers mlghL make lf a Lax ls
lmposed ln only one area (e.g., from sugar-sweeLened beverages Lo salLy, hlgh faL snacks). ?ouLh and
low lncome populaLlons Lend Lo respond mosL Lo prlce lncreases on unhealLhy foods and beverages,
Lobacco, and alcohol.
Lnergy subsldles on fossll fuels such as coal, gasollne, and dlesel are wldespread and have slgnlflcanL
healLh and economlc consequences. Subsldles encourage excesslve energy consumpLlon wlLh Lhe
resulLanL lncrease ln amblenL parLlculaLe maLLer polluLlon LhaL causes lower resplraLory lnfecLlons (ln
chlldren), and cancers, hearL dlseases, and chronlc obsLrucLlve pulmonary dlsease ln adulLs. 1he lMl
recenLly esLlmaLed LhaL on a posL-Lax basls, energy subsldles amounLed Lo uS$1.9 Lrllllon ln 2011, or 2.7
of global Cu and 8.1 of governmenL revenue (ClemenLs 8, Coady u, labrlzlo S, eL al., 2013). Plgh
lncome counLrles amounL for 40 percenL of Lhe LoLal. Cll exporLers accounL for abouL one-Lhlrd.
8emoval of Lhese subsldles would drop CC
2
emlsslons by 13.
1hese Lypes of energy subsldles lncrease Lhe rlsks of nCus and damage Lhe envlronmenL. 1hey also
dlverL publlc resources away from spendlng LhaL could be more pro-poor, such as healLh lnLervenLlons
LhaL address lnfecLlous dlsease and nCus, and educaLlon, and soclal proLecLlon programs. Subsldy
reform, followed by approprlaLe Lax measures, would be prlorlLy measures for reduclng nCus. A recenL
CLCu reporL (2013) found wlde varlaLlons ln Lhe effecLlve Lax raLes per unlL of energy ln CLCu counLrles.
1here are also wlde varlaLlons ln effecLlve Lax raLes across Lypes of fossll fuels. 1he CLCu reporL found
LhaL, wlLh some excepLlons, counLrles wlLh sLeeper lmpllclL carbon Laxes Lend Lo have lower carbon
emlsslons per unlL of economlc acLlvlLy.
Lnergy subsldy reform, followed by approprlaLe Lax measures, should be a prlorlLy measure for reduclng
nCus (Aldy, 2013). lran had some of Lhe hlghesL energy subsldles ln Lhe world prlor Lo lLs 2010 energy
subsldy reform. Large fuel prlce lncreases reduced carbon dloxlde, sulfur dloxlde, and nlLrogen oxlde
emlsslons by 10-20 percenL. 1he governmenL accompanled Lhe reform wlLh cash Lransfers Lo
households LhaL were esLlmaLed, aL Lhe Llme, Lo reduce poverLy lncldence from 12 Lo 2 percenL. 1he
energy reform program was laLer suspended ln 2012 due Lo Lhe macroeconomlc slLuaLlon (ClemenLs 8,
Coady u, labrlzlo S eL al., 2013).
kegu|at|on]|eg|s|at|on
8ans on Lobacco and alcohol adverLlslng, Lhe deslgnaLlon of smoke free publlc places, resLrlcLlons on
access Lo reLalled alcohol, and Lhe esLabllshmenL and enforcemenL of drlnk drlvlng laws are well
recognlzed as lmporLanL elemenLs of comprehenslve efforLs Lo reduce Lhe rlsks from Lobacco smoklng
and alcohol use. WPC recommends resLrlcLlons on markeLlng of unhealLhy food and beverages Lo
chlldren buL adopLlon has been llmlLed Lo daLe. Sweden Look Lhe earllesL acLlon-ln 1991, lL banned all
8

Lelevlslon adverLlslng of food Lo chlldren. lood labellng has been wldely accepLed ln many counLrles. ln
response Lo Lhe rapldly rlslng raLes of obeslLy among school age chlldren ln Mexlco, Lhe governmenL
lnLroduced regulaLlon Lo lmprove access Lo safe waLer and healLhy foods ln schools, and Lo prohlblL
sugary drlnks and whole mllk (8lvera and Cordero, 2012).
Cne of Lhe mosL powerful and lmmedlaLe levers governmenLs can use Lo reduce dleLary rlsk facLors for
chronlc dlsease ls Lo regulaLe Lhe amounL of lndusLrlally processed Lrans faLs ln Lhe food supply.
uenmark was Lhe flrsL counLry Lo adopL such regulaLlon, ln 2004. loods cannoL have more Lhan 2 of
Lrans faLs. uenmark's pollcy has resulLed ln a remarkable fall ln Lhe grams of Lrans faL ln fasL food from
abouL 30 g per servlng ln 2001 Lo less Lhan 1 g ln 2006 (urosLby, 2008). ArgenLlna, AusLrla, 8razll, Chlle,
lceland, Sweden, SwlLzerland, new ?ork ClLy, and SouLh Afrlca have slnce Laken measures Lo reduce or
ellmlnaLe Lrans faLs from foods. A sLudy of Lhe Lrans faL conLenL ln popular fasL foods (Mcuonalds, klC)
ln 20 counLrles from 2004-03 found huge varlaLlons ln Lhe amounL of Lrans faL ln Lhe servlngs of slmllar
producLs, from less Lhan 1 gram ln uenmark and Ceorgla Lo 10 grams ln new ?ork ClLy and 24 grams ln
Pungary (dally lnLake of 3 grams of Lrans faL ls assoclaLed wlLh a 23 lncrease ln Lhe rlsk of lschemlc
hearL dlsease) (SLender S, uyerberg !, AsLrup A, 2006). Whlle Lhe amounL of lndusLrlally processed Lrans
faL has fallen ln Lhe unlLed SLaLes from volunLary acLlon ln Lhe food lndusLry, Lhe u.S. lood and urug
AdmlnlsLraLlon ls Laklng sLeps ln laLe 2013 Lo deLermlne lf lL should be ellmlnaLed (luA, 2013).
AnoLher focus of regulaLlon ls salL ln processed foods. WPC recommends LhaL consumpLlon be llmlLed
Lo less Lhan 3 grams of salL per day (or 2300 mg of sodlum) Lo reduce Lhe rlsk of cardlovascular dlsease
and sLroke. A recenL lnsLlLuLe of Medlclne reporL endorsed efforLs Lo lower excesslve sodlum lnLake, buL
found LhaL efforLs Lo lower sodlum lnLake Lo &0&) $(1&2 $&0&$/-less Lhan 1300 mg of sodlum per day-ls
noL supporLed by Lhe evldence on healLh ouLcomes (lnsLlLuLe of Medlclne, 2013). SouLh Afrlca has seL
maxlmum salL levels for bread, margarlne and spreads, savory soups, processed meaLs, soup powders,
and sLock cubes. 1he regulaLlon was a response Lo research showlng LhaL (a) bread accounLed for 40 of
salL lnLake ln SouLh Afrlca, and (b) reduclng salL ln bread Lo levels LhaL would noL affecL quallLy or LasLe
could prevenL 2,000 faLal and 2,300 non-faLal sLrokes annually, and 3000 deaLhs from lschemlc and
hyperLenslve hearL dlsease (8erLram M, SLeyn k, WenLzel-vll[oen L, 1ollman S, Pofman k, 2012). ln
SouLh Afrlca, Lhe regulaLlon was accompanled by Lechnlcal asslsLance provlded by mulLlnaLlonal
companles Lo small and medlum enLerprlses Lo help wlLh Lhe reformulaLlon of Lhe producLs (Alexander L,
?ach u, Mensah C, ?ep C, 2012).
lor amblenL parLlculaLe maLLer polluLlon, Lhere are several lmporLanL regulaLory measures LhaL
governmenLs can Lake. uependlng upon feaslblllLy of lmplemenLaLlon, four key measures are: (1)
requlremenLs for emlsslon conLrol devlces on new vehlcles, (2) sLandards for cleaner fuels, (3) lnspecLlon
and malnLenance of vehlcles, and (4) fuel efflclency sLandards ln vehlcles. ln areas where household
coal use ls common, bannlng of coal for household use-and enforcemenL of Lhe ban-ls lmporLanL.
1he lrlsh CovernmenL banned Lhe sale of coal ln uublln ln 1990. ln Lhe slx years afLer Lhe ban, Lhe
sLandardlzed resplraLory deaLh raLe fell by 13.3 and Lhe sLandardlzed cardlovascular deaLh raLe fell by
10.3. (Clancy L, Coodman , Slnclalr P, uockery u, 2002). 1hese reducLlons LranslaLed Lo abouL 116
fewer resplraLory deaLhs and 243 fewer cardlovascular deaLhs per year ln uublln afLer Lhe coal ban.
1he world's leadlng cause of ln[ury deaLhs are Lhose relaLed Lo LransporLaLlon. WlLhouL a change ln road
safeLy pollcles, Lhe World 8ank and WPC predlcL a large lncrease ln LransporL-relaLed deaLhs ln low and
mlddle lncome counLrles ln Lhe comlng years (WPC, 2004). Chlsholm u, nacl P, Pyder A, 1ran n, eden
M, 2012, modeled Lhe cosL-effecLlveness of sLraLegles Lo prevenL road Lrafflc ln[urles ln Sub-Saharan
Afrlca and SouLh LasL Asla and found LhaL a comblnaLlon of enforcemenL of speed llmlLs, drlnk-drlvlng
laws, and moLorcycle helmeL requlremenLs would be cosL-effecLlve. 1hese measures are feaslble Lo
lnsLlLuLe ln low and mlddle-lncome counLrles and can reduce deaLhs. lor example, vleLnam's passage of
9

a mandaLory helmeL law ln 2007 was accompanled by a 16 reducLlon ln Lhe rlsk of road Lrafflc head
ln[urles and an 18 reducLlon ln Lhe rlsk of road Lrafflc deaLhs (assmore !, 1u n, Luong M, Chlnh n,
nam n, 2010).
1he rlsk of oLher Lypes of ln[urles could be reduced wlLh regulaLory acLlons. Self-harm ls anoLher leadlng
caLegory of ln[urles, Lhe second mosL lmporLanL cause of ln[ury deaLhs afLer LransporLaLlon, wlLh a
parLlcularly hlgh burden among young women ln Chlna. 8egulaLlon Lo reduce access Lo leLhal meLhods
can play an lmporLanL role ln reduclng deaLhs from self-harm relaLed Lo Lhese meLhods. lor example, a
2003 sysLemaLlc revlew found evldence showlng a reducLlon ln sulclde deaLhs ln response Lo pesLlclde
resLrlcLlons, flrearm conLrol leglslaLlon, deLoxlflcaLlon of domesLlc gas, resLrlcLlng Lhe prescrlblng and
sale of barblLuraLes, changlng Lhe packaglng of analgeslcs Lo bllsLer packeLs, and mandaLory use of
caLalyLlc converLers ln cars (Mann !, ApLer A, 8erLoloLe ! eL al., 2003).
nome, schoo|, workp|ace, and bu||t env|ronment
nouseho|d a|r po||ut|on. Pousehold alr polluLlon from solld fuels falls beLween smoklng and exposure
Lo second hand smoke ln Lerms of lLs harm Lo healLh. Whlle Lhe lmproved blomass cooksLoves LhaL have
been promoLed ln recenL years can save on fuel, much cleaner Lechnologles wlll be needed before
healLh beneflLs are seen. 1yplcal household exposure Lo flne parLlculaLe maLLer (M
2.3
l.e. maLLer less
Lhan 2.3 m ln dlameLer), whlch ls more closely llnked Lo adverse healLh effecLs Lhan larger parLlcles,
from solld fuel use ls abouL 200 g/m
3
. LlLLle cardlovascular beneflL wlll resulL unLll very clean
lnLervenLlons are lnLroduced LhaL brlng down LoLal exposure Lo M
2.3
Lo under 33 g/m
3
(8aumgarLner
1, SmlLh k, Chockallngam A, 2012). Several measures can help promoLe Lhe subsLlLuLlon of solld fuels
wlLh cleaner Lechnologles, lncludlng lncreaslng access Lo elecLrlclLy. Lven Lhough cooklng everyLhlng
wlLh elecLrlclLy may be Loo expenslve for poor households, cerLaln lmporLanL cooklng Lasks-such use of
a hoL waLer keLLle or rlce cooker- could be wlLhln reach lf a household has access Lo elecLrlclLy.
CovernmenLs can supporL measures Lo expand access Lo llquefled peLroleum gas (LC) for cooklng (8ox
2 dlscusses lndonesla's move Lo replace Lhe use of kerosene wlLh LC for cooklng).
Schoo|s and Workp|aces. SLrong evldence suggesLs LhaL publlc healLh lnLervenLlons are mosL effecLlve
when Lhey are relnforced ln mulLlple slLes where people make cholces abouL nuLrlLlon, physlcal acLlvlLy,
and Lobacco use. 8lsks for nCus could be reduced wlLh wellness programs ln Lhe workplace and school
programs (educaLlonal currlculum, healLhy school lunches, physlcal educaLlon programs, physlcal acLlvlLy
breaks durlng lnsLrucLlon, playground spaces and equlpmenL). ln low lncome counLrles, ensurlng access
Lo safe drlnklng waLer ln workplaces and schools could reduce Lhe consumpLlon of sugar-sweeLened
beverages.

10

8ox 1! kep|ac|ng kerosene w|th ||quef|ed petro|eum gas (LG) for cook|ng
Whlle kerosene ls seen as a cleaner cholce for cooklng Lhan solld fuels (blomass and coal), some
kerosene devlces, especlally wlck sLoves used by poor communlLles for cooklng, can sLlll emlL slgnlflcanL
amounLs of healLh-damaglng polluLanLs. Whlle gaps remaln ln our knowledge of Lhe healLh lmpacL of
kerosene use for cooklng, enough ls known Lo promoLe Lhe replacemenL of kerosene wlLh cleaner
Lechnologles such as LC and elecLrlclLy wherever posslble (Lam n, SmlLh k, CauLhler A, 8aLes M, 2012).
ln an efflclenL markeL wlLh llghL Laxes on LC, Lhe World 8ank esLlmaLed LhaL cooklng and heaLlng waLer
wlLh LC would cosL a household abouL $13 per monLh, maklng lL a dlfflculL cholce for very poor
households (ko[lma, 2011). 8uL many households could afford LC lf pollcles were enacLed Lo make Lhe
LC markeL more efflclenL and lf Lhese efflclency galns could be passed on Lo Lhe consumer. unlversal
prlce subsldles on LC Lo promoLe lLs use are lnefflclenL. A far more efflclenL approach, adopLed ln
8razll and Lhe uomlnlcan 8epubllc, ls Lo lnclude asslsLance for purchaslng LC ln soclal safeLy neL
programs (ko[lma, 2011).
ln 2007, Lhe lndoneslan governmenL lnLroduced a pro[ecL Lo converL cooklng fuel from kerosene Lo LC
ln 30 mllllon households by 2011 ln order Lo achleve healLh and envlronmenLal beneflLs and Lo reduce
Lhe governmenL subsldy for peLroleum fuels. Whlle kerosene and LC are boLh subsldlzed ln lndonesla,
conslderlng Lhe energy equlvalence of Lhe fuels, and Lhe relaLlve subsldles, Lhe governmenL esLlmaLed,
based on 2006 daLa, LhaL lL would save abouL uS$2.2 bllllon annually from Lhe converslon (8udya and
ArofaL, 2011). 1he governmenL markeL LesLed lLs approach, before launchlng Lhe program ln !akarLa,
dlsLrlbuLlng free packages of a 3 kg LC cyllnder, a flrsL gas-flll, a one burner sLove, a hose, and a
regulaLor Lo ellglble households. As Lhe program expanded, and converslon packages were dlsLrlbuLed,
Lhe governmenL wlLhdrew Lhe supply of kerosene from Lhe area. 1hls kerosene Lo LC converslon
pro[ecL was faclllLaLed by Lhe facL LhaL lndonesla has [usL a slngle sLaLe-owned naLlonal oll company,
erLamlna, so coordlnaLlng Lhe dlsLrlbuLlon of LC was relaLlvely easy. 8y Lhe end of 2009, more Lhan
44 mllllon converslon packages had been dlsLrlbuLed ln 13 provlnces, ln 6 provlnces, all subsldlzed
kerosene had been wlLhdrawn (8udya and ArofaL, 2011).
1he bu||t env|ronment. 1he bullL envlronmenL, such as sLreeLs and sldewalks, lnfluences how safe and
accesslble lL ls Lo blcycllng, walklng, and Lhe pursulL of oLher physlcal acLlvlLy. 1hls envlronmenL can be
modlfled Lhrough sLreeL connecLlvlLy, sldewalk deslgn, dedlcaLed recreaLlon and exerclse spaces, seL-
aslde sLreeL space for recreaLlon on cerLaln days of Lhe week, and proxlmlLy Lo urban LransporL (8ox 2).
SeparaLlng four-wheeled vehlcles from pedesLrlans and blcycllsLs, englneerlng Lrafflc calmlng measures
Lo reduce speeds, and ldenLlfylng and correcLlng dangerous secLlons of roadway are lmporLanL measures
Lo reduce Lrafflc-relaLed ln[urles. 1he laLLer can be done ln low cosL ways, for example, placlng waLer
fllled barrels ln fronL of rlgld barrlers. Changes Lo Lhe bullL envlronmenL, such as Lhrough consLrucLlng
barrlers aL brldges and oLher [umplng slLes, can also reduce sulclde rlsk (Mann !, ApLer A, 8erLoloLe ! eL
al., 2003).
Lmpower|ng consumers w|th better |nformat|on
lnformaLlon can lmprove lndlvlduals' knowledge abouL Lhe healLh consequences of Lhelr cholces. Cver
Llme, more counLrles are supporLlng focused educaLlon campalgns and warnlngs on packaglng abouL Lhe
healLh consequences of Lobacco and alcohol use. LfforLs Lo change behavlor alone, wlLhouL Lhe
lnLroducLlon of beLLer sLoves, seem Lo have llLLle lmpacL on household alr polluLlon from solld fuels.

11





!















roducL labellng on foods ranges from slmple labels, lncludlng warnlngs, Lo deLalled lnformaLlon on
calorles and food composlLlon. Whlle sLudles suggesL LhaL provldlng lnformaLlon leads Lo consumers
havlng greaLer knowledge, lL appears Lo be relaLlvely lneffecLlve aL sLlmulaLlng behavlor change (Sacks C,
8ayner M, Swlnburn 8, 2009, Llbel C, 8ersh 8, 8rescoll v, ulxon L, 2009). Powever, Lhere ls evldence
LhaL producL labels have resulLed ln changes ln food lndusLry behavlor (Mozaffarlan u, SLampfer M,
2010). lor example, Canada and Lhe unlLed SLaLes have mandaLed Lhe declaraLlon of Lrans faL and
saLuraLed faL on food labels whlch has resulLed ln some volunLary reducLlon by manufacLurers ln Lhe
Lrans faL conLenL of Lhelr producLs (8aLnayake W, L'Abbe M, Mozaffarlan u, 2009). 1here ls some
evldence LhaL lnformaLlon on menus aL Lhe polnL of purchase modesLly lmproves food cholces, buL some
sLudles have shown LhaL food labellng may resulL ln hlgher energy lnLake ln cerLaln populaLlon
subgroups (Larson n, SLory M, 2009). 8uL lnformaLlon on menus may have an lmpacL on alLerlng Lhe
food lndusLry's cholce of producL lngredlenLs or menu opLlon cholces. lndla plans Lo lnLroduce
mandaLory labellng on Lhe Lrans faL and saLuraLed faL conLenL of cooklng olls. Chlle has lnLroduced
warnlng labels on processed foods hlgh ln faL, sugar, and salL.
ubllc lnformaLlon and educaLlon campalgns have also been LesLed as a way Lo reduce self-ln[ury.
Powever, Lhe research evldence Lo daLe shows LhaL whlle Lhese campalgns can lncrease awareness of
menLal lllness, Lhey have no deLecLable effecL on prlmary ouLcomes of decreaslng sulcldal acLs or on
lnLermedlaLe measures, such as more LreaLmenL seeklng or lncreased anLldepressanL use" (Mann !,
ApLer A, 8erLoloLe ! eL al., 2003).
8ox 2. Improv|ng the bu||t env|ronment |n 8ogot and Copenhagen
8ogoL, Colombla has a neLwork of 128 km of seL-aslde sLreeL space for recreaLlonal cycllsLs and
pedesLrlans on Sundays and holldays, called 3+'$(04! (cycleway"). 3+'$(04! allows resldenLs from all
socloeconomlc groups Lo be physlcally acLlve ln a safe envlronmenL. lL ls hugely popular and has
lnsplred efforLs ln oLher clLles, over 70 uS clLles have now lnsLlgaLed such cycleways (Plpp !, Lyler A,
kuhlberg !, 2012). 8ogoL's program has been accompanled by a blcycle paLh program called 3+'$(2#%!.
A recenL cross-secLlonal sLudy of Lhese Lwo programs found LhaL mosL 3+'$(04! parLlclpanLs (60) meL
recommended levels for physlcal acLlvlLy ln lelsure Llme and mosL 3+'$(2#%! parLlclpanLs (71) meL
Lhese levels by cycllng for LransporLaLlon (1orres A, SarmlenLo C, SLauber C, Zarama 8, 2012). Around 3
ln 10 3+'$(04! parLlclpanLs and half of 3+'$(2#%! users were of low socloeconomlc sLaLus. ln
Copenhagen, where blcycle lanes, speclal parklng, and Llmed Lrafflc llghLs all faclllLaLe and encourage
cycllng, more Lhan 33 of resldenLs blke Lo and from work. Concerns abouL cycllsLs' exposure Lo
parLlculaLe maLLer alr polluLlon and Lo Lrafflc accldenLs ln Copenhagen led Lo a recenL healLh lmpacL
assessmenL Lo quanLlfy Lhe overall healLh effecLs of lncreased cycllng (Polm A, Clumer C, ulderlchsen
l, 2012). 1he assessmenL found LhaL Lhe poslLlve healLh effecLs of Lhe physlcal exerclse ouLwelghed Lhe
negaLlve effecLs of polluLlon and accldenLs, a flndlng LhaL ls ln llne wlLh Lhe resulLs of oLher sLudles (ue
ParLog !, 8oogaard P, nl[land P eL al., 2010).

12

1he Way Iorward
AdopLlon of WPC's recommended besL buys" ouLllned ln 1able 2 would make a slgnlflcanL dlfferenL ln
reduclng Lhe currenL Lra[ecLory of Lhe growLh of nCus and ln[urles ln low- and mlddle-lncome counLrles.
1he Commlsslon on lnvesLlng ln PealLh sLrongly endorses Lhe lmplemenLaLlon of Lhese measures. Cf
Lhese, Lobacco LaxaLlon would have Lhe slngle greaLesL lmpacL. 1he besL buys" are relaLlvely
lnexpenslve and mosL counLrles would llkely have Lhe flscal capaclLy Lo fund Lhese acLlvlLles from Lhelr
own budgeLs. Several oLher prlorlLy lnLervenLlons Lo reduce nCus and ln[urles are dlscussed ln Lhls
paper, lncludlng energy subsldy reform, followed by approprlaLe Lax measures. Some counLrles have
redlrecLed parL of Lhe savlngs from Lhe reducLlon ln fossll fuel subsldles Lo cash Lransfer or oLher soclal
safeLy neL measures Lo poor households. CovernmenLs can also Lake measures Lo promoLe Lhe swlLch
from Lhe use of solld fuels ln Lhe home Lo cleaner fuels for cooklng and heaLlng, where solld fuel use ls a
problem. ln[ury prevenLlon can be addressed wlLh Lhe enforcemenL of speed llmlLs, drlnk drlvlng laws,
and moLorcycle helmeL use. 1axes on alcohol and Lobacco can reduce consumpLlon and be an
lmporLanL source of revenue for governmenLs. Some counLrles are now explorlng Lhe use of Laxes Lo
promoLe healLhler dleLs. lor example, several counLrles have lnLroduced Laxes on sugar-sweeLened
beverages. ollcy wlll needed Lo be gulded by research and evaluaLlon on Lhe effecLs of such Laxes and
Lhelr feaslblllLy ln dlfferenL counLrles and culLural conLexLs.
lnLernaLlonal agencles could help ln (a) maklng Lhe lnvesLmenL case for Lhese acLlvlLles, (b) provldlng
Lechnlcal asslsLance (such as on LaxaLlon, regulaLlon/leglslaLlon), (c) provldlng some flnanclng ln Lhe
pooresL counLrles Lo help lnLroduce Lhe lnLervenLlons and (d) helplng bulld Lhe evldence base for oLher
cosL-effecLlve populaLlon-wlde measures Lo address nCus and ln[urles.


13

8eferences
Aldy !. ueslgnlng energy and envlronmenLal flscal lnsLrumenLs Lo lmprove publlc healLh. Commlsslon on
lnvesLlng ln PealLh Worklng aper. 2013.

Alexander L, 8lrd 8, ?ach u, Mensah C, ?ep C. SLealLh revenLlon: epslCo 1ackles SalL as nCu
revenLlon SLraLegy. 5%!).(2" 6(#2)!$ (. 7#-$+' 8&!$%9: May 2012.

8ahl 8, 8lrd 8, Walker M. 1he uneasy Case AgalnsL ulscrlmlnaLory Lxclse 1axaLlon: SofL urlnk 1axes ln
lreland. 7#-$+' ;+)!)'& <&0+&1. 2003, 31: 310-333.
8aumgarLner !, SmlLh k, Chockallngam A. 8educlng cardlovascular dlseases Lhrough lmprovemenLs ln
household energy: An overvlew wlLh lmpllcaLlons for pollcy-relevanL research. =$(-!$ 8&!2% 2012,7: 243-
247.
8ecker C, Murphy k. A Lheory of raLlonal addlcLlon. 6(#2)!$ (. 7($+%+'!$ >'()(*?. 1988, 96: 673-700.

8erLram M, SLeyn k, WenLzel-vll[oen L, 1ollman S, Pofman k. 8educlng Lhe sodlum conLenL of hlgh-salL
foods: effecL on cardlovascular dlsease ln SouLh Afrlca. 5 @.2 A&" 6: 2012, 102:743-3.
8udya P, and ArofaL M?. rovldlng Cleaner Lnergy Access ln lndonesla 1hrough Lhe Megapro[ecL of
kerosene Converslon Lo LC. >)&2B? 7($+'? 2011,39: 7373-7386.
Cawley !, Meyerhoefer C. 1he medlcal care cosLs of obeslLy: an lnsLrumenLal varlables approach. 6
8&!$%9 >'(): 2012, 31:219-30.

Chaloupka l, ?urekll A, long C. 1obacco Laxes as a Lobacco conLrol sLraLegy. C(-!''( 3()%2($: 2012, 21:
172-180.
Chlsholm u, nacl P, Pyder A, 1ran n, eden M. CosL effecLlveness of sLraLegles Lo combaL road Lrafflc
ln[urles ln sub Saharan Afrlca and SouLh LasL Asla: maLhemaLlcal modellng sLudy. DA6: 2012, 344:e612.
Clancy L, Coodman , Slnclalr P, uockery u. LffecL of alr-polluLlon conLrol on deaLh raLes ln uublln,
lreland: an lnLervenLlon sLudy. C9& E!)'&%: 2002, 360: 1210-14.
ClemenLs 8, Coady u, labrlzlo S eL al. Lnergy Subsldy 8eform: Lessons and lmpllcaLlons. lMl, !anuary 28,
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