title: Potential health gains and health losses in eleven EU countries attainable through feasible prevalences of the life-style related risk factors alcohol, BMI, and smoking: a quantitative health impact assessment.
abstract: Influencing the life-style risk-factors alcohol, body mass index (BMI), and smoking is an European Union (EU) wide objective of public health policy. The population-level health effects of these risk-factors depend on population specific characteristics and are difficult to quantify without dynamic population health models.
  
  
  
  For eleven countries-approx. 80 % of the EU-27 population-we used evidence from the publicly available DYNAMO-HIA data-set. For each country the age- and sex-specific risk-factor prevalence and the incidence, prevalence, and excess mortality of nine chronic diseases are utilized; including the corresponding relative risks linking risk-factor exposure causally to disease incidence and all-cause mortality. Applying the DYNAMO-HIA tool, we dynamically project the country-wise potential health gains and losses using feasible, i.e. observed elsewhere, risk-factor prevalence rates as benchmarks. The effects of the "worst practice", "best practice", and the currently observed risk-factor prevalence on population health are quantified and expected changes in life expectancy, morbidity-free life years, disease cases, and cumulative mortality are reported.
  
  
  
  Applying the best practice smoking prevalence yields the largest gains in life expectancy with 0.4 years for males and 0.3 year for females (approx. 332,950 and 274,200 deaths postponed, respectively) while the worst practice smoking prevalence also leads to the largest losses with 0.7 years for males and 0.9 year for females (approx. 609,400 and 710,550 lives lost, respectively). Comparing morbidity-free life years, the best practice smoking prevalence shows the highest gains for males with 0.4 years (342,800 less disease cases), whereas for females the best practice BMI prevalence yields the largest gains with 0.7 years (1,075,200 less disease cases).
  
  
  
  Smoking is still the risk-factor with the largest potential health gains. BMI, however, has comparatively large effects on morbidity. Future research should aim to improve knowledge of how policies can influence and shape individual and aggregated life-style-related risk-factor behavior.
authors: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. S.Lhachimi@Erasmusmc.nl.|Research Group for Evidence Based Public Health, Institute for Public Health and Nursing, University Bremen & Leibniz Institute for Epidemiology and Prevention Research, Bremen, Germany. S.Lhachimi@Erasmusmc.nl.|Department of Statistics and Mathematical Modeling, Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. S.Lhachimi@Erasmusmc.nl.|Department of Public Health, Heinrich Heine University, Duesseldorf, Germany. S.Lhachimi@Erasmusmc.nl.
authors: Stefan K
authors: SK
authors: Lhachimi
authors: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors: Wilma J
authors: WJ
authors: Nusselder
authors: Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.|Center for Prevention and Health Services Research (PZO), National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors: Henriette A
authors: HA
authors: Smit
authors: Descriptive Studies and Health Planning Unit, Fondazione IRCCS "Istituto Nazionale Tumori", Milan, Italy.
authors: Paolo
authors: P
authors: Baili
authors: Department of Pharmacology & Therapeutics, Trinity Centre for health sciences, St James's Hospital, Dublin, Ireland.
authors: Kathleen
authors: K
authors: Bennett
authors: Tobacco Control Unit, Institut Català d'Oncologia-IDIBELL, L'Hospitalet de Llobregat Barcelona, Barcelona, Spain.|Department of Clinical Sciences, School of Medicine, Campus of Bellvitge, Universitat de Barcelona, Barcelona, Spain.
authors: Esteve
authors: E
authors: Fernández
authors: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Center for Prevention and Health Services Research (PZO), National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors: Margarete C
authors: MC
authors: Kulik
authors: IASO -the International Association for the Study of Obesity, IOTF -the International Obesity TaskForce, London, UK.
authors: Tim
authors: T
authors: Lobstein
authors: European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK.
authors: Joceline
authors: J
authors: Pomerleau
authors: Department of Statistics and Mathematical Modeling, Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Division of Human Nutrition, Wageningen University, Wageningen, Netherlands.
authors: Hendriek C
authors: HC
authors: Boshuizen
authors: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors: Johan P
authors: JP
authors: Mackenbach
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology / Q000401:mortality; D015992:Body Mass Index; D002908:Chronic Disease / Q000453:epidemiology* / Q000401:mortality; D000431:Ethanol / Q000008:administration & dosage / Q000009:adverse effects*; D005060:Europe / Q000453:epidemiology; D005062:European Union; D005260:Female; D062489:Health Impact Assessment; D006801:Humans; D015994:Incidence; D008017:Life Expectancy; D008019:Life Style; D008297:Male; D008954:Models, Biological; D009017:Morbidity; D009765:Obesity / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D015995:Prevalence; D011634:Public Health; D012307:Risk Factors; D012309:Risk-Taking; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology / Q000401:mortality
chemical_list: D000431:Ethanol
keywords: Alcohol; BMI; Health impact assessment; Life-style related risk-factors; Modeling; Smoking