PhD defence C.M. (Charlotte) Dieteren

Dissertation in short:

Currently, non-communicable diseases (NCDs) account for approximately 70% of all deaths worldwide. The ongoing rise in NCD rates is partly driven by aging populations but is also linked to an increase in unhealthy behavior, such as smoking, unhealthy nutrition, harmful alcohol consumption and physical inactivity. These unhealthy behaviors so far have been studied separately, while these behaviors mostly occur in combination. In addition, the modifiable character of unhealthy behaviors creates opportunities for health policies to stimulate health choice and hence improve public health.

The NCD burden is no longer a western problem. Of all NCD related deaths, 80% occur in low- and middle-income countries. The COVID-19 pandemic, which overwhelmed healthcare systems globally, emphasized the importance of heath behaviors as the COVID-19 virus has shared modifiable risk factors with common NCDs (e.g. obesity and smoking). 

To curb the rise in NCDs we must understand the distribution of unhealthy behaviors and health outcomes in the population and tackle these through the design of appropriate health policies. For prevention policies to be successful, they need to be accepted and adopted by the target population. 

This thesis provides insights in the distribution of unhealthy behaviors in low-, middle-, and high-income countries, assessed the relationship between health behaviors and health outcomes, and ends with the assessment of public preferences regarding health policies. 

The central objective of this thesis was to contribute to a better understanding of the relationship between health behaviors and health outcomes and explores public preferences for governmental health policies to improve public health.