8.2. Limitations

If not otherwise specified, and similarly to most of the literature on cost-effectiveness analysis in public health, analyses generally take a health system perspective, regardless of the payer. This means that costs and effects are usually focused on what matters most for a health system. While some analyses, for example those on labour market outcomes and the broader economy, take a broader system perspective, any cost and benefit is usually calculated with regards to the additional impact that a healthier population may have on these dimensions. As a consequence, and if not otherwise specified in the study, the analyses do not generally consider certain dimensions including, for example: * Costs for other governmental institutions and private institutions or individuals that are not directly related to the implementation of the public health action. So, for example, costs for police enforcing an intervention are generally included but any cost related to justice, lobbying and litigation to avoid the implementation of policies, or to contrast action to avoid the implementation, may not be included; * Any additional burden (e.g. the broader social burden) and long-term consequence that are not explicitly mentioned in the analysis; * Any perceived or real pleasure at the individual level related to engaging in an activity or lifestyle that has a negative impact on health; * Any impact on dimensions related to individual and societal benefits that derive from third parties’ exposure to unhealthy lifestyles and risk factors to population health; * Any transfer related to the implementation of the public health actions such as any revenue from a tax, as well as any expenditure originating from a subsidy; * Certain substitution effects that could result from the implementation of the intervention.