Transcript GPI Atlantic National Round Table on the Environment and

Genuine Progress Index for Atlantic Canada
Indice de progrès véritable - Atlantique
The Economic Impact of
Physical Inactivity:
Implications for Advocacy
Coalition for Active Living – Atlantic
Halifax, Nova Scotia, 13 April, 2007
Valuing a Healthy Population
GPI Population Health Reports include:
• Cost of Chronic Illness in Canada (focus on
preventable portion)
• Women’s Health in Atlantic Canada
• Income, Health and Disease in Canada; Equity
and Disease in Atlantic Canada
• Costs of Tobacco, Obesity, Physical Inactivity
• Cost of HIV/AIDS in Canada
• Economic Impact of Smoke-Free Workplaces
• Value of Care-giving
Costs of Chronic Disease: NS
->New Dept Health Promotion
• 60% medical costs = $1.2 billion / year
• 76% disability costs = $900 million
• 78% premature death costs = $900
million
• 70% total burden of illness = $3 billion
= 13% GDP
Cost of Chronic Illness in
Nova Scotia 1998 (2001$ million)
Circulatory
Cancer
Respiratory
Musculoskeletal
Endocrine
Nervous system
Mental
TOTAL:
Hosp.
Doctor
Drugs
Other
Total
Direct
Premat.
Death
DisTOTAL
ability
161.6
71.4
21.6
55.9
18.5
55.3
104.2
26.6
11.8
3.2
20.3
7.2
27.9
17.7
63.6
7.5
16.6
22.0
29.3
19.2
39.2
137.8
49.6
22.7
53.8
30.1
56.0
88.2
389.6
140.3
64.1
152.0
85.0
158.5
249.2
326.8
427.2
43.4
3.5
43.8
30.0
16.0
244.4
14.5
78.1
307.2
27.0
158.6
72.3
960.8
582.1
185.5
462.8
155.8
347.0
337.5
488.4
114.8
197.5
438.1
1,238.8
890.8
901.9
3,031.5
What Portion is
Preventable? Excess Risk
Factors Account for:
• 40% chronic disease
• 50% chronic disease mortality
• 25% medical care costs = $500 mill./yr
• 38% total burden of disease = $1.8 bill.
(includes direct and indirect costs)
Excess Risk Factors Account for
(% economic burden of disease)
• Tobacco:
10%
• Physical Inactivity:
7%
• Obesity:
5.5%
• High blood pressure:
5%
• Lack fruits/vegetables:
3%
• High blood cholesterol:
2.5%
• Alcohol:
2%
Costs of Key Risk Factors,
Nova Scotia (2001 $ millions)
Deaths
Direct
Indirect
Total
Tobacco
1,600
$188
$300
$488
Obesity
1,000
$120
$140
$260
700
$107
$247
$354
Physical
Inactivity
What underlying conditions
support & are necessary for
regular physical activity? E.g.:
1) Free time (incl. work-life balance)
2) Awareness of preventive value and worth
3) Volunteerism (e.g. after school sports coaching)
4) Facilities (e.g. parks, nature trails for walking
and running)
How are these conditions currently valued?
Our key indicator of wellbeing:
= “If the economy is growing we are better off”
• More work hours make economy grow
• More stress, more Prozac sales ($4 billion),
more cigarette sales, more fast food Anything can make economy grow - Juan
• “More” is always “better” vs balance
• Free time has no value
And its companion messages...
• Natural resource depletion makes
economy grow (vs nature trails)
• Economy can grow if poverty, inequity
grow = Affects physical activity (lifestyle
interventions ineffective for low-income)
• Volunteer, unpaid work =no value.
So 12.3% decline no policy attention
• Fossil fuels, GHGs make economy grow
And health....
• Sickness = growth industry. Canada spends
$103 billion/year treating sickness - up by
6.5% /year since 1998 = double 1980
• Diabetes up 5-fold globally. Lilly: “You’ve got
to be in diabetes”
• vs. Prevention = 2% of health budget
Current measures send misleading
signals to policy makers, public
Why does this matter for
physical activity?
The power of indicators =
• reflect values,
• determine policy agenda,
• affect behaviour (students)
If we don’t count and measure physical
activity in our core measures of progress, it
has no “value.” Necessary conditions will
not be given priority in policy agenda.
What are the consequences
for physical activity?
•
Volunteer time, free time getting
squeezed out
•
N.S. = 30,000 fewer volunteers than in
1997 = decline of 10.7% (sport coaching?)
•
Statcan = working moms =75 hour week
“Time poverty” vs balance
Key conditions of physical activity
undermined - All un-noticed!
Total Work Hours, Full-time
couple with children, Canada
1900
2000
Male, paid work
58.5
42
Female, paid work
--
36.5
Male, unpaid work
N.A.
22.4
Female, unpaid work 56
33.6
Total work hours 114.5
134.5
By contrast, GPI sees health
promotion, physical activity as
investment in human capital
(Change language – vs “cost”)
What are the costs of
physical inactivity?
• 90% greater chance of heart disease if
inactive. 1/3 of heart disease could be
avoided if all Nova Scotians were
physically active.
• 20% stroke, hypertension, colon cancer,
type 2 diabetes, 27% of osteoporosis,
11% breast cancer, could be eliminated
by becoming physically active.
• Links to depression, mental health
Costs of physical inactivity
• Inactivity costs NS $107m (direct) + $247m
(indirect) = $350m/year
• More than 700 Nova Scotians die
prematurely every year because they are
physically inactive = 9% of all early deaths.
• Every year 2,200 potential years of life are
lost in N.S. due to physical inactivity
Replicated for HRM, B.C.
The Good News: Annual
Savings from 10% Reduction
in Physical Inactivity ($millions)
• Hospital, physician, drug costs
$4.6
• Total direct health costs
$7.5
• Economic productivity gains
$17.2
(avoided premature death and disability)
Total annual economic savings
$24.7
• Lives saved / year
50
• Years of life gained / year
156
Costs of obesity
• Obesity: 56% diabetes 2 in NS
attributable to obesity; 37%
hypertension; 22% heart disease; 24%
gallbladder disease; + stroke, cancers
(colorectal, endometrial, postmenopausal breast), arthritis etc.
• Obesity costs NS health care system =
$120m/year (6.8% budget) + $140m
indirect productivity losses = $260m
• 39% N.S. overweight (BMI = >27)
50% Nova Scotians are inactive
(2005). Only 21% physically active
(CCHS) (3 kcal/kg/day), age 12+, 2001 (%)
30
21
21
20
20
23
21
17
16
17
17
15
10
5
BC
Al
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ar
io
M
an
it o
ba
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B
N
S
N
I
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N
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C
Percent
25
27
26
T R E N D S:
• % exercising regularly in NS now stagnant
after improvement in 1990s (63% inactive
1994, 52% 1998, 50% now).
• Improvement among women but decline
among men (43% inactive 1998; 48% today; cf
60%->52% fem). Gap closing fast
• All 4 Atlantic provs rank below Cdn average
• Obesity = more than doubled; childhood
asthma, obesity up sharply
Obesity Trends* Among U.S. Adults
BRFSS, 1985
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
BRFSS – Behavioural Risk Factor Surveillance System - CDC
Obesity Trends* Among U.S. Adults
BRFSS, 1986
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1987
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1988
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1989
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1990
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1991
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1992
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1993
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1994
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1995
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1996
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 2001
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2002
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2003
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 1995, 2005
(*BMI 30, or about 30 lbs overweight for 5’4” person)
1995
1990
2005
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
The Economic Case for
Physical Activity:
Implications for Advocacy
• Physical inactivity is costly (health care costs,
productivity losses) – reaches non-health
officials: E.g. Cost of Chronic Disease -> OHP
• Changing language: ‘Cost’ to ‘Investment’ /
‘Rate of return’ – the Capital Approach
• Beyond lifestyle to underlying social causes –
free time/volunteering, income/equity, etc.
Costs of overwork
• US: $100 billion cost due to work fatigue:
accidents, errors, productivity, health
• Valdez, Chernobyl ($300b), 3-Mile Island,
Bhopal, road accidents (trucking - 50%+)
• Sleep down 25%, 15% clinical insomnia,
CVD, gastrointenstinal (ulcers = 2-8x)
• Family stress: shift work 60% + divorce
Time Stress
• Statistics Canada 1999: Longer hours -> more
smoking, poor diet, unhealthy weight gain, +
less physical activity
• F-t working mothers - 75-hour week,
(invisible when ignore unpaid work - women
2x labour force; 2/3 housework)
• Effect on diet (Harvard longit. study)
• Stress: Overworked and underworked - equal
risk of heart attack (Japanese study)
= Economics as if People
did not Matter
• The more we produce and consume,
the “better off” we are
• Growing economy = “healthy,” robust
economy. Shopping is patriotic
• Vs health as balance. Security, health,
community, environment, free time,
volunteerism, recreation have no value
Translate to Advocacy: What
can we do about this?
• How can we assign free time,
volunteerism, health, the natural
environment their true value?
• How can we give physical activity the
attention it deserves?
• Clare O’Conner (HSF) on using the
economic case / GPI #s to change policy
1) We can change the way
we measure progress
What we measure:
 reflects what we value as a society;
 determines what makes it onto the
policy agenda;
 influences behaviour
Good indicators can
help Nova Scotians:
 foster common vision and purpose;
 identify strengths and weaknesses;
 change public behaviour;
 hold leaders accountable at election
time
 initiate actions that promote wellbeing
In Genuine Progress Index:
 Health, security, free time, education, unpaid
work (voluntary + h’hold), have value
 Sickness, crime, disasters, pollution are costs;
so reductions in crime, poverty, GHGs,
ecological footprint are progress
 Human, social, natural capital valued
 Growing equity signals progress
Valuing Voluntary Work
• Nova Scotians give 140 million hrs of
voluntary work/yr = 73,000 FTE jobs
• Worth nearly $2 billion /year to NS
economy (use at Volunteer Awards)
• Nationwide decline in volunteer work
cost Canadians $2 billion in lost services
in 2000
= Invisible in conventional accounts
Implications for Advocacy: Point
to Cost-Effective Interventions
- E.g.: School-based smoking prevention =
At least 10:1
– WIC nutrition program - 3:1
– Counselling pregnant women (LBW) - 5:1
– Workplace interventions: 2: 1 etc
2) New policy initiatives that
address underlying causes
Learning from the Europeans, rather than
compare with US: US passed Japan with
longest hours - rapid growth at expense of
quality of life
• Scandinavia - family-friendly work top concern
• Germany = 6 weeks vacation; Denmark = 5 1/2
Making Part-time Work
Desirable
• Netherlands: 1,370 paid work hours / yr
Canada: 1,732 paid work hours / year
• Non-discrimination law: equal hourly pay,
pro-rated benefits, equal promotion opp.
• Netherlands: unemployment 12.2% —> 2.7%
- Highest rate of part-time in OECD
- Involuntary part-time = 6% = <1/6 Atlantic
- New bill gives workers “right” to reduce hrs
Value/expand free time: Danes
have 11 hrs more free time each
wk than Canadians
50
45
40
35
30
25
20
15
10
5
Source: Andrew Harvey, “Canadian Time Use in a Cross-National Perspective,” Statistics in Transition,
November, 1995
0
Un p a id Wor k
Fr ee T i m e
Bu l ga r i a
Ca n a d a
U.S.A .
U.K.
Fi n l a n d
Den m a r k
25.6
24.3
25
24.4
21.9
16.8
33
35.4
36.7
40.5
41.1
46
Sharing the Work Can...
• Reduce unemployment, underemployment
and overwork
• Improve work-life-family balance and
health; enhance recreation opportunities
• Increase free time and community service
• Protect the environment, spare the planet
from over-consumption, natural resource
depletion
3) Physical Activity and Equity
• Education, income, employment,
social networks are key determinants
of health, recreation participation
• Lifestyle interventions effective for
higher income/education groups, not
lower = can widen inequity, health gap
• Low-income = higher rates all risk
factors; lower activity /participation
Heart Health Costs of
Poverty
• Higher risk smoking, obesity, physical
inactivity, cardiovascular risk = costly
• York U: 6,366 Canadian deaths; $4 billion
health care costs / year are attributable to
poverty-related heart disease
• NS could avoid 200 deaths, $124 million
per year if all Nova Scotians were as heart
healthy as higher income groups
Health Costs of Poverty
• Most reliable predictor of poor health,
premature death, disability: 4x more
likely report fair or poor health = costly
• e.g. (1) Increased hospitalization:
Men 15-39 = +46%; 40-64 = +57%
Women 15-39 = +62%; 40-64 = +92%
Health Cost of Inequality
• BMJ: “What matters in determining
mortality and health is less the overall
wealth of the society and more how evenly
wealth is distributed. The more equally
wealth is distributed, the better the health
of that society.”
• e.g. Sweden, Japan vs USA.
• Canada, NS more unequal since early 1990s –
implications for health?
Costs of Socioeconomic
Inequality in Nova Scotia
• Use of physician services:
– No high school
= +49% than degree
– High school diploma = +12% more
– Lower income
= +43% than higher
– Lower middle income = +33% more
Excess Physician Use
(=small fraction total costs)
• Educational inequality = $42.2 million
= 17.4% of total
• Income inequality
= $27.5 million
= 11.3%
= costs avoided if all Nova Scotians were
as healthy as higher income / university
If we explicitly value...
• Our free time and true value of physical
activity
• The time we spend with family and children
• Our voluntary contributions to community
• Health and Equity
Then we will naturally explore policy options
that are currently not on the political agenda
By including these values in
our core measures of progress
We can draw attention to models that:
– go beyond superficial coping, stress
relief
– can improve health and wellness
– quality of our lives, expand physical
activity opportunities
Can we do it?
Percentage Waste Diversion in Nova Scotia
60
% Diversion
50
40
30
20
10
0
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Can it be
done?...1900s/1980s...
Valuing physical activity to
improve wellbeing and
leave a better world for our
children
Genuine Progress Index for Atlantic Canada
Indice de progrès véritable - Atlantique
www.gpiatlantic.org