This is an archive copy of a document originally located at http://www.nphp.gov.au/sigpah/gaa/index.htm. All copyright remains with the creator.
Physical inactivity is responsible for an estimated 8,000 deaths per year in Australia, and costs the health system at least $400m in direct health care costs. In addition, the burden of disease study, conducted by AIHW, indicated that physical activity ranked second, only to tobacco control, among the most important factors in disease prevention in Australia. These data, point to an under-recognition of physical activity among risk factors, in terms of resources and attention.
A report examining the costs of physical inactivity was recently published by the Commonwealth Department of Health and the Australian Sports Commission. This report estimated the direct costs of physical inactivity in Australia (Stephenson et al. 2000). The findings are summarised in this chapter; the full report describes the methods used, and the conservative nature of assumptions made, compared with many other recent health costing studies.
The study identified that about one-half of the adult Australian population was insufficiently active for health gain, and that substantial morbidity could be attributed to this level of inactivity. The modeling strategies used were conservative, but estimated that the preventable fractions [amount of disease that could be prevented if the population were at least moderately active] were 18 per cent for coronary heart disease, up to 16 per cent for stroke, 13 per cent for non-insulin dependent diabetes mellitus (NIDDM), 19 per cent for colon cancer, between 9-12 per cent for breast cancer and up to 10 per cent for depression symptoms. Physical inactivity was found to contribute to more than 8,000 deaths in Australia each year, of which, 1,531 would occur in people under the age of 70 years and would represent an estimated 77,000 premature potential years of life lost because of inactivity. These deaths were considered avoidable if sedentary and insufficiently-active people adopted at least moderate, regular physical activity.
The annual, direct healthcare costs attributable to physical inactivity were about $400m each year. Indirect costs, including time off work and the social costs of inactivity would more than double this amount. The estimation of social and economic sector costs is very difficult, and would be based on a range of complex assumptions. Substantial further work may be needed to quantify these dimensions. Nonetheless, this direct costs analysis was conservative, as overseas studies have reported direct costing estimates about twice those reported in the Australian study, as a proportion of overall health expenditure.
The report presented an analysis of potential savings in direct health care costs if public health interventions were able to increase the proportion of the population that was physically active. The analysis indicated that gross savings of up to $8m in healthcare costs might be achieved for every one per cent gain in the proportion of the population that is sufficiently active. It was further estimated that more than $30m per year might be saved by increasing the proportion of adults active in the whole population by five per cent would be an achievable target in public health terms if sufficient resources were directed to physical activity (Bauman et al. 1996). Moreover, it was estimated that about 122 deaths per year from heart disease, diabetes and colon cancer could be avoided for every one per cent increase in the proportion of the population that achieved a level of sufficient and regular physical activity. These estimates indicated that one quarter of these deaths occurred in people under 70 years and that 1,764 life years could be gained for every one per cent increase in moderate activity levels.
The cost estimates in the Stephenson study were compared with earlier 'health costing of risk factor' studies in Australia and elsewhere. An Australian study estimated that total saving of around $274m may occur if the population became active (Roberts 1987). The recent Stephenson study proposed a saving of about $400m, or about $8.6m per one per cent increase in moderate physical activity participation (in mid-1990s dollars). A recent New Zealand study reported a direct and indirect cost saving of around $162m, if the whole population became active. This would equate to a saving of $972m if applied to the Australian population, but included indirect costs. A detailed costs-of-illness (COI) study of physical inactivity was produced in Canada (CFLRI 1996). This study focused on chronic heart disease, non-insulin dependent diabetes and colon cancer in 1993. This estimate of about $12m saved per one per cent increase in activity was greater than the current Australian estimate. A recent US study estimated that about 2.4 per cent of the direct costs of health expenditure was attributable to physical inactivity - twice the proportion estimated in Stephenson's study.
Studies using simulation modelling have examined the economics of physical activity in a number of countries. In Britain, Munro et al. (1997) suggested that the costs of a physical activity intervention would be £332 per life-year saved - less expensive than antismoking advice from a doctor (£700/life year saved), cholesterol screening (£3,700/life year saved) or treating hypertension (£8,500). A US study reported that exercise was cost-effective ($11,313 per QALY saved), compared to treating hypertension (>$25,000 per QALY) or treating ischaemic heart disease (Hatziandreu et al. 1988). A more recent US study suggested that promoting walking was a useful strategy, with savings of up to $4.3 billion if the entire sedentary population became active (Jones and Eaton 1994). Another US study proposed that the 'lifetime health system added costs of $1,900 per sedentary person might be invested in community strategies to increase physical activity participation' (Keller et al. 1989) - several hundred times greater than current Australian expenditures on physical activity.
The Stephenson study of health costs suggests that physical activity costs are similar to the costs associated with other major risk factors, such as the direct costs of diet- and nutrition-related disease ($771m, according to Crowley et al. 1992). The costs of obesity have been assessed as contributing to between two and seven per cent of total healthcare costs (WHO 1997). The healthcare costs of tobacco in Australia have been estimated at $671m (AIHW 1996).
In November 1999, the AIHW published the 'burden of disease' study for Australia. This was based on the World Health Organization's 'Global burden of disease study' (Murray and Lopez 1996), in which an assessment of overall health problems is based on both mortality and disability components. The central measure is the disability-adjusted life year (DALY) which provides a more expanded framework for assessing health than the traditional epidemiological use of mortality alone.
The AIHW report (Mathers et al. 1999) identified preventable risk factors that contribute to the overall disease burden for Australia. Together, prevention-oriented risk factors account for at least one-third of all mortality and disability. The leading risk factors are shown in Figure 1, which has been adapted from the AIHW report. The first ranked contributor to population ill health is tobacco use, then physical activity. This study was not the first to identify physical inactivity as the second ranked hazard to population health - previous estimates from US studies were very similar (McGinnis and Foege 1993). In these Australian data, physical inactivity ranks first as the leading contributor to preventable illness and morbidity among women, given their lower tobacco usage rates than men. Looking at genders combined (Figure 1), after physical inactivity, in order, come the risk factors hypertension, obesity, nutritional intakes and cholesterol, alcohol (benefits minus risks), illicit drug use, occupational hazards and unsafe sex (including HIV infection). Thus, physical inactivity is very important from the preventive health and health economic perspectives, and far more important than would be suggested by the current allocation of funds across all sectors concerned with active participation and lifestyles at the population level.
The recent 'Burden of disease' (BOD) study enabled a comparison of physical inactivity with other risk factors. For example, physical inactivity was associated with twice as many deaths and nearly three times as many DALYs as high cholesterol levels (which contributed to 6,550 deaths and 64,000 DALYs). Among younger adults, inactivity was associated with more disability and, in older age groups, with higher risk of mortality (Mathers et al. 1999).
According to the BOD study, the loss of an estimated 13,000 lives each year in Australia was attributable to physical inactivity. This estimate was higher than that derived in the costings study above (Stephenson 2000) but was probably due to the conservative assumptions underpinning the health economics paper. Nonetheless, inactivity contributes between one-half and two-thirds of the number of deaths usually attributed to tobacco use.
Figure 1. Proportion of total burden of disease in Australia, genders
combined, attributable to preventable risk factors. Adapted from
Mathers et al. 1999
In conclusion, the estimates in the health costings study and the Burden of Disease (BOD) study reinforce the importance of physical activity, and are similar to estimates from overseas research (Colditz 1999, Hahn et al. 1990, McGinnis and Foege 1993). Nonetheless, physical activity appears to be under-recognised in terms of public health importance for priority-based resource allocation. Health sector and non-health sector investment in physical activity interventions (as distinct from elite sport investment) is rather smaller than for other risk factors. Compared to the tens of millions of dollars spent in campaigns and National strategies for illicit drug use, or tobacco control, audits of State and National resource allocation will confirm that the investment in physical activity may be as low as 10 per cent of what it should be, given these data on the preventive role of physical activity.
The challenge is to turn these data into policy and programs, across sectors interested in physical activity, and to develop interventions, funded at and above the investment thresholds for effectiveness, to increase levels of activity among all Australians. Some of the strategies and evidence for interventions of this sort are discussed in part 2 of this report.
Mathers C, Vos T, Stevenson C. (1999). Burden of disease and injury in Australia, AIHW Catalogue PHE 17, Canberra: Australian Institute of Health and Welfare.
Bauman A, Bellew B, Booth M, et al. (1996). Towards best practice for the promotion of physical activity in the Areas of New South Wales. NSW Health Department, Centre for Disease Prevention & Health Promotion.
Canadian Fitness and Lifestyle Research Institute. (1996) The economics of participation. Progress in Prevention Bulletin No 10.
Hatziandreu E, Koplan J, Weinstein M, et al. (1988). A cost-effectiveness analysis of exercise as a health promotion activity. American Journal of Public Health 78:1417-21.
Jones TF, Eaton CB. (1994). Cost benefit analysis of walking to prevent coronary heart disease. Archives of Family Medicine 3:703-10.
Keller EB, Manning W, Newhouse JP, et al. (1989). The external costs of a sedentary lifestyle. American Journal of Public Health 79:975-81.
McGinnis JM, Foege WH. (1993). Actual causes of death in the United States. Journal of the American Medical Association 270:2207-12.
Murray CJL, Lopez AD. (1996). The global burden of disease. Geneva: Harvard School of Public Health and World Health Organization.
Roberts A. (1987). The economic benefits of participation in regular physical activity. Canberra: Recreation Minister’s Council of Australia.
Stephenson J, Bauman A, Armstrong T, et al. (2000). The costs of illness attributable to physical inactivity. Canberra: Commonwealth Department of Health and Aged Care.
World Health Organization (WHO). Consultation on Obesity (1998). The economic costs of overweight and obesity. In Obesity: prevention and managing the global epidemic. Geneva: WHO.
Next: Part 1 (cont.) - 1.3 Recent physical activity participation data for Australian adults
Previous: Part 1 - 1.1 Recent evidence for health benefits of physical activity
This is an archive copy of a document originally located at http://www.nphp.gov.au/sigpah/gaa/index.htm. All copyright remains with the creator.
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