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The Cost of Physical Inactivity in Nova Scotia

Key Message

Considering both direct and indirect costs, the total economic burden of physical inactivity in Nova Scotia is estimated at $354 million annually.

Source

Colman, Robert, Ph.D, & Hayward, K. (2002). The Cost of Physical Inactivity in Nova Scotia. Halifax, Nova Scotia: Recreation Nova Scotia and Sport Nova Scotia.

Purpose

Physical activity provides proven health benefits. It protects against heart disease, stroke, hypertension, type 2 diabetes, colon cancer, breast cancer, osteoporosis, obesity, depression, anxiety, and stress. Epidemiological studies estimate that 36% of heart disease, 27% of osteoporosis, 20% of stroke, hypertension, diabetes 2, and colon cancer, and 11% of breast cancer are attributable to physical inactivity.

Regular physical activity also protects against obesity and assists weight control; fosters development of healthy muscles, bones and joints; increases strength and endurance; improves behavioural development in children and adolescents; and helps maintain function and preserve independence in older adults. Studies show that regular exercisers have much less overall lifetime morbidity than those who are sedentary, indicating that avoided medical costs due to physical activity are not simply deferred to older ages.

METHODOLOGY
To estimate the economic costs of physical inactivity (or of any other risk factor) in Nova Scotia, the following steps are necessary:

1. The epidemiological evidence is examined to ascertain the relationship between physical inactivity and various diseases. This is expressed as the “relative risk” (RR) of developing a particular disease for a physically inactive person compared to an active person. The relative risk is determined by dividing the rate of the disease among sedentary people by the rate of disease among active people. For example, if sedentary people are twice as likely to develop heart disease, then the relative risk (RR) is 2.

In this case, the relative risks for seven chronic diseases, and the methodology for assessing the economic cost of physical inactivity, are taken from an analysis by Katzmarzyk, Gledhill, and Shephard in the Canadian Medical Association Journal (CMAJ), 28 November, 2000. GPI Atlantic used the same method in early 2000, also based on a CMAJ analysis, to assess the cost of obesity in Nova Scotia.33 To the best of our knowledge the November, 2000, CMAJ article is the first Canadian study to use previously published meta-analyses and large prospective epidemiological studies to estimate the relative risks attributable to physical inactivity for various chronic diseases. This now makes it possible, for the first time, to assess the economic cost of physical inactivity in Nova Scotia.

2. The second step is to ascertain the prevalence of a risk factor within a given population. Because the CMAJ article uses the Canadian Fitness and Lifestyle Research Institute’s Physical Activity Monitoring Survey results (2.4 above), this analysis does the same in order to obtain comparable results and maintain the same methodology. However, the CMAJ article used 1997 survey results, while this Nova Scotia analysis uses the most recent 2000 results. Coincidentally, the 2000 Nova Scotia rate of physical inactivity (62%) is identical to the 1997 Canadian physical inactivity rate, so that the population attributable fraction of each disease is also identical. (see NEXT steps in full report.)

Evidence

According to the Canadian Fitness and Lifestyle Research Institute, 62% of Nova Scotians and 61% of Canadians are currently too inactive to reap the health benefits of regular physical activity.

It is estimated that physical inactivity costs the Nova Scotia health care system $66.5 million a year in hospital, physician and drug costs alone, equal to 4% of total government spending on these services. When all direct health care costs are added, including private expenditures, a sedentary lifestyle costs Nova Scotians $107 million a year in direct medical care expenditures. This spending is currently added to the provincial Gross Domestic Product and economic growth statistics, and is thus mistakenly taken as a sign of prosperity and progress. The Genuine Progress Index counts this spending due to physical inactivity as a cost - not a gain - to the economy.

Physical inactivity costs the Nova Scotia economy an additional $247 million each year in indirect productivity losses due to premature death and disability. Adding direct and indirect costs, the total economic burden of physical inactivity in Nova Scotia is estimated at $354 million annually.

More than 700 Nova Scotians die prematurely each year due to physical inactivity, accounting for 9% of all premature deaths. These premature deaths result in the loss of more than 2,200 potential years of life every year in the province before age 70. In other words, if all Nova Scotians were physically active, the province would gain 2,200 productive years of life each year, with corresponding gains to the economy. If just 10% fewer Nova Scotians were physically inactive – that is, if the rate of physical inactivity were 56% instead of 62% - the province could save an estimated $4.6 million every year in avoided hospital, drug, and physician costs, and $7.5 million in total health care spending. Added to an estimated $17 million in productivity gains, total economic savings to Nova Scotia from a 10% reduction in physical inactivity amount to $24.7 million.

Given the enormous health care burden of a sedentary lifestyle, health campaigns aimed at promoting regular physical activity, including provision of adequate access to quality sport and recreation programs and facilities for all Nova Scotians, have the potential to reduce the enormous human and economic burden of physical inactivity.

Direct Costs of Physical Inactivity, Nova Scotia
Table 1 gives the relative risk (RR) estimates for each of seven chronic diseases that have been associated with physical inactivity, based on epidemiological studies reviewed by Katzmarzyk et al., and the population attributable fractions for each disease based on Nova Scotia’s physical inactivity prevalence rate of 62%. This table corresponds with Table 2 in Katzmarzyk et al (CMAJ 163 (11), page 1437).

A relative risk of 1.9 for coronary heart disease (or coronary artery disease as it is also called) means that physically inactive people have a 90% greater chance of having that disease than those who are physically active. As noted above, this is a conservative estimate by comparison with the Statistics Canada analysis of National Population Health Survey results reported above. The bracketed numbers following the relative risk ratios represent the possible range of results based on a 95% confidence interval (CI).

A population attributable fraction (PAF) of 35.8% for heart disease means that more than one third of heart disease in Nova Scotia could be avoided if all Nova Scotians were physically active. This is higher than the 22% estimate for the U.S. reported above. Table 1 also indicates that about 20% of stroke, hypertension, colon cancer, and type 2 diabetes, as well as 27% of osteoporosis and 11% of breast cancer, could be eliminated if Nova Scotians who are presently sedentary became physically active.

Table 1: Relative risk and population attributable fraction due to physical inactivity for major chronic diseases, Nova Scotia, 2000.

Disease RR (and 95% CI) PAF (%)
• Coronary heart disease 1.9 (1.6 – 2.2) 35.8
• Stroke 1.4 (1.2 – 1.5) 19.9
• Hypertension 1.4 (1.2 – 1.6) 19.9
• Colon cancer 1.4 (1.3 – 1.5) 19.9
• Breast cancer 1.2 (1.0 – 1.5) 11.0
• Type 2 diabetes 1.4 (1.2 – 1.6) 19.9
• Osteoporosis 1.6 (1.2 – 2.2) 27.1

Note: Based on a prevalence of physical inactivity of 62% in Nova Scotia in 2000 according to the Canadian Fitness and Lifestyle Research Institute Source: Katzmarzyk et al., Canadian Medical Association Journal 163 (11), Nov. 28, 2000, page 1437.

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