Memorandum by Dr Adrian Davis (RTS 157)
ECONOMIC COSTS OF PHYSICIAL INACTIVITY IN
THE ADULT POPULATION
The Slower Speeds Initiative has submitted evidence
both written and orally which has highlighted the negative impact
of speed and inappropriate speed. One important impact is the
supression of walking and cycling journeys. In public health terms
this suppression has important consequences and this memorandum
highlights the likely scale of the economic costs and so the need
for actions across government to reduce road danger in order that
people can choose to walk and cycle.
A physically active lifestyle is now recognised
to be an important element of a healthy lifestyle and one that
reduces the risks of ill-health and premature deathi. Walking
and cycling are both identified as ideal forms of physicial activity
as they can be incorporated into daily routinesii. 44 per cent
of all trips are under two miles in length and 70 per cent under
five milesiii. This knowledge is set against a trend in declining
levels of physical activity, found most starkly within western
Research in the last decade provides some indication
of the costs to the economies of countries of physicial inactivity
and helps to demostrate the economic value of devoting resources
to halt and then reverse the trend of declining levels of physical
activity including walking and cycling. Costs are generally divided
between those directly associated with health care costs to the
NHS, and indirect costs which can include a range of costs not
attributable to the NHS, such as costs to employers from days
lost through sick leave.
Importantly, the largest contribution to mortality
reduction arises from the group who are currently irregularly
inactive. In that group increases in physical activity brings
about the largest reduction in mortality because the group is
large and because the difference in risk between being irregularly
active and regularly active is also relatively large. Substantial
contributions to mortality reduction also arise from the sedentary
group, primarily because even low levels of physical activity
reduce the risks of ill-health.
Data from the Health Survey for Englandiv has
demonstrated that, using a criterion of less than one 30 minute
period of moderate activity a week, 23 per cent of men and 26
per cent of women are sedentary. Furthermore, around six out of
ten men and seven out of ten women are not reaching recommended
levels of physical activity. In the UK it is estimated that about
37 per cent of deaths from Coronary Heart Disease (CHD) are due
to lack of physical activity and that 9 per cent of deaths from
CHD could be avoided if people who are currently sedentary or
have a light level of physical activity increased their level
of physical activity to a moderate level. The direct annual health
care costs of heart disease in the UK are £1.6 billionv.
In addition, it has been acknowledged that health care costs for
CHD substantially underestimate the costs:
Looking only at the costs of CHD to the health
care system grossly underestimates the total cost of CHD. CHD
also costs the UK economy about £8,500 million because of
the days lost due to death, illnes and informal care of people
with disease. In total CHD costs the UK economy about £10,000
million a year.
The costs to the NHS of other major diseases
associated with physicial inactivity are also substantial and
therefore there are economic savings to be made from avoidance.
One example is that the costs of type 2 diabetes in the UK have
been calculated to be £2 billion (2000 prices)vi. Physical
activity has been demonstrated to be inversely related to the
incidence of type 2 diabetes.vii Physical activity can contribute
to the prevention, and following early detection, to the reversal
and prevention or delay of complication in type 2 diabetes.
The beneficial effects of moderate intensity
physical activity are even more important to those sub-groups
of the population who are at elevated risk of type 2 diabetes
due to being overweight, having an elevated blood pressure, and
a positive parental history of type 2 diabetesviii. Reducing physicial
inactivity could also help reduce economic costs, for example,
of colon cancer, osteoporosis, mental health problems, and falls
among older people.
It is widely believed that the significant increase
world-wide is due to greater relative declines in physical activity
than increases in energy intakeix. The National Audit Office has
calculated that the known direct costs of treating obesity in
England in 1998 was £9.4 million (at 1998 prices). By far
the largest component of this cost was the 519,486 general practitioner
consultations which cost £6.8 million although this is likely
to be an underestimate as the latest figures for GP consultations
was for 1991-92. Additionally, no data was available for consultations
with practice nurses and dieticians in primary care.
There is a strong association between physical
inactivity and obesity and each is associated with direct health
care costs. Public health researchers are increasingly recognising
that afforts focused on improving the environment so that walking
and cycling are more attractive to people may have a substantial
impact in reducing physical inactivityx. Indeed, increasingly
public health research is focusing on environmental factors in
enabling people to build physical activity into their daily lifestylesxi,
xii. Speed and inappropriate speed is a major deterrent to the
use of these modes of transport.
Environmental influences are also increasingly
reflected in public policy statements. The 1999 Charter on Transport,
Environment and Health, approved by Ministers of the Member States
of the World Health Organisation, which included the UK, highlighted
the key role of walking and cycling as transport modes in enhancing
healthxiii. Across a range of public policy fields which include,
health, environment, and transport there is widespread recognition
that programmes focused on increasing levels of walking and cycling
in meeting travel needs also:
provide the greatest potential for
reduce direct and indirect health
care costs; and
deliver a range of substantial benefits
associated with less motorised transport including quality of
Given that over 44 per cent of trips are under
two miles in length and 70 per cent under five milesxv there is
tremendous potential for increasing the amount of walking and
cycling. Reducing road danger by enhanced speed management to
reduce illegal and inappropriate speeds would be an important
Dr Adrian Davis
For the Slower Speeds Initiative, February 2002
i Department of Health, 1999 Saving lives;
Our healthier nation, London: Stationary Office.
ii World Health Organisation/Federation
of Sports Medicine, 1995 Exercise for Health:WHO/FIMS Committee
on physical activity for health, Bulletin of the World Health
Organisation, 73(2) pp. 135-136.
iii Department for Transport, Local Government
and the Regions, 2000 National Travel Survey: 1997-99 Update,
iv Department of Health, 1999 Health Survey
for England: Cardiovascular Disease '98, London: Stationary Office.
v Britton, A McPherson, K 2000 Monitoring
the Progress of the 2010 Target for Coronary Heart Disease Mortality:
Estimated Consequences on CHD Incidence and Mortality from Changing
Prevalance of Risk Factors. National Heart Forum: London.
vi Kings Fund et al, 2000 TARDIS:
Type 2 diabetes. Accounting for a major resource demand in society
in the UK.
vii Helmrich, S, Ragland, D, Leung, R and
Paffenbarger, R. 1991 Physical activity and reduced occurance
of Non-Insulin Dependent Diabetes Mellitus, New England Journal
of Medicine, 325: pp. 147-152.
viii Lynch, J et al, 1996 Moderate
intense physical activities and high levels of cardiorespiratory
fitness reduce the risk of Non-Insulin Dependent Diabetes in middle
aged men, Archives of Internal Medicine, 156: pp. 1307-1313.
ix Pescatello, L and Van Heest, J 2000 physical
activity mediates a healthier body weight in the presence of obesity,
British Journal of Sports Medicine, 34: pp. 86-93.
x Stevens, W, Hillsdon, M, Thorogood, M
and McArdle, D 1998 British Journal of Sports Medicine, 32: pp.
xi Oja, P,Vuori, I, and Paronen, O 1998
Daily walking and cycling to work: their utility as health enhancing
physical ectivity, Patient Education and Counselling, 33: S87-94.
xii Owen, N, Leslie, E, Salmon, J and Fotheringham,
M 2000 Environmental determinants of physicial activity and sedentary
behaviour, Exercise and Sports Science Reviews, 28(4), pp. 153-158.
xiii World Health Organisation, 1999 Charter
on transport, environment and health, Copenhagen: WHO.
xiv British Medical Association, 1997 Road
Transport and health, London: BMA.
xv Department for Transport, Local Government
and the Regions, 2000 National Travel Survey: 1997-99 Update,