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The Economic Benefits of a More Physically Active Population an International Analysis The economic benefits of a more physically active population An international analysis Marco Hafner, Erez Yerushalmi, William Phillips, Jack Pollard, Advait Deshpande, Michael Whitmore, Francois Millard, Shaun Subel, Christian van Stolk For more information on this publication, visit www.rand.org/t/RR4291 Published by the RAND Corporation, Santa Monica, Calif., and Cambridge, UK © Copyright 2019 RAND Corporation R® is a registered trademark. RAND Europe is a not-for-profit research organisation that helps to improve policy and decision making through research and analysis. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions. Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org www.randeurope.org i Preface This report examines the potential economic benefits of physical activity. Specifically, it looks at the potential gains in economic output and healthcare expenditure savings under different physical activity improvement scenarios at the population level. This study contributes to the existing literature in three ways. First, we synthesise and evaluate, in a systematic manner, the existing empirical evidence on the association between physical activity and mortality risk, using a meta-analytical approach to adjust for study heterogeneity and potential publication bias in the literature. Second, using large-scale, international workplace survey data, we quantify the associations between physical activity and workplace performance, with a specific focus on levels of sickness absence and levels of presenteeism. Finally, we examine the macroeconomic effects of reduced premature mortality and reductions in sickness absence and presenteeism associated with making the population of a country more physically active. The report will be of interest to policymakers in the fields of public health and at the same time to a much broader spectrum of readers, including private sector agents, in particular in the health and life insurance domains. The Vitality Group, part of Discovery Ltd, commissioned RAND Europe to carry out this research project. RAND Europe had full editorial control and independence of the analyses performed and presented in this report. This work informs the public good and should not be taken as a commercial endorsement. RAND Europe is an independent, not-for-profit policy research organisation that aims to improve policy- and decision making in the public interest through research and analysis. This report has been peer-reviewed in accordance with RAND’s quality assurance standards. For more information about RAND Europe or this document, please contact Marco Hafner ([email protected]) at: RAND Europe Westbrook Centre, Milton Road Cambridge CB4 1YG United Kingdom Tel. +44 1223 353 329 iii Executive summary According to the World Health Organization (WHO), insufficient physical activity is recognised as one of the leading risk factors for death, posing a global public health problem associated with up to 5 million premature deaths every year (Lee et al. 2012; WHO 2018). The health benefits of physical activity are relatively well established, with research showing that it is associated with lower risk of hypertension, cardiovascular disease, breast and colon cancer, as well as diabetes. Furthermore, physical activity has been associated with positive effects on mental health, possibly reducing the risk of the onset of dementia and having positive effects on anxiety and depression (PAGAC 2008, 2018). Despite the health benefits of physical activity, insufficient physical activity has become increasingly prevalent over the last decades. Globally, it is estimated that about 30 per cent of the population is physically inactive, but the prevalence rate varies across countries. For instance, the share of the population who are physically inactive is estimated to be more than twice as high in high-income countries than in low-income countries. Furthermore, in high-income countries, the prevalence of insufficient physical activity is growing over time (Guthold et al. 2018). The factors associated with increasing levels of physical inactivity have been identified as being partly due to insufficient participation in physical activity during leisure time and partly due to an increase in sedentary behaviour during domestic and occupational activities. In addition, an increase in passive modes of transport may be associated with lower physical activity at the population level (WHO 2018). With public health responses to address the problem often being inadequate and governments and public bodies having to address increasingly competing priorities with finite financial resources, economic analysis can help to quantify the scale of the issue and increase public and private engagement in the topic and motivate actions. Most existing economic analyses on the economic burden of insufficient physical activity are based at the national level; only a few studies take a more global perspective (Ding et al. 2016, 2017). Existing studies use a range of methodologies, but most apply the cost-of-illness (COI) approach. However, these studies vary in terms of what costs are included (e.g. direct and indirect) and in terms of what health conditions associated with physical inactivity are considered, making a comparison of the burden across countries more challenging. For instance, some COI studies estimate the direct costs associated with physical inactivity in terms of national healthcare or medical expenditures for specific diseases, whereas other studies also try ot take into account indirect costs associated with lost productivity, including, for instance, the loss in lifetime income for individuals dying prematurely because of a disease associated with physical inactivity (Ding et al. 2017). iv The economic benefits of a more physically active population Objectives and research approach of this study The aim of this study is to examine the potential global macroeconomic implications of getting people to be more physically active across different countries by using a comprehensive modelling framework that overcomes some of the limitations of the traditionally applied methodologies in existing economic studies assessing the cost of physical inactivity. Our analytical approach represents a so-called lost-economic output approach because we apply a dynamic, multi-country, computable general equilibrium (CGE) macroeconomic model. Such a macroeconomic model simultaneously solves multiple equations that relate to production from firms’ and households’ demand, both within a country and between countries, through trade linkages. This type of modelling approach has gained ground in health economics in applications to HIV/AIDS, malaria, anti-microbial resistance, pandemic influenza and non-communicable diseases (see e.g. Rutten & Reed 2009; Smith et al. 2005; Taylor et al. 2014), among others. Our analysis examines how improvements in physical activity at the population level affect the effective labour supply in the economy through a reduction in premature mortality and improvements in productivity, which subsequently are reflected in and measured by changes in a country’s or region’s gross domestic product (GDP). We focus on GDP as the measure of total output of an economy because it represents a proxy for the health of an economy and because it is often the metric of interest for a variety of policy- and decision makers. In essence, in order to achieve the study objectives, the study aims to answer the following research questions: 1. What are the potential global economic benefits associated with getting people ot be more physically active and how do the economic effects vary by country? a) What is the contribution of premature mortality associated with insufficient physical activity? b) What is the contribution of insufficient physical activity associated with workplace productivity? 2. What level of healthcare expenditure could be saved? 3. What can public policy and private stakeholders do in order to improve physical activity levels at the population level? This study contributes to the existing literature in three ways. First, we synthesise and evaluate, in a systematic manner, the existing empirical evidence on the association between physical activity and relative mortality risk, using a meta-analytical approach to adjust for study heterogeneity and potential publication bias in the literature. Second, using large-scale, international workplace survey data, we quantify the associations between physical activity and workplace performance, with a specific focus on levels of sickness absence and levels of presenteeism. Finally, putting some of these quantitative empirical estimates with regards to mortality and productivity together and applying them in the macroeconomic modelling framework, we assess how different physical activity improvement scenarios
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