“If we had a drug in our therapeutic armamentarium that conferred all the benefits of regular exercise it would be the single best treatment for preventing disease and improving overall health and life expectancy”. O’Keefe JH et al 2013
The cost of health
Maintaining good health and fighting disease and other health problems are enormously expensive. The NHS annual budget is £149 billion which is 9.9% of GDP and 30% of spending on public services. Almost all of this spent on treating disease and very little on prevention. NHS spending is planned to increase by 4% per annum but the demands are set to rise even more steeply. None of this takes into account the astronomical costs of managing the Covid pandemic.
The cost of treatment of common diseases
The cost of treatment of a variety of common diseases has been estimated. Here are a few with strong links to a sedentary lifestyle.
Cardiovascular disease: In one recent year there were almost 180,000 deaths and there were over 1.6 million inpatient episodes (which include consultant visits, ordinary admissions and day cases) The direct healthcare cost of all Cardiovascular Disease was £8.7 billion and the total economic cost (including healthcare cost, informal care and loss of productivity) was £18.9 billion. The average cost of a hospital admission for a CVD event is estimated to be £4,614.
Diabetes: The cost of direct NHS patient care (which includes treatment, intervention and complications) for those living with type 2 diabetes was estimated at £8.8 billion, and the indirect costs (such as loss of productivity) were estimated to be £13 billion.
Obesity: the total annual cost to the NHS, including treatment and its consequences) was estimated to be £2 billion with a total economic impact to the nation of around £10 billion.
Colorectal cancer: annual treatment costs were approximately £1.1 billion.
These conditions comprise only a part of the overall cost of sedentary dependent disease. Other examples include osteoporosis, falls and hypertension.
All of these estimates vastly understate the overall costs to all those involved – the NHS, the national economy, the individual’s finances and their employers productivity and expenses.
The possible impact of prevention
It is estimated that only 4 per cent of the total healthcare budget is spent on prevention, compared to 70 per cent spent on treating long-term conditions. Despite this, in the past five years £900m (€1bn; $1.2bn) has been cut from the UK public health grants given to local councils. These grants support reduction of chronic disease morbidity and expense. As one commentator has said: “A greater emphasis needs to be placed on programmes that facilitate people making positive lifestyle choices. Capacity building, agency, and self-efficacy need to be tools for reducing pressure on already overburdened healthcare services.”
The cost of inactivity
Public Health England has calculated the potential cost benefits of exercise in the prevention of five common conditions which are in part caused by inactivity – coronary heart disease, stroke, breast cancer, colon/rectum cancer and diabetes mellitus. They chose these conditions because they had well validated measures of the “population attributable fractions” for physical inactivity – ie what proportion of the cause of each disease could be blamed on inactivity. For this small number of diseases – out of 20 possible conditions – their conclusion was that the possible savings from increasing physical activity amounted to about £450 million per annum. That sounds like a gross underestimate to me.
Another view of these costs was given by a British Heart Foundation publication, “Economic costs of physical inactivity” based on 2010/11 figures. The following table illustrates the overall costs and the costs to the NHS of those conditions to which inactivity is a substantial contributor.
|Condition||Cost to the NHS||%contribution of inactivity||Cost of inactivity|
|Coronary heart disease||£5 billion||10.5%||£543 Million|
|Type 2 diabetes||£1.2 billion||13%||£158 million|
|Breast cancer||£0.3 billion||17.9%||£54 million|
|Colon cancer||£3.5 billion||18.7%||£65 million|
The total cost of inactivity further increases when considering the wider economic costs. These include sickness absence, estimated at£5.5 billion per year, and the premature death of productive people of working age from ‘lifestyle-related’ diseases, estimated at £1 billion per year. In 2008, the DoH estimated that the average cost of physical inactivity for every primary care trust (PCT) in England was £5 million.
The European view
A 2015 report from the Centre for Economic and Business Research calculated that physical inactivity was the 4th leading risk factor for global deaths, the cause of 500,000 deaths in the EU with a cost of £84 billion a year to the European economy. They reckoned that physical inactivity was a bigger risk to public health than smoking. The study also showed that being physically inactive goes beyond physical disorders. One in four Europeans (or 83 million) is affected by mental ill health. The research estimates the indirect cost of inactivity-related mood and anxiety disorders to be over €23bn Euros a year.
The medical costs of disease are only a very small part of the overall cost to the nation. For instance the British Heart Foundation and Oxford University used the same diseases to calculate the direct cost to the NHS. They reckoned that in 2003–4, over 35 000 deaths could have been avoided if the population were physically active at the levels recommended by the UK government – and that physical inactivity was responsible for 3.1% of morbidity and mortality in the UK, contributing over £1 billion to the direct health cost burden to the UK National Health Service.
Next week I will look at the costs and possible savings in the budget for social care.