Genuine Progress Index for Atlantic Canada Indice de progrès véritable - Atlantique The Economic Impact of Physical Inactivity: Implications for Advocacy Coalition for Active Living – Atlantic Halifax, Nova Scotia, 13 April, 2007

Valuing a Healthy Population GPI Population Health Reports include: Cost of Chronic Illness in Canada (focus on preventable portion) Women’s Health in Atlantic Canada Income, Health and Disease in Canada; Equity and Disease in Atlantic Canada Costs of Tobacco, Obesity, Physical Inactivity Cost of HIV/AIDS in Canada Economic Impact of Smoke-Free Workplaces Value of Care-giving

Costs of Chronic Disease: NS ->New Dept Health Promotion 60% medical costs = $1.2 billion / year 76% disability costs = $900 million 78% premature death costs = $900 million 70% total burden of illness = $3 billion = 13% GDP

Cost of Chronic Illness in Nova Scotia 1998 (2001$ million)

What Portion is Preventable? Excess Risk Factors Account for: 40% chronic disease 50% chronic disease mortality 25% medical care costs = $500 mill./yr 38% total burden of disease = $1.8 bill. (includes direct and indirect costs)

Excess Risk Factors Account for (% economic burden of disease) Tobacco: 10% Physical Inactivity: 7% Obesity:5.5% High blood pressure:5% Lack fruits/vegetables:3% High blood cholesterol:2.5% Alcohol:2%

Costs of Key Risk Factors, Nova Scotia (2001 $ millions)

What underlying conditions support & are necessary for regular physical activity? E.g.: 1)Free time (incl. work-life balance) 2)Awareness of preventive value and worth 3) Volunteerism (e.g. after school sports coaching) 4) Facilities (e.g. parks, nature trails for walking and running) How are these conditions currently valued?

Our key indicator of wellbeing: = “If the economy is growing we are better off” More work hours make economy grow More stress, more Prozac sales ($4 billion), more cigarette sales, more fast food - Anything can make economy grow - Juan “More” is always “better” vs balance Free time has no value

And its companion messages... Natural resource depletion makes economy grow (vs nature trails) Economy can grow if poverty, inequity grow = Affects physical activity (lifestyle interventions ineffective for low-income) Volunteer, unpaid work =no value. So 12.3% decline no policy attention Fossil fuels, GHGs make economy grow

And health.... Sickness = growth industry. Canada spends $103 billion/year treating sickness - up by 6.5% /year since 1998 = double 1980 Diabetes up 5-fold globally. Lilly: “You’ve got to be in diabetes” vs. Prevention = 2% of health budget Current measures send misleading signals to policy makers, public

Why does this matter for physical activity? The power of indicators = reflect values, determine policy agenda, affect behaviour (students) If we don’t count and measure physical activity in our core measures of progress, it has no “value.” Necessary conditions will not be given priority in policy agenda.

What are the consequences for physical activity? Volunteer time, free time getting squeezed out N.S. = 30,000 fewer volunteers than in 1997 = decline of 10.7% (sport coaching?) Statcan = working moms =75 hour week “Time poverty” vs balance Key conditions of physical activity undermined - All un-noticed!

Total Work Hours, Full-time couple with children, Canada Male, paid work Female, paid work Male, unpaid workN.A.22.4 Female, unpaid work Total work hours

By contrast, GPI sees health promotion, physical activity as investment in human capital (Change language – vs “cost”)

What are the costs of physical inactivity? 90% greater chance of heart disease if inactive. 1/3 of heart disease could be avoided if all Nova Scotians were physically active. 20% stroke, hypertension, colon cancer, type 2 diabetes, 27% of osteoporosis, 11% breast cancer, could be eliminated by becoming physically active. Links to depression, mental health

Costs of physical inactivity Inactivity costs NS $107m (direct) + $247m (indirect) = $350m/year More than 700 Nova Scotians die prematurely every year because they are physically inactive = 9% of all early deaths. Every year 2,200 potential years of life are lost in N.S. due to physical inactivity Replicated for HRM, B.C.

The Good News: Annual Savings from 10% Reduction in Physical Inactivity ($millions) Hospital, physician, drug costs $4.6 Total direct health costs $7.5 Economic productivity gains $17.2 (avoided premature death and disability) Total annual economic savings $24.7 Lives saved / year50 Years of life gained / year 156

Costs of obesity Obesity: 56% diabetes 2 in NS attributable to obesity; 37% hypertension; 22% heart disease; 24% gallbladder disease; + stroke, cancers (colorectal, endometrial, post- menopausal breast), arthritis etc. Obesity costs NS health care system = $120m/year (6.8% budget) + $140m indirect productivity losses = $260m 39% N.S. overweight (BMI = >27)

50% Nova Scotians are inactive (2005). Only 21% physically active (CCHS) (3 kcal/kg/day), age 12+, 2001 (%)

T R E N D S: % exercising regularly in NS now stagnant after improvement in 1990s (63% inactive 1994, 52% 1998, 50% now). Improvement among women but decline among men (43% inactive 1998; 48% today; cf 60%->52% fem). Gap closing fast All 4 Atlantic provs rank below Cdn average Obesity = more than doubled; childhood asthma, obesity up sharply

Obesity Trends* Among U.S. Adults BRFSS, 1985 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. BRFSS – Behavioural Risk Factor Surveillance System - CDC

Obesity Trends* Among U.S. Adults BRFSS, 1986 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. Adults BRFSS, 1987 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. Adults BRFSS, 1988 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. Adults BRFSS, 1989 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. Adults BRFSS, 1990 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. Adults BRFSS, 1991 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. Adults BRFSS, 1992 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. Adults BRFSS, 1993 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. Adults BRFSS, 1994 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. Adults BRFSS, 1995 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. Adults BRFSS, 1996 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

1995 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1995, 2005 (*BMI 30, or about 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

The Economic Case for Physical Activity: Implications for Advocacy Physical inactivity is costly (health care costs, productivity losses) – reaches non-health officials: E.g. Cost of Chronic Disease -> OHP Changing language: ‘Cost’ to ‘Investment’ / ‘Rate of return’ – the Capital Approach Beyond lifestyle to underlying social causes – free time/volunteering, income/equity, etc.

Costs of overwork US: $100 billion cost due to work fatigue: accidents, errors, productivity, health Valdez, Chernobyl ($300b), 3-Mile Island, Bhopal, road accidents (trucking - 50%+) Sleep down 25%, 15% clinical insomnia, CVD, gastrointenstinal (ulcers = 2-8x) Family stress: shift work 60% + divorce

Time Stress Statistics Canada 1999: Longer hours -> more smoking, poor diet, unhealthy weight gain, + less physical activity F-t working mothers - 75-hour week, (invisible when ignore unpaid work - women 2x labour force; 2/3 housework) Effect on diet (Harvard longit. study) Stress: Overworked and underworked - equal risk of heart attack (Japanese study)

= Economics as if People did not Matter The more we produce and consume, the “better off” we are Growing economy = “healthy,” robust economy. Shopping is patriotic Vs health as balance. Security, health, community, environment, free time, volunteerism, recreation have no value

Translate to Advocacy: What can we do about this? How can we assign free time, volunteerism, health, the natural environment their true value? How can we give physical activity the attention it deserves? Clare O’Conner (HSF) on using the economic case / GPI #s to change policy

1) We can change the way we measure progress What we measure:  reflects what we value as a society;  determines what makes it onto the policy agenda;  influences behaviour

Good indicators can help Nova Scotians:  foster common vision and purpose;  identify strengths and weaknesses;  change public behaviour;  hold leaders accountable at election time  initiate actions that promote wellbeing

In Genuine Progress Index:  Health, security, free time, education, unpaid work (voluntary + h’hold), have value  Sickness, crime, disasters, pollution are costs; so reductions in crime, poverty, GHGs, ecological footprint are progress  Human, social, natural capital valued  Growing equity signals progress

Valuing Voluntary Work Nova Scotians give 140 million hrs of voluntary work/yr = 73,000 FTE jobs Worth nearly $2 billion /year to NS economy (use at Volunteer Awards) Nationwide decline in volunteer work cost Canadians $2 billion in lost services in 2000 = Invisible in conventional accounts

Implications for Advocacy: Point to Cost-Effective Interventions - E.g.: School-based smoking prevention = At least 10:1 –WIC nutrition program - 3:1 –Counselling pregnant women (LBW) - 5:1 –Workplace interventions: 2: 1 etc

2) New policy initiatives that address underlying causes Learning from the Europeans, rather than compare with US: US passed Japan with longest hours - rapid growth at expense of quality of life Scandinavia - family-friendly work top concern Germany = 6 weeks vacation; Denmark = 5 1/2

Making Part-time Work Desirable Netherlands: 1,370 paid work hours / yr Canada:1,732 paid work hours / year Non-discrimination law: equal hourly pay, pro-rated benefits, equal promotion opp. Netherlands: unemployment 12.2% —> 2.7% - Highest rate of part-time in OECD - Involuntary part-time = 6% = <1/6 Atlantic - New bill gives workers “right” to reduce hrs

Value/expand free time: Danes have 11 hrs more free time each wk than Canadians Source: Andrew Harvey, “Canadian Time Use in a Cross-National Perspective,” Statistics in Transition, November, 1995

Sharing the Work Can... Reduce unemployment, underemployment and overwork Improve work-life-family balance and health; enhance recreation opportunities Increase free time and community service Protect the environment, spare the planet from over-consumption, natural resource depletion

3) Physical Activity and Equity Education, income, employment, social networks are key determinants of health, recreation participation Lifestyle interventions effective for higher income/education groups, not lower = can widen inequity, health gap Low-income = higher rates all risk factors; lower activity /participation

Heart Health Costs of Poverty Higher risk smoking, obesity, physical inactivity, cardiovascular risk = costly York U: 6,366 Canadian deaths; $4 billion health care costs / year are attributable to poverty-related heart disease NS could avoid 200 deaths, $124 million per year if all Nova Scotians were as heart healthy as higher income groups

Health Costs of Poverty Most reliable predictor of poor health, premature death, disability: 4x more likely report fair or poor health = costly e.g. (1) Increased hospitalization: Men = +46%; = +57% Women = +62%; = +92%

Health Cost of Inequality BMJ: “What matters in determining mortality and health is less the overall wealth of the society and more how evenly wealth is distributed. The more equally wealth is distributed, the better the health of that society.” e.g. Sweden, Japan vs USA. Canada, NS more unequal since early 1990s – implications for health?

Costs of Socioeconomic Inequality in Nova Scotia Use of physician services: –No high school = +49% than degree –High school diploma = +12% more –Lower income = +43% than higher –Lower middle income = +33% more

Excess Physician Use (=small fraction total costs) Educational inequality = $42.2 million = 17.4% of total Income inequality = $27.5 million = 11.3% = costs avoided if all Nova Scotians were as healthy as higher income / university

If we explicitly value... Our free time and true value of physical activity The time we spend with family and children Our voluntary contributions to community Health and Equity Then we will naturally explore policy options that are currently not on the political agenda

By including these values in our core measures of progress We can draw attention to models that: –go beyond superficial coping, stress relief –can improve health and wellness –quality of our lives, expand physical activity opportunities

Can we do it? Percentage Waste Diversion in Nova Scotia

Can it be done? s/1980s...

Valuing physical activity to improve wellbeing and leave a better world for our children

Genuine Progress Index for Atlantic Canada Indice de progrès véritable - Atlantique