Genuine Progress Index for Atlantic Canada Indice de progr

1
Genuine Progress Index for Atlantic CanadaIndice
de progrès véritable - AtlantiqueThe Economic
Impact of Physical InactivityImplications for
AdvocacyCoalition for Active Living
AtlanticHalifax, Nova Scotia, 13 April, 2007
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Valuing a Healthy Population

• GPI Population Health Reports include
• Cost of Chronic Illness in Canada (focus on
  preventable portion)
• Womens 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

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Costs of Chronic Disease NS -gtNew 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
  

4
Cost of Chronic Illness in Nova Scotia 1998
(2001 million)
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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)

6
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

7
Costs of Key Risk Factors, Nova Scotia (2001
millions)
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What underlying conditions support are
necessary for regular physical activity? E.g.

• Free time (incl. work-life balance)
• 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?

9
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

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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

11
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 Youve got
  to be in diabetes
• vs. Prevention 2 of health budget
• Current measures send misleading signals to
  policy makers, public

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Why does this matter for physical activity?

• The power of indicators
• reflect values,
• determine policy agenda,
• affect behaviour (students)
• If we dont 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.

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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!

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Total Work Hours, Full-time couple with children,
Canada

• 1900 2000
• Male, paid work 58.5 42
• Female, paid work -- 36.5
• Male, unpaid work N.A. 22.4
• Female, unpaid work 56 33.6
• Total work hours 114.5 134.5

15

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

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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.

18
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 / year 50
• Years of life gained / year 156

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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 gt27)

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50 Nova Scotians are inactive (2005). Only 21
physically active(CCHS) (3 kcal/kg/day), age
12, 2001 ()
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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-gt52 fem).
  Gap closing fast
• All 4 Atlantic provs rank below Cdn average
• Obesity more than doubled childhood asthma,
  obesity up sharply

22
Obesity Trends Among U.S. AdultsBRFSS, 1985
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610. BRFSS Behavioural
Risk Factor Surveillance System - CDC
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Obesity Trends Among U.S. AdultsBRFSS, 1986
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
24
Obesity Trends Among U.S. AdultsBRFSS, 1987
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
25
Obesity Trends Among U.S. AdultsBRFSS, 1988
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
26
Obesity Trends Among U.S. AdultsBRFSS, 1989
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
27
Obesity Trends Among U.S. AdultsBRFSS, 1990
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
28
Obesity Trends Among U.S. AdultsBRFSS, 1991
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
29
Obesity Trends Among U.S. AdultsBRFSS, 1992
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
30
Obesity Trends Among U.S. AdultsBRFSS, 1993
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
31
Obesity Trends Among U.S. AdultsBRFSS, 1994
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
32
Obesity Trends Among U.S. AdultsBRFSS, 1995
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
33
Obesity Trends Among U.S. AdultsBRFSS, 1996
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
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Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 20
35
Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 20
36
Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 20
37
Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 20
38
Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
39
Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
40
Obesity Trends Among U.S. AdultsBRFSS, 2003
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
41
Obesity Trends Among U.S. AdultsBRFSS, 2004
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
42
Obesity Trends Among U.S. AdultsBRFSS, 2005
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
43
Obesity Trends Among U.S. AdultsBRFSS, 1990,
1995, 2005
(BMI ?30, or about 30 lbs overweight for 54
person)
1995
1990
2005
No Data lt10 1014
1519 2024 2529
30
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The Economic Case for Physical ActivityImplicati
ons for Advocacy

• Physical inactivity is costly (health care costs,
  productivity losses) reaches non-health
  officials E.g. Cost of Chronic Disease -gt OHP
• Changing language Cost to Investment / Rate
  of return the Capital Approach
• Beyond lifestyle to underlying social causes
  free time/volunteering, income/equity, etc.

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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

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Time Stress

• Statistics Canada 1999 Longer hours -gt 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)

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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

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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 OConner (HSF) on using the economic case /
  GPI s to change policy

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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

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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

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In Genuine Progress Index

• Health, security, free time, education, unpaid
  work (voluntary hhold), 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

52
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

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Implications for Advocacy Point to
Cost-Effective Interventions

• - E.g. School-based smoking prevention At
  least 101
• WIC nutrition program - 31
• Counselling pregnant women (LBW) - 51
• Workplace interventions 2 1 etc

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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

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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 gt 2.7 -
  Highest rate of part-time in OECD
  - Involuntary part-time 6 lt1/6 Atlantic
  - New bill gives workers right to reduce hrs

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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

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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

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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

59
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

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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
  15-39 46 40-64 57 Women 15-39 62
  40-64 92

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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?

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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

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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

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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

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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

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Can we do it?Percentage Waste Diversion in Nova
Scotia
67
Can it be done?...1900s/1980s...
68

Valuing physical activity to improve wellbeing
and leave a better world for our children
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Genuine Progress Index for Atlantic CanadaIndice
de progrès véritable - Atlantique

• www.gpiatlantic.org