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Next Step 2014 presentation by Ajay Mahal from Monash University
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Next Step 2014 presentation by Ajay Mahal from Monash University


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  • Pics from free source: wikimedia commons (
  • Health analogous to ability in this context (self-reported health highly dependent on type of work undertaken e.g. office vs. construction worker)
    Evidence from high income countries specifically shows that chronic disease affects wages, earnings, workforce participation, hours worked, retirement age. Wages are inverse to ill health but hours worked, and retirement age have been shown to increase with reduced wellness as there is an impetus to maintain a certain level of earnings despite a decreased level of productivity. (Downward 2007)
  • - wage penalty for obesity (employer saving money for health insurance possible Bhattacharya and Bundorf) - increasing with age after 25yrs
    more significant for females
                       -different occupations affected differently (higher penalty for
                        those requiring interpersonal interactions)
                       -relationship between wages and beauty (social conventions
                        around valuation of overweight/obese persons) – Hamermesh and Biddle 1994 – obesity affects perception of beauty
    Self-esteem issues having negative impact on wages a (Mocan and Tekin 2011)
    Wada 2010 – higher body fat associated with lower wages in both men and women, black and white in US
    Graphs Tome 2010 (US data 1988 to 1994 NHANES III) “vertical lines refer to the values defining the quintiles of the % body fat distribution, different for each subgroup” Max earning capacity at 24.7%, 35%, 23.3% and 41.3% for white males, black males, white females and black females respectively.
    Positive relationship between physical appearance and wages, different for men and women between countries (Doorley 2012)
  • Neg association between weight and occupation attainment (Morris 2006)
    Health related to labour force participation (Cai 2006)
    Relationship between academic achievement and sports participation Pfeifer (2010)
    Social effects: Improvement of social skills/social capital; Networking opportunities (Lechner 2009)
    Sport participation and type of employment – higher sport participation in women = higher proportion of full-time work; no relationship in males (Lechner 2009)
  • Reviews of impact of physical activity utilize threshold of PA (such as 30 min moderate exercise/day for adults)
    Systematic review of PA vs. health related quality of life (HRQL) showed consistent positive result between the two in general adult population (based primarily on cross-sectional data) – qualitative review (Bize 2007)
    Puetz review showed: association between physical activity and a reduced risk of experiencing feelings of low
    energy and fatigue when active adults were compared with sedentary peers (odds ratio = 0.61; 95% CI 0.52, 0.72).
  • Physical activity is a primary preventive measure against many chronic conditions (diabetes mellitus, cancer, osteoporosis, osteoarthritis, depression, obesity, hypertension)
    Physically active persons (compared to less physically active) have decreased incidence of CHD, high BP, colon and breast cancers, type 2 diabetes, metabolic syndrome and depression;
    (Adults aged 18–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity. – WHO 2013)
    “Globally, 6% of deaths are attributed to physical inactivity”; 4th leading risk factor for global mortality (WHO 2013)
    Relative risk (active vs. sedentary) Colon cancer =.5; Breast cancer= .7; CHD = .6; Stroke = 0.6; type 2 diabetes = 0.6; gallbladder disease = 0.8; osteoporosis = F:0.6 (Popkin 2006)
  • Notes on graph “Effects of sport participation at least monthly for the population of individuals who are active in the decision period.
    Hourly wage (x100)
    W(x100) 5% sig. A symbol on the line of the mean effect indicates significance at the 5% level based on a two-sided t-test (symmetric bootstrapped p-values based on 499 bootstrap replications). Monthly gross earnings are measured as gross earnings in the month before the interview. Accumulated average earnings are monthly earnings summed up year by year until the year in question divided by the number the valid interviews up to the respective year. Earnings and wages are coded as zero if individuals are not employed. Wages are multiplied by 100 to be presentable on the same scale as earnings. All monetary measures are in year 2000 EUROs.”
    Although, estimates of the monthly earnings gains are somewhat volatile, on average
    After 16 years for men as well as for women there is a monthly gross earnings gain of about 100 EUR (leading to a total gain over 16 years of approximately 20,000 EUR). In most cases, these gains are at least significant at the 10% level after about 4 to 6 years (this significance level is not indicated in the figure). They appear to increase over time. Similarly, positive average wage effects of almost 1 EUR per hour are present
  • BMI inversely related to job strenuousness for males “A male worker who spends 18 years in the most fitness-demanding occupation
    has a Body Mass Index 3.5 full units (24.7 pounds) lighter than a person in the least demanding
    occupation. Comparatively little of this relationship seems due to selective transition into and
    out of jobs by individuals of different weights.” (Lakdawalla 2006)
  • From 2013 report from American Heart Association
    Disutility of sport/exercise pervading view in terms of economic benefits (Downward 2007)
  • Pics from open source
  • Transcript

    • 1. Physical Activity, Health & Economic Outcomes Ajay Mahal, Monash University February 11, 2014
    • 2. Outline • Linking Physical Activity to Economic Outcomes • So Why Don’t People Exercise More? • Key Research Gaps
    • 3. I. Physical Activity & Economic Outcomes • Physical Activity Indirectly Impacts Economic Outcomes via Health • Physical Activity directly impacts Economic Outcomes
    • 4. Health and Economic Outcomes • Labour Market Effects of Ill Health Poor Health and Lower Productivity Poor Health and Work Force Participation (Ill Person, Caregiver, Income Generation) • Expenses associated with Ill Health
    • 5. Obesity Penalty: % Body Fat versus Earnings Evidence from the US (Source: Tome 2010)
    • 6. SRH and Labour Force Participation in Australia, 15-59 years, 2001 Sources: Kavetsos 2011, Morris 2006, Cai 2006)
    • 7. Adult Employment (%) is Lower in Households with Members with Chronic Disease in India, 2004 Variables Households Matched With Chronic Households Condition Heart Disease 43.61 46.38 Cancer 48.50 51.82 Mahal et al (2013); Mahal et al (2014)
    • 8. Out of Pocket Spending on Cancer by Indian Households, 2004 Source: Mahal et al. (2013) Variables Households With Cancer Matched Households 118.33 44.77 OOP Expenditure on individuals without cancer (15-day period) (INR) 38.30 48.98 OOP Expenditure on conditions other than cancer (15-day period, INR) 15.54 28.83 OOP Spending in 15-day reference period (INR)
    • 9. Physical Activity and Health Physiological influence of Physical Activity (PA): cognitive ability physical functionality energy levels/motivation (Angevaren 2008) (Maiorana 2001) (Puetz 2006) mental ill health risk chronic conditions all-cause mortality (dose-response) (Dunn 2001) (Warburton 2006) (Bauman 2003)
    • 10. Physical Inactivity main cause globally for: •21-25% breast and colon cancers •27% diabetes mellitus •30% ischaemic heart disease (WHO 2013)
    • 11. Effect of sports activity on over 16 year period in Europe (2000 Euros) (Source: Lechner 2006)
    • 12. Direct Effects: Physical Activity and Appearance • Fitness-related facial cues create the same impressions as faces that vary in attractiveness • Fitness creates a perception as being more outgoing, socially competent, intelligent, and healthy (Lakdawalla 2006, Zebrowitz 2008)
    • 13. II. So Why Don’t People Exercise More? Health: Illness, Overweight/Obesity Demographics: Older Ages, Women, Families with Infant Children Socioeconomic Status: Educational Attainment, Income, Opportunity cost of time Psychological/Cultural: Belief in Sporting Ability, Deemphasize athletic endeavours Environment: Availability of Facilities, Networks
    • 14. US Adults meeting Federal Physical Activity Guidelines Population Group Prevalence, 2011 (Age ≥ 18y), % Total (Both sexes) 21.0 All Males 24.9 All Females 17.1 Non-Hispanic White only 23.0 Non-Hispanic Black only 18.0 Hispanic or Latino 15.4 American Indian/Alaskan Native only 17.0 Asian only 16.7 (Go 2012)
    • 15. III. Key Research Gaps in Low- and MiddleIncome Countries • Economic Outcomes: Research on Physical Activity and its Implications for Economic Outcomes (particularly labor market outcomes) in Low- and Middle-Income Countries • Economic Roots of Physical Inactivity (income and occupational status, neighbourhood effects, migrant workers, urbanization) • Evaluation of Interventions/Policies