UNITED STATES SPORTS ACADEMY
Do Physically Inactive Citizens Cost A Government More Money Than Active Citizens?
A Class Paper Submitted for
Contemporary Issues in Sport
Professor: Dr. Michael Culpepper
June 18th, 2010
Table of Contents
What is Physical Activity?
What are the Causes of Physical Inactivity?
What are the Consequences of Physical Inactivity?
What are the Costs of Physical Inactivity?
What is needed to Increase Physical Activity in a Country?
What is the Cost to Implement/Facilitate what is Needed?
During such dire economic times, the struggles that various Government departments
face for allocated funds are fiercely competitive. However, one of the highest areas of
expenditure is Health Care Services that are provided to the people and I believe that a
correlation must be shown between physical inactivity and health care service costs, to
prove to a government that a greater emphasis should be placed on facilitating and
encouraging physical activity in order to decrease health care costs.
What is Physical Activity/Inactivity?
Physical activity refers to energy expenditure that results from any bodily movement by
the skeletal/muscular systems (www.who.org). Physical inactivity, (a lack of the required
amount of physical activity) is a major, independent risk factor for many chronic diseases
such as type 2 diabetes, breast/colon cancer and stroke to name a few (www.hhs.gov).
More specifically, it is recommended that adults (aged 19-65) engage in at least 30
minutes of physical activity at moderate-intensity, five days per week or 20 minutes of
physical activity at vigorous intensity, three days per week (www.who.org). Children
aged 5-18 are recommended to engage in at least 60 minutes of physical activity at
moderate-vigorous intensity, every day (www.who.org, www.cdc.gov, Medibank Private
(2008), www.hhs.gov, www.heart.org).
The Physical Activity Guidelines for Americans, released by the U.S. Department of
Health and Human Services, describes an inactive person as anyone who participates in
what is known as baseline activity or the routine, low-intensity activities most people take
part in daily such as walking slowly, standing, lifting lightweight objects etc. (2008).
Physical activity in children is especially important for their development and growth and
studies show that as much as 40 percent of bone mass is developed in four years of
From this we can derive that someone who is considered to be physically inactive is
someone that engages in less than the recommended moderate physical activity per week.
The people that fall in this category therefore place themselves at higher risk of
cardiovascular disease, diabetes and osteoporosis to name a few. It is therefore important
to identify the main causes of physical inactivity.
What are Causes of Physical Inactivity?
Rates of physically active citizens around the world have dropped significantly due to a
number of reasons. The WHO identifies some major contributors to the physical
inactivity crisis: high density traffic, population overcrowding, increased poverty, low
air-quality and a lack of parks/sports and recreational facilities (www.who.org).
In addition to these factors some other factors should also be considered. Firstly, our
primary methods of transportation have changed; before the technological innovations of
the past century and a half, transportation between destinations primarily consisted of
walking, running, horseback riding and canoeing. All of these methods involved a
certain degree of physical effort from the individual engaging in that mode of
transportation; most modern forms of transportation today however require little to no
effort from the person being transported (trains, automobiles, busses etc). Information
from a national travel survey indicated that the proportion of primary school children that
walk to school decreased from 63% by 12 % in 10 years (NICE, 2008).
Secondly, advances in technology are not only allowing the world to become more
connected, but they are also inadvertently causing more sedentary lifestyles. Inventions
such as the television and satellites provide an enticing opportunity for young and old to
sit down and be entertained for hours. Unfortunately, the conventional past times that
involved being outside, playing and interacting with other people have been for the most
part replaced by the television and computer which cause their users to sit obediently
before them for a large portion of their leisure time.
What are the consequences of Physical Inactivity?
As early as 2002, the World Health Organization (WHO) described physical inactivity as
one of the top ten major causes of disease and disability in the world and also estimated
that as many as 2 million people per year (in 2002) died as a result of physical inactivity
Careful attention must therefore be placed on what many have coined as a major growing
global health issue. According to the WHO, it is estimated that anywhere from 60 – 85%
of people in the world are leading sedentary lifestyles (WHO, 2002). People who lead
such lifestyles place themselves at risk for developing numerous diseases and therefore
physical inactivity appears to be one of the largest issues of our time that doesn’t get the
adequate amount of attention it deserves.
Physical inactivity increases all causes of mortality; risks of cardiovascular disease,
diabetes and obesity are doubled by physical inactivity. Risks of colon cancer, angina,
high blood pressure and disorders such as depression and anxiety are all increased by a
sedentary lifestyle (www.who.org). In addition to all of this, physical inactivity also
reduces the functional ability of individuals (www.hhs.org). Functional Ability refers to
a person’s ability to perform everyday tasks or activities such as walking and climbing
stairs and research has also shown that people who are physically active have lower rates
of breast cancer (www.hhs.org).
Heart Disease and stroke are two of the leading causes of pre-mature death in the United
States (www.hhs.org) and people who do a certain amount of moderate-vigorous
intensity aerobic activity are significantly less likely to prematurely die (Figure 1.1).
FIGURE 1.1 – Risk of Premature Death based on Physical Activity Rates (Physical
Activity Guidelines for Americans, 2008)
The World Health Organization estimates that one in three adults around the world is
overweight and that one in ten are obese (WHO, 2006). People who are overweight
and/or obese also have a much higher risk of cardiovascular disease and other disabilities;
one of the key ingredients to preventing obesity is by moderate physical activity (WHO,
What are the costs of Physical Inactivity?
Research was conducted in Australia and it was found that physical inactivity was costing
the Australian Economy 1.5 Billion dollars in direct health care costs for several
particular diseases: Stroke, Coronary Heart Disease, Type 2 Diabetes, Breast Cancer,
Colon Cancer, Depression and Falls (Medibank, 2008), as indicated in figure 1.2.
Physical Inactivity (PI) is also estimated to cost the UK over 8 Billion pounds annually
which would include treatment of illnesses and absenteeism from work etc due to PI
FIGURE 1.2 – Estimated costs associated with various diseases/illnesses caused by
inactivity in Australia (Medibank Private, 2008).
Information gathered from various developed countries has indicated just how huge the
costs of physical inactivity are: it is estimated that for every dollar that is spent on PA
(either for time or equipment), results in a savings of more than three times the
investment (WHO, 2003). Health care costs that are associated with illnesses such as
cardiovascular disease and obesity account for 9.4 % of U.S. national health expenditure
in 1995 and over 6% of total health care costs in Canada (WHO, 2003).
A study of over 25000 people in Sao Paulo, Brazil, revealed that the leading risk factor
for cardiovascular disease was physical inactivity (60%) (Matsudo et al. 2002).
Cardiovascular Diseases are responsible for over 300,000 deaths in Sao Paulo each year
and it is estimated that sedentarianism costs $330.00 per person per year (Matsudo et al.
What is needed to Increase PA in a Country?
Based on the barriers or limiting factors of PA, some common themes arise in terms of
what elements/strategies are needed to increase physical activity in a country.
Among most strategies are the need for a multi-agency public policy, a nation based
advocacy program that highlights the economic benefits of physical activity, the
promotion of physical activity programs for communities and families (such as Hoops for
health), as well as the formulation of programs that are easy to access and require little
time to participate (WHO 2003).
Governments should also allocate a certain portion of its budget for the promotion of
physical activity, there should be an ease of access for the public to exercise in sports/
recreational facilities or open spaces. As stated earlier, it is estimated that for every US
dollar spent on equipment or time engaging in PA, a savings of $3.2 dollars was achieved
(Matsudo et al. 2002). In the Cayman Islands, where the population has doubled in the
past ten years (www.eso.ky), there is now a shortage of recreational facilities because
investment has been made in the refurbishment of the facilities. But whilst the population
was growing, the number of recreational facilities/open areas for physical activity did not
increase proportionately. England and Wales have an estimated population of 53 million
people and have over 27000 national parks (NICE, 2008), an average of 1 national park
per 2000 persons. In Grand Cayman, (Cayman Islands) there are 16 parks
(www.rpcu.gov.ky) for a population of over 50,000 people, an average of 1 park (which
is much smaller than a typical national park) per 3125 people.
Open public spaces should also always be maintained to a very high standard and made
to be attractive and easily accessible by various forms of active transport (cycling,
walking etc) to encourage maximum usage (NICE, 2008).
Transportation systems should be designed in such a way as to encourage PA (NICE,
2008). In Finland, most cities are designed in such as way that they encourage walking
and cycling; perhaps this is why the Finnish people are rated as some of the healthiest in
the world (www.who.org). By organizing a transportation system with careful thought, a
country can country can subconsciously cause its citizens to choose methods of transport
(commuting etc) that are better for their health.
Participation in global physical activity events, such as world walking day and world
challenge day (www.tafisa.net), are also great ways to raise the consciousness of a
country and to encourage the society to be physically active when they realize how
involved so many other countries are in doing the same.
Schools should play a primary role in ensuring children get the recommended amount of
physical activity through their classes. Schools normally occupy the vast majority of
children in any society and therefore have control over how much physical activity they
engage in through PE classes. Schools recreational areas should therefore be built in
such a way as to encourage varied activities and should mandate children to have the
sufficient amount of physical activity each week (NICE, 2008). Active children are
much more likely to become active adults and one of the many benefits of PA is that is
improves cognitive function and academic performance (NICE, 2008).
What does it cost to implement/facilitate what is needed?
It is extremely difficult to put an exact cost on implementing the strategies recommended
by the various health authorities due to the differences in service costs in various
countries (NICE,2008); for example, the cost of constructing a walking outdoor track in
Florida versus the Cayman islands. However, the evidence is overwhelming that
supports implementing strategies or developing infrastructure to encourage PA versus not
doing so and paying for health care to treat the illnesses and other symptoms related to
There is overwhelming evidence that supports the rising concern of physical inactivity
throughout the world and with an estimated average of 60% of people in the world not
receiving the recommended amounts of physical activity (WHO, 2003). PI increases the
risks of almost every major disease and is responsible for as many as 2 million deaths per
year (NICE, 2008). To combat this, Governments must allocate sufficient funding,
implement/enforce policies, and maintain sufficient open public spaces to tackle the
global inactivity phenomenon and if successful, will simultaneously eliminate or
drastically reduce the money that is spent on direct and indirect costs of health care as a
result of PI. It is in every Government’s best interest to pay more attention to the issue of
physical inactivity and with an estimated savings of 3 times the amount of money
invested in PA (Matsudo, et al.2002), it is clear that inactive citizens certainly cost a
government more money than active citizens.
The World Health Organization http://www.who.org
United States Department of Health and Human Services, 2008: Physical activity
guidelines for Americans. Retrieved from http://www.hhs.gov
MediBank Private, 2008. The cost of physical inactivity: What is the lack of participation
in physical activity costing Australia? Retrieved from http://www.medibank.com.au
Australian Government: Department of Health and Ageing: Retrieved from
Canadian Public Health Association. Retrieved from http://www.cpha.ca/
American Public Health Association. Retrieved from http:// www.apha.org
Public Health Agency of Canada. Retrieved from http://www.phac-aspc.gc.ca
East Carolina University – Department of Health Education and Promotion (Cost
calculator). Retrieved from http://www.ecu.edu/picostcalc/
World Health Organization, 2003. Health and development through physical activity and
sport. WHO Document Production Services, Geneva, Switzerland.
The Center for Disease Control. Retrieved from http:// www.cdc.gov
Matsudo V, Matsudo S, Andrade D, Araujo T, Andrade E, de Oliveira LC, Braggion G,
2002. Promotion of physical activity in a developing country: The Agita São Paulo
experience. Public Health Nutr. Feb; 5(1A):253-61.
Cayman Islands Government. Retrieved from http://www.gov.ky
Cayman Islands Economics and Statistics Office. Retrieved from http://www.eso.ky
The Association for International Sport for All. Retrieved from http:// www.tafisa.net
National Institute for Health and Clinical Excellence, 2008. Physical activity and the
environment: Costing report implementing NICE guidelines. Retrieved from
Recreation, Parks and Cemeteries Unit, Cayman Islands. Retrieved from