Getting people active can revive an economy – global study

By now most of us who follow the media – and Discovery Health’s behaviour-changing incentivised approach to health via its global Vitality program – are well acquainted with the benefits of an active lifestyle. What’s been unquantified until now are the GDP benefits to individual countries. They’re massive according to a combined study released by Rand Europe and Vitality. It shows that if all adults aged 18-64 walked just 15 minutes more a day, the world economy would grow by an estimated $100bn a year until 2050. South Africa’s slice of that would probably pay off a decade of Zuptoid looting in way less time – without huge foreign investment or a massive injection and deregulation of small to medium businesses. For SA, the empirical analysis found that 29% of males and 47% of females are insufficiently active – ‘insufficiently active’ being defined as not meeting the minimum weekly recommended activity of at least 150 minutes of moderate-intensity exercise. Get more people active and we’re talking billions saved in absenteeism, not to mention presenteeism (being at work, but less productive). These findings are a wake-up call. Two more lessons for SA, following the example set by our world-beating Springboks; get fit and stay honest. Hope springs. – Chris Bateman

Global study shows how fitter SA bodies could lead to a fitter SA economy with potential growth of $500m a year

Vitality statement:

The results of a ground-breaking academic study on the relationship between global economic growth and exercise, carried out by Vitality and RAND Europe, reveal significant benefits to the economy and life expectancy if physical activity levels increase globally.

The study finds that the world’s GDP would gain more than $100bn (£80bn or R1,5trn) each year until 2050 if people:

  • walked 15 minutes more a day;
  • did a slow jog of half a mile (one kilometre) a day, or;
  • took 1,500 extra steps a day.

The economic improvement arises from lower mortality rates (more people alive and contributing to the economy), reduced absenteeism, and lower presenteeism driven by the impact of physical activity on mental health. 

Dinesh Govender, Discovery Vitality Chief Executive, says; “Physical inactivity, and the devastating impact it has on people’s quality of life, mortality and morbidity, is one of the key public health challenges we face. Considering that 28% of the global population are not physically active enough – 38% in South Africa – Vitality’s commitment to get people moving is more relevant than ever.”

Vitality has been successfully incentivising people to lead fitter and healthier lives and ultimately transforming the way insurance works, for over 20 years. The insurers connected by Vitality, now collectively accountable for more than 35% of the world’s individual protection market, are committed to addressing significant global challenges like inactivity. This is evidenced by the network’s commitment last year to make 100 million people 20% more active by 2025.

Read also: Cape Town leads the way in healthy living, driving – Discovery

In South Africa specifically, Vitality has over many years designed interventions that have a tangible impact on health outcomes. Govender said; “In 2015, we pioneered a step-change in how people tracked their physical activity and health with our Vitality Active Rewards with Apple Watch benefit. Vitality members bought over 231,000 fitness devices in 2019 alone.”

Independent research has validated the efficacy of incentives combined with a behaviour-change programme. “In 2018, we released the largest study on behaviour change and incentives with RAND Europe. This study showed that members with Vitality Active Rewards and Apple Watch were 34% more active – illustrating the power of incentives designed to achieve lasting behaviour change,” Govender explains.

Similarly, the 2019 study aims to further deepen the global understanding of the real economic impact of a physically inactive population. It assesses how different physical activity improvement scenarios may affect the economy of countries up to 2050 and shows the significant influence of regular exercise on economic growth, workforce productivity and life expectancy.

Govender continues: “This ground-breaking study provides proof of the relationship between exercise, productivity, mortality and economic growth. It strengthens our resolve to continue to encourage people to Move More and become part of a global health movement.”

Some of the findings show that:

  • If the physically inactive were to reach the World Health Organisation’s recommended levels of exercise, employees would gain up to five additional days of productive time each year, and the global economy would grow by an estimated $220bn every year. 
  • Life expectancy could increase by at least 2.5 years, on average, for a person aged 40 years in this scenario.
  • In addition to getting inactive people active, if those currently active increased their physical activity levels by 20%, the global economy could grow by in excess of $360bn every year; equivalent to the size of Singapore’s economy. Economic gains for the US economy would $95bn (£73bn) a year until 2050, and $11bn (£8.5bn) a year for the UK economy, in this scenario. 
  • Economic gains can be attributed to the reduction of premature deaths in the working age population, improving rates of sick leave and improved levels of workplace productivity associated with regular exercise.

The study uses a novel approach to synthesise the existing evidence on physical activity and mortality risk by taking study design and publication bias into account. It utilises Vitality’s extensive proprietary dataset on workplace health, derived from its Healthiest Workplace initiative in seven countries, to assess the relationship between physical activity and performance at work. It combines the mortality and productivity effects into a single model to project the true economic cost of physical inactivity over time.

Hans Pung, President of RAND Europe, comments on the significance of the study; “This is the first time that a multi-country macroeconomic model has been applied to the area of physical activity, facilitating a detailed assessment of the current and future implications of insufficient physical activity.”

Pung also highlights the relevance for policymakers and employers, “The study points to a significant relationship between inactivity and productivity loss, driven largely by ill-health related presenteeism. We hope that these insights will support policy makers and employers with new perspectives on how to enhance the productivity of their populations.”

For South Africa, the positive knock-on effect on the economy of an increase in physical activity, is equally acute. The RAND study shows that if South Africa succeeds in getting 20% of adults more active over the next 30 years, the average GDP will increase by $500m; and if all inactive people reach the minimum WHO physical activity levels, GDP will increase by between $1.6 and $2.1bn.

Study rationale

  • According to the World Health Organisation (WHO) insufficient physical inactivity is recognised as one of the leading risk factors for death, posing a global public health problem. Globally, it is estimated that every year, physical inactivity is associated with more than 5 million deaths and is contributing to global healthcare expenditures, as well as lost productivity. While many countries have developed national action plans to tackle growing prevalence of physical inactivity, gaps challenges persist with their implementation, often associated with an uncoordinated or underfunded approach.
  • Physical inactivity is associated with the onset of a number of different diseases, including cardiovascular disease, stroke, diabetes and cancer (e.g. breast or colon). Physical inactivity is also associated with a mortality and morbidity burden. A healthy population has a positive effect on a country’s economic output (e.g. measured as gross domestic product). Reducing physical inactivity has a positive effect on a country’s labour force by reducing premature mortality and improving rates of sickness absence and levels of presenteeism.
  • We believe the implications of this study can be far-reaching, informing policy around the world on issues of public health and state budgets.

Methodology

  • RAND Europe used a dynamic computational general equilibrium (DSGE) macroeconomic model in this study. DSGEs are used in macroeconomics to explain economic phenomena, such as economic growth and business cycles, and the effects of economic policy, through econometric models based on applied general equilibrium theory and microeconomic principles. The model has been extensively peer reviewed and tested. 
  • The productivity data stems from data collected as part of Vitality UK’s Britain’s Healthiest Workplace (BHW) Survey, as well as AIA’s Asian Healthiest Workplace Survey. In both, employers are asked about their provision of health and well-being interventions, while employees are asked over 100 questions related to demographic factors (age, gender, education, income), lifestyle and health behaviour (nutrition, smoking habits, physical activity, sleep behaviour), health factors (mental and physical health indicators, chronic and musculoskeletal conditions), as well as workplace productivity and job and life satisfaction. Overall, the sample pool was significant, yielding a collective sample size of 120 143 across seven countries.
  • Multivariate regression models were employed to investigate the associations between physical activity and a set of outcome measures, including workplace productivity, quality of life and a set of sleep measures. Depending on the analysis, physical activity is included in the analysis as two variables. First, as a binary indicator taking the value one if the individual regularly achieves the recommended level of physical activity per week (e.g. 150 minutes of moderate or 75 minutes of vigorous physical activity) or zero otherwise. Second, as a continuous variable measuring the MET minutes an individual of physical activity an individual performs every week. 
  • To measure work engagement, the workplace surveys include questions that build the Utrecht Work Engagement Scale (UWES), which includes three dimensions of work engagement: vigour, dedication, and absorption. The nine questions related to the scale are measured on a 7-point Likert scale.
  • To investigate the relationship between physical inactivity and elevated mortality risk, the study uses meta-regression analysis. Meta-regression analysis is a form of systematic review employing a range of statistical methods to synthesise and evaluate specific empirical literature. It helps to better understand the existing research findings on a given empirical effect of interest.
  • The study uses the MET unit as a measure for how much energy an individual exerts in performing a physical task. It a measure which adjusts for body size, and is defined as the amount of oxygen consumed while sitting at rest, equal to 3.5 ml oxygen per kg body weight per minute. Alternatively, one MET is defined as 1 kcal/kg/hour and is roughly equivalent to the energy cost of sitting quietly. For comparison, cycling is estimated to equal 3.5-16 METs and running 6-23 METs, depending on intensity.
  • On attaining the associations between physical activity to productivity and mortality, these effects are then plugged into the DSGE model to yield the economic outcomes. The analysis on the future economic benefits of changes to physical activity at the population level is based on demographic projections on how the population of each country or region evolves over time. To that end, we demographic projections are generated using input data from the UN and an adapted version of Chapin’s cohort-component model, which are implemented as five-year projections using Stata. The cohort-component model starts with the current base population and is categorized for each country region by age, gender and skill level. The base population subsequently evolves by applying assumptions on mortality, fertility and migration rates. The outcome of the model is a projection of the population by (5-year) age, gender and skill groups up to thirty years, applied to each of the 24 countries or regions.

Annual GDP gain by country relative to the status quo (in 2019 USD billions present values), at specific years. 

Based on all adults achieving a 20% increase in physical activity, as well as meeting at least the World Health Organisation minimum requirements (scenario 3). For instance, assume the population of South Africa begins meeting the conditions of scenario 3 from 2020, it would gain $1.40bn in GDP in 2030 and so forth.

  2030 2040 2050
Argentina 1.21 1.88 2.82
Australia 5.72 8.14 11.23
Austria 1.16 1.32 1.48
Canada 5.93 7.00 8.15
China 32.77 59.44 99.71
Ecuador 0.24 0.38 0.57
France 7.44 8.46 9.49
Germany 12.36 13.64 15.27
Hong Kong 0.43 0.53 0.63
Japan 9.75 10.28 10.14
Malaysia 0.80 0.98 1.16
Netherlands 2.28 2.59 2.91
New Zealand 0.88 1.25 1.72
Pakistan 1.19 1.86 2.79
Philippines 0.92 1.43 2.14
Singapore 0.46 0.57 0.67
South Africa 1.40 2.20 3.06
South Korea 3.43 4.11 4.72
Sri Lanka 0.30 0.46 0.69
Thailand 1.09 1.34 1.58
United Kingdom 9.49 12.13 15.05
United States 85.26 109.59 137.98
Vietnam 0.69 1.07 1.60
Rest of the World 89.61 132.24 188.19