Published on December 10, 2020
By Kurt Waltenbaugh
As I head into the holidays this year, I’m thankful for the gift of health more than ever. The health of my family, elders, co-workers, and friends.
Unfortunately, this “gift of health” isn’t by accident nor evenly distributed across communities (for example, take a look at race and inequity right here in Minneapolis). Health is a privilege, reserving its benefits for some but not all.
We know certain behaviors influence the achievement and maintenance of good health. By avoiding tobacco and alcohol, exercising at least 150 minutes each week, and maintaining a reasonable diet and body fat percentage, you are likely healthy. In fact, research indicates those who maintain this lifestyle are “82% less likely to die from cardiovascular disease and 65% less likely to die from cancer when compared with those with the least healthy lifestyles.” Consider it the “home run” for living a long, healthy life.
However, more than 60% of the population – and more than 80% of those over age 65 – have at least one chronic illness and account for more than 90% of our medical spend.
So what’s the ROI of population health? If everyone lived a “home run” lifestyle, we could significantly reduce our $3.5 trillion-dollar budget, or 18% of GDP, by up to $2.8 trillion.
To put it in perspective, medical spend is almost the equivalent of the total 2019 $4.4 trillion federal budget (i.e., military, social security, Medicare, Medicaid, education, transportation, etc.).
By thinking of population health ROI and treating healthy lifestyles as a societal need much like the military (i.e. defense) or education, we could cut spend in half. By reinforcing or “financing” healthy behavior (e.g., social determinants of health interventions, disease prevention, etc.) with a $7,500 annual rebate for all U.S. adults, our medical spend could be $2 trillion less than what it is today, and tax burdens reduced. A win for everyone.
Yet, fewer than 3% of us can lead a “healthy” lifestyle due to barriers.
Personally, with limited social options this year, going for a bicycle ride has been critical to my wellbeing, both physically and mentally. It’s not surprising. Countless studies correlate fitness with health:
- “Aerobic exercises, including jogging, swimming, cycling, walking, gardening, and dancing, have been proved to reduce anxiety and depression.”
- “Exercise directly affects the brain. …evidence suggests that exercise is not only necessary for the maintenance of good mental health, but it can be used to treat even chronic mental illness.”
- “We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death.”
- “Our general conclusion is that exercise is so effective that it should be considered as a drug…”
- “Regular exercise may reduce our risks of developing some cancers by as much as 69%.”
- 150 minutes a week of moderate activity, merely 30 minutes a day five days a week. Activities that count as ‘moderate’ include a brisk walk, mowing the lawn, cleaning the house, “light” bicycling (10-12 mph), doubles tennis, etc.
Sounds easy, right? However, federal research data suggests otherwise:
- Only 1 in 3 children are physically active each day.
- Less than 5% of adults get 30 minutes of daily activity.
- Fewer than 20% of adults meet the aerobic and muscle strengthening guidelines.
- Children now spend 7.5 hours per day in front of a sedentary device (e.g., TV, video game, smartphone).
While these averages are stunning, they mask the real issue: These behaviors are not evenly distributed or accessible. Some communities are active while others are next to zero. For example, let’s look at the percent of adults who are physically inactive by state level.
In places like Washington, Montana, Utah, Colorado and Minnesota, there is a clear geographic bias – they have more physically active populations. In contrast, Mississippi, Louisiana, Alabama, Missouri, and Kentucky, along with other states in the southern part of the U.S., do not.
Additional disparities are present when looking at fitness within communities by race and ethnicity as demonstrated in the CDC comparison maps.
These disparities, or barriers to health, result in a significant added disease burden, for both cancer and chronic illness. According the National Center for Biotechnology Information, 30-65% of racial, ethnic, and gender differentials in physical activity are attributed to differences in education, socioeconomic status, time constraints, and locational attributes.
These barriers exist because of unequal access to education, economic stability, work-life balance, and suitable environments. In a community with unsafe streets for walking due to limited lighting or elevated crime rates, children spend less time outdoors. Without easy access to parks or gym membership funds and limited school budgets cutting sports and physical education classes, children grow up without the benefits of physical activity.
These differences build up over a lifetime, resulting in shorter lifespans, higher chronic illness and cancer rates, and massive medical intervention – medical intervention that could be avoided by spending much smaller amounts of money upfront, preventing illnesses from happening in the first place.
Instead of spending smaller dollar amounts earlier to prevent disease, insuring longer and healthier lives for everyone, we wait until people become sick. We then overspend to patch them up, resulting in the worst of both worlds – higher cost, poorer health, and shorter lives.
Let me now amend my initial statement: While I’m thankful for my health and the health of those around me, we must do better. We must consider public health ROI. The privileges allowing me to live a healthy life should not be hoarded but rather shared across every community. In sharing this privilege, not only do we help everyone live healthier, longer lives, we save money and build a stronger nation. Everyone does better.
And with that vision in mind, in step with those who help and work to achieve it, I’m truly thankful.