Where is physical activity in the US healthcare system?

US healthcare has been ranked as both the costliest and the poorest quality1 among high-income countries. Our traditional fee-for-service model clearly incentivises treatment of sickness and disease ahead of disease prevention. One of us (IA) works in Alabama, a prime example of a US state with poor health outcomes. Alabama is ranked 48th out of 50 states for overall health, 45th in the proportion of people who meet physical activity guidelines, 49th in cardiovascular health and 44th in mental health, and is among the five worst states for obesity and in the top three for increasing prevalence of diabetes.2

To address the challenge of poor health outcomes, the US healthcare system has begun moving towards a value-based reimbursement system with the passage of the Affordable Care Act, which aims to lower costs and improve quality. Since 80% of diseases (eg, hypertension, heart disease, type 2 diabetes, obesity, multiple cancers and osteoporosis) in the USA are related to poor lifestyles,3 the promotion of physical activity and healthy eating are low-cost measures that could significantly impact quality outcomes. Given …