The economic cost of physical inactivity in China
Highlights
► New estimates of the total economic cost of physical inactivity in China. ► Include the indirect impacts of inactivity through overweight, and through obesity. ► Based on recent data from the Chinese Behavioral Risk Factors Surveillance report. ► Recent national estimates of the economic burden for five major chronic diseases.
Introduction
Non-Communicable Diseases (NCDs) are China's leading cause of death, as they are estimated to account for 85% of annual deaths in the country (MOH & China CDC, 2011). Similar to other regions worldwide, NCDs in China are largely due to modifiable risk factors, namely tobacco use; unhealthy diets and excessive energy intake; and physical inactivity (Hu et al., 2011, Wang et al., 2005, Yang et al., 2011a, Yang et al., 2011b). While the public health burdens of the tobacco and obesity epidemics in China are somewhat well-studied (Popkin, 2008, Yang et al., 2011a), physical inactivity has remained an under-researched field in this country.
Rapid modernization and urbanization have been associated with increased sedentary lifestyles in China. Physical activity has been dropping at an alarming rate: Between 1991 and 2006, average weekly physical activity among adults fell by more than a third (Ng et al., 2009). China has recently experienced the highest rates of decline in physical activity compared to the US, the UK, Brazil and India (Ng and Popkin, 2012). In parallel, the incidence of NCDs increased substantially: For instance, between 1993 and 2003, the prevalence of cardiovascular diseases increased from 31.4 to 50.0%, and diabetes from 1.9 to 5.6% (Wang et al., 2007). The 2007 Chinese Behavioral Risk Factors Surveillance Survey (BRFSS) reported 31.1% of Chinese aged 15–69 not meeting the targets for healthy levels of physical activity of at least 30 min of moderate intensity activity on ≥ 5 days per week, or at least 20 min of vigorous intensity activity on ≥ 3 days per week (China CDC, 2010).1 The 2010 BRFSS reported that 11.9% of Chinese aged 18 and above reported participating in physical activity regularly, i.e., at least 3 times per week, and at least 10 min for recreational physical activities, and 83.8% reported not doing any physical activities at all (China CDC, 2011).
Recently the Chinese Government recognized the importance of healthy eating and active lifestyles in reducing NCDs, by making them integral components of the Healthy China 2020 Plan (Hu et al., 2011). Within this context, our study provides a recent scientific estimate for the economic cost of physical inactivity in China, using the latest available national data in 2007. Evaluating the economic burden of physical inactivity in this country can help policymakers further justify the importance of investments in public health initiatives promoting physical activity.
Section snippets
Methods
The economic costs of physical inactivity are evaluated using the cost-of-illness approach,2
Results
Table 1 summarizes the main relative risk statistics and the corresponding Population Attributable Risk indicators for each chronic disease, using recent prevalence data: The 2007 Chinese Behavioral Risk Factors Surveillance reported that the prevalence of physical inactivity among adults was 31.1%; while the prevalence of overweight was 25.8% and the prevalence of obesity was 7.6% (China CDC, 2010). PARs show for instance that inactivity is directly responsible for 16% of stroke cases in
Discussion
Our analysis has shown that physical inactivity currently contributes between 12% and 19% to the risks associated with the five major NCDs in China, namely coronary heart disease, stroke, hypertension, cancer, and type 2 diabetes. As a result, physical inactivity is imposing a substantial economic burden on the country, as it is responsible for almost one sixth of direct (medical) and indirect (non-medical) yearly costs of the main NCDs in the country. This ratio is close to the direct medical
Conflict of interest statement
The authors declare that there are no conflicts of interest.
Acknowledgments
We thank experts and colleagues at the Ministry of Health, P.R. China and Chinese Centers for Disease Control and Prevention who developed the 2011 China NCDs Report. We also thank the journal's peer reviewers, in addition to David Bloom and Younghwan Song, for their helpful comments and suggestions. The model used in this paper is based on related work commissioned by funds from Nike, Inc. We thank Lisa MacCallum, Nithya Gopu and Anne Cotleur, our liaisons at Nike, Inc., for their support.
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