THE ECONOMIC VALUE OF WALKING: Making use of walking for transport efficiency and economic regenerat

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THE ECONOMIC VALUE OF WALKINGMaking use of
walking for transport efficiency and economic
regenerationWednesday 3rd July
2002Staffordshire UniversityStoke-on-Trent
THE FIFTH NATIONAL WALKING CONFERENCE
C A S T
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Personal CostThe new epidemics of the 21st
CenturyThe costs of obesity and heart
diseaseDr. Richard MendelsohnDirector of
Public Health, Eastern Birmingham Primary Care
TrustDr. David PitchesSpecialist Registrar in
Public Health,Heart of Birmingham Primary Care
Trust
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What is cardiovascular disease?

• group of conditions in which blood vessels are
  narrowed or blocked, resulting in reduced blood
  supply to target organs
• cardiovascular disease is the main cause of death
  in the UK, accounting for 39 of all deaths

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• half of all CVD deaths are from coronary heart
  disease
• one quarter of all CVD deaths are due to strokes

British Heart Foundation 1998
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Premature death from cardiovascular disease

• most common cause of premature death in men under
  65
• causes 36 of premature deaths
• third most common cause of premature death in
  women
• causes 28 of premature deaths
• causes over 70,000 premature deaths per year

British Heart Foundation 1998
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What is coronary heart disease (CHD)?

• narrowing of the arteries supplying the heart
  muscle
• angina is pain due to this narrowing
• heart attack (myocardial infarction) occurs when
  the blood supply is blocked by a blood clot
• treatment is with clot-busting drugs (more
  rarely angioplasty Dynorod-style)

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Extent of heart disease in UK

• 300,000 people have a heart attack every year
  half of these people die from their heart attack
• kills one in four men and one in six women
• decreasing trend since 1970s
• rates are much higher in more deprived
  socio-economic groups

British Heart Foundation 1998
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Heart disease and deprivation

• premature death rate for male manual workers is
  58 higher than professionals
• although death rates in all groups are falling,
  they are falling fastest in non-manual workers so
  differences are actually widening
• social inequalities account for 5000 deaths and
  47,000 lost years of working life annually in men
  aged 20-64

Office of National Statistics and BHF
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Office of National Statistics 2001
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ONS 2001
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Office of National Statistics 2001
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International comparisons

• Scottish men have 50 higher death rates from
  coronary heart disease than East Anglia
• Scottish women have 80 higher death rates
• In the EU, only Finland and Ireland have higher
  rates of CHD than the UK
• South Asians living in the UK have a 50 higher
  risk of premature death from CHD than average

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Age-standardised death rates per 100,000 in
England demonstrating north-south gradient
British Heart Foundation
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Obese or overweight?

• obesity - excessive adipose tissue (body fat)
• overweight - increased weight in proportion to
  height
• may be fat or muscle!

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How do we measure obesity?

• 1. Body mass index (BMI)
• weight in kilograms
• height in cms squared

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How do we measure obesity?

• 2. Waist-hip ratio
• waist circumference
• hip circumference
• ratio of 1.0 or more is at risk

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• BMI of 18.5 to 24.9 considered normal
• BMI of 25 to 29.9 overweight
• BMI greater than 30 obese
• Individuals with a BMI greater than 25 are at
  greater risk of premature death or disability
• Individuals with a BMI greater than 30 have a
  50-100 increased risk of premature death

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The energy balance
CALORIE INTAKE
PHYSICAL ACTIVITY
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• Evidence that being active benefits health
• Who would you expect to be fitter and have less
  heart disease -
• bus conductors or bus drivers?

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As early as the 1950s they were compared and
the conductors had 30 less heart disease than
the drivers
Morris 1953, The Lancet
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Comparative Energy Expenditure
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Health consequences of obesity (1)

• High blood pressure, hypertension
• High blood cholesterol, dyslipidemia
• Type 2 (non-insulin dependent) diabetes
• Insulin resistance, glucose intolerance
• Hyperinsulinemia
• Coronary heart disease
• Angina pectoris
• Congestive heart failure
• Stroke

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Health consequences of obesity (2)

• Gallstones
• Cholescystitis and cholelithiasis
• Gout
• Osteoarthritis
• Obstructive sleep apnea and respiratory problems
• Some types of cancer (including endometrial,
  breast, prostate, and colon)

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Health consequences of obesity (3)

• Poor female reproductive health (including
  menstrual irregularities, infertility, irregular
  ovulation)
• Bladder control problems (including stress
  incontinence)
• Uric acid nephrolithiasis

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Health consequences of obesity (4)

• depression
• eating disorders
• distorted body image
• low self esteem

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Cardiovascular disease

• Incidence (rate of new cases) of disease is
  greater in overweight people
• high blood pressure is twice as common in obese
  people compared to those with healthy weight
• physical activity cuts risk of death by 30-50

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BHA 2000
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Diabetes

• weight gain of 5 to 8 kg doubles the risk of type
  2 diabetes
• 80 of people with type 2 diabetes are overweight
  or obese

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Cancer

• cancers of the colon, gallbladder, prostate,
  kidney, endometrium (lining of the womb)
• a 10kg increase in weight from age 18 to midlife
  doubles a womans risk of breast cancer

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Musculoskeletal problems

• every 1kg increase in weight increases the risk
  of arthritis by around 10

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Pregnancy

• obesity during pregnancy increases risk of death
  in both mother and baby and risk of diabetes
  during pregnancy
• obesity during pregnancy increases risk of
  maternal high blood pressure by 10 times
• obesity is associated with irregular menstrual
  cycles and infertility

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Quality of life

• limited mobility, and decreased endurance can
  affect quality of life
• risk of social or job discrimination

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Benefits of weight loss

• reduction in risk factors for heart disease,
  diabetes and certain cancers
• lowers blood pressure, cholesterol and blood
  sugar
• reduces risk of premature death

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Results of a US study

• followed a group of women for 12 years
• lost an average of 5kg
• 20 fall in total mortality
• 50 reduction in certain cancers
• 30-40 deduction in diabetes-related deaths

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What causes obesity?

• main two factors are calories in and calories out

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The complex science bit

• complex interactions between different chemicals,
  hormones, and parts of the brain which regulate
  appetite
• ageing - bodys metabolic rate slows with age
• genetic factors and congenital anomalies
  determine susceptibility and influences how the
  body uses fat for energy or storage
• medical conditions - thyroid, adrenal gland
  disorders
• cultural and social pressure

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Physical activity tends to reduce with obesity
Regional Lifestyle Survey
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Trends in the USA

• prevalence (ie proportion of people) of obesity
  has nearly doubled since 1980 from 15
  to 27
• 13 of children are seriously overweight
• 61 of American adults are overweight or obese

CDC
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Trends in the UK

• prevalence rising faster in UK than other
  European countries
• prevalence has almost trebled in the UK since
  1980

NAO report
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Why are so many people overweight?

• behaviour
• eating too many calories
• yet actually average consumption has fallen!
• environment
• home, school and work all have barriers to
  physical activity

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• Obesity in Birmingham now
• 20 of Brummies are obese, compared to 16.6
  nationally
• 31 more people aged 16-44 are obese in the West
  Midlands compared to England and Wales

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The costs of obesity in the USA

• in the US obesity cost 117 billion in 2000 and
  caused 300,000 premature deaths
• direct costs to the US health service in 1995
  were 51.6 billion (5.7 of total spending)
• 39 million working days lost
• 90 million hospital bed days

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The costs of obesity to the NHS

• in 1998 estimated at 500 million (NAO)
• indirect costs were a further 2 billion
• 18 million days of sickness absence
• 40,000 lost years of working life

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Obesity and health professionals

• limited services available for obesity compared
  to eg diabetes or heart disease
• often not perceived to be a serious medical
  problem by doctors
• tends only to be treated once other disorders set
  in, rather than before they develop

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The cost of heart disease

• 1600 million to the NHS in 1996 alone
• around 4 of total cost (43 billion)
• just 11.6 million spent on health promotion
• a further 8.5 billion production losses
• total costs around 10 billion per year
• similar to primary education

BHF 1998
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Why Walking?

• Accessible to all low cost, not sporty
• Daily routine 6 x 5 minutes
• Moderately intense
• Good evidence
• Suitable for sedentary/unfit
• Sustained for long periods
• Social contact

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• Benefits of walking
• 30 minutes /mod vigorous activity
• Reduce heart disease by 30
• Reduce risk of diabetes by 50
• Reduce risk of falls /osteoporosis
• Improve quality of life - independent old age,
  mental health

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• Whats the message?
• Walking just half an hour six days a week will
  improve your quality of life
• Thats three lots of five minute walks (eg from
  home to the bus stop ) and a fifteen (2km) minute
  walk at lunchtime

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Walking in the UK

• of 13000 deaths each year from heart disease in
  under-65s, 3000 could be avoided by walking half
  an hour each day
• one premature death is avoided for every 3-4000
  adults who walk half an hour per day
• in context, one premature death from breast
  cancer is avoided for every 1500 women screened
• walking is a cost-effective intervention!

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Walking in Birmingham

• a third of Birmingham adults say they walk less
  than a quarter of a mile each week
• only 15 walk the recommended 2 miles or half an
  hour five days or more per week
• of the 420 deaths from heart disease each year in
  Birmingham in adults under 65, around 120 would
  have been avoided if everybody had walked the
  recommended minimum

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Conclusions

• whilst heart disease is falling we cannot afford
  to be complacent
• a overweight and obese generation is growing up
  and storing massive problems for their future
  health
• heart disease is still the biggest cause of
  premature deaths in the UK
• obesity accounts for around 5 of health
  expenditure in many countries
• the health service bears the cost of obesity but
  lacks power to change lifestyles and behaviours