Politicians are starting to look at the economic consequences of a sporting nation when physical activity will be the great national cause in 2024, echoing the Paris Games. And the figures are more than encouraging.
In a context of seeking savings in the accounts of the National Health Insurance Fund (Cnam), could physical and sporting activity be one of the solutions to reduce health costs in France? If the health benefits of physical and sporting activity are no longer in doubt, the savings made possible thanks to this still seem underestimated.
“As much as we have scientific proof of its effectiveness, until now, we have not made progress on the economic aspect. However, several studies show that savings can be made in the more or less long term,” explains Alain Fuch, consulting physician, who participated in the production of the first report commissioned on the subject, in 2022, by the Ministry of Sports and the Olympic and Paralympic Games. A subject that politicians have just taken up, while physical activity will be the great national cause in 2024, the year of the Paris Games.
Physical inactivity quantified in billions of euros
“It is well demonstrated, confirms Martine Duclos, head of the sports medicine department at Clermont-Ferrand University Hospital and director of the National Observatory of physical activity and sedentary lifestyle (Onaps). The cost of physical inactivity in France amounts to 140 billion euros per year, according to data from the National Health Insurance Fund. This is also a largely underestimated figure, since we have not measured the cost linked to chronic diseases in terms of morbidity. [état de maladie].”
“This figure fluctuates depending on age: 840 euros per year if the person is aged 20 to 39, 23,275 euros if the person is aged 40 to 74.*”
Martine Duclos, director of Onapsat franceinfo: sport
Last year, the Ministry of Sports and the Olympic and Paralympic Games took up the subject and commissioned research to identify studies and work on the economic consequences of physical activity on health. Never before has research work of this magnitude been carried out by the Ministry of Sports, which today “took the turn towards prevention”, assures Alain Fuch.
Millions in health care spending savings per year
In this document entitled Evaluate the socio-economic impacts of health sport in Franceit is thus established that “physical activity reduces the risk of coronary heart disease by 20 to 50%, the risk of stroke by 20% to 60%, the risk of type 2 diabetes by 45% and up to 65% if it is practiced at high intensity among subjects at risk”. Physical activity also reduces the risk of developing certain types of cancer, from 22 to 27% for colon cancer, from 19 to 27% for breast cancer, from 15 to 19% for stomach cancer. or even 19 to 51% for esophageal cancer.
Concretely, according to a study by the National Council for Physical and Sports Activities, carried out in 2007, “if more than a million physically inactive French people reached the WHO recommendations [150 minutes d’activité physique hebdomadaires d’intensité modérée pour les adultes], more than 250 million euros in health expenses would be saved each year”. More recently, in 2018, the Office of Sports Economics modeled potential economic gains based on increasing levels of physical and sporting activity (PSA) in France. Observation: by increasing the number of regular practitioners by 10%, the net gain is estimated at 300 million euros per year. It climbs to 1.3 billion per year for a 50% increase in practitioners, and up to 2.6 billion per year when the number of regular practitioners doubles.
On a country scale, the potential savings are considerable and could even increase its gross domestic product (GDP). Experts worked on a modeling of three scenarios of increase in the level of physical activity over thirty years, taking into account the evolution of health expenses and that of the loss of productivity linked, for example, to absenteeism due to illness . According to their calculations, increasing the level of physical activity of the French population would allow an annual increase in GDP of 2.98 to 13.94 billion dollars from 2050, underlines the study The economic benefits of a more physically active populationpublished in 2019.
Immediate effects at any age
Above all, the reports prove that the observed savings occur quickly. “Our study demonstrated that a physical activity program provides a better quality of life in patients with a history of coronary heart disease or moderate heart failure. People who followed this program saw their health care costs decrease by 30% in the same year of the program, i.e. a reduction of 1,300 euros per year”, affirms Alain Fuch, author of the scientific study As du coeur, carried out in 2014, on the psycho-behavioral and medico-economic impact of an adapted physical activity (APA) program in non-drug therapy.
This observation of a reduction in costs linked to health expenditure is confirmed at all ages of the population and particularly among seniors. An analysis by the Public Policy Institute, published in 2015, estimated the direct annual costs saved thanks to avoided falls, following an APA program for residents of retirement homes. This reduction would amount to between 1,842 and 3,242 euros per patient each year.
If this type of APA program were generalized to 500,000 residents, France could save between 421 and 771 million euros each year. “We know that falls are very often the trigger for accelerated aging. To avoid them, you must mobilize your body, continue to send all the movement signals which engage the brain and the musculoskeletal system (muscles, joints the bones..) as a whole. In short, moving protects against falling”, explains Irène Margaritis, professor of sports physiology and deputy to the risk assessment directorate at ANSES (National Health Security Agency).
Stable healthy life expectancy
These savings in health costs therefore go hand in hand with healthy life expectancy, in other words the number of years that a person can expect to live without suffering from incapacity in the actions of daily life.“There is a very clear link between physical activity and life expectancy, since there is a reduction in mortality and morbidity with physical activity. And at the same time, an extension of life in good health “, poses Irene Margaritis.
Because if “the French are living longer and longer, the gain in these years of life is not always associated with years of life in good health”, recalls the Directorate of Research, Studies, Evaluation and Statistics (Drees), in one of its reports published in 2018.
For around twenty years, the healthy life expectancy of the French has remained stable while life expectancy has increased. “We are one of the longest-lived nations, but on the other hand we are very poorly ranked for years of healthy life. We are roughly in the middle of European countries, with an average age at which chronic diseases develop around fifty years old, notes Martine Duclos.
France, a country of cure and not prevention
Although numerous studies on the subject demonstrate a direct link between reduced health costs and physical activity, policies are only beginning to look more closely at this parameter. Contacted by franceinfo: sport, the General Directorate of Health, which works with the Ministry of Sports on the subject, confirms this consideration “the importance of promoting physical activity as a major determinant of improving the health of the population”.
The ministry also specifies that a “twenty experiments are in progress”, (…) “concerning care pathways integrating or centered on APA with multi-actor flat-rate care”, in order to evaluate “efficiency (…), contributing to providing additional data, necessary for the orientation of public health policy, on the impact of these interventions in terms of health economics”. Why did you wait so long?
“First, we do not have a culture of prevention, but a culture of care. Then, the effects of prevention are only observed from four or five years, which is not the length from the point of view of a politician, who wants immediate results.”
Martine Duclos, director of Onapsat franceinfo: sport
More than this political awareness, it is an entire country to educate in this sense. “Doctors are starting to be trained on the effects of physical activity,” underlines the head of the sports medicine department at Clermont-Ferrand University Hospital. “Now, where we need to move forward is the management of physical activity for therapeutic purposes,” As for Alain Fuch, he advances. To try to become more of a country of prevention than of cure.
* according to a report from France Stratégie, titled Socio-economic assessment of the health effects of public investment projects and published in 2022.