Inputs and Outcomes of Physical Activity: A Health Economic Perspective

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Public investments in physical activity, particularly in times of fiscal austerity, are
regular targets governmental budget cuts. From a health economic perspective,
this is especially problematic as physical activity, for all its well-documented health benefits, actually represents an appropriate mechanism to reduce the increasing costs of public health systems. An estimation of a return on investment of public spending on physical activity thus may serve as a useful point of reference for policy makers when allocating financial resources.
Drawing on existing economic evaluation methods, the present thesis develops a
health return on investment (HROI) framework, describing the relationship between input (public investments), output (physical activity), and outcome (health costs). Moreover, in sections four to seven, four academic papers are presented, providing new empirical evidence to the different relationships of such HROI framework. In sections four and five, the focus is on the input-output relationship. Section four takes a look at the effect of sport-related public investments on sport participation. The results indicate that the effects are most likely lagged and that, in particular, investments in sports infrastructure do positively affect sports participation. Section five demonstrates that, in addition to sport-related spending, public investments in other areas have to be considered. For example, a positive relationship between transport infrastructure and sports participation can be demonstrated. Section six and seven then concentrate on the output-outcome relationship. Section six investigates the effect of physical activity on out-of-pocket health costs of the elderly. The results show that older people can in fact significantly reduce their health costs by becoming physically active. Section seven analyzes the effect of physical activity on health costs from a macro-perspective. Applying the comparative risk method allows to estimate the costs of inactivity for the period 2001-2013.
Moreover, the study reveals that demographic changes are likely to increase the
costs of physical inactivity. Overall the thesis represents a first step in measuring the HROI of public investment in physical activity. It adds to the existing empirical evidence on two of the core relationships of the HROI framework by specifically considering the transformative context of an aging society.
Translated title of the contributionInputs und Outcomes von körperlicher Aktivität: Eine gesundheitsökonomische Perspektive
Original languageEnglish
Place of PublicationKöln
PublisherDeutsche Sporthochschule Köln
Number of pages49
Publication statusPublished - 03.06.2020


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