Killing us slowly

killing us softly

Body Mass Index (BMI)/Wikimedia Commons

While the National Transportation Safety Board (NTSB) was this week suggesting states make bicycle helmets mandatoryan act that has been shown to discourage cycling – the Rand Corporation was calculating that a lack of exercise is already leading to shorter, less healthy lives in the U.S. and costing the country $5 billion a year in health-care costs in the process.

Not only that, the think tank’s report said, the lack of basic fitness is dragging down the economy to the tune of tens of billions of dollars per year as the result of “mortality, absenteeism, (and) presenteeism.”

Presenteeism is being on the job but not fully functioning because of illness or other medical conditions. It has been linked to significant costs in lost productivity.

Getting Americans up and moving enough to generate a minimum increase in fitness in the U.S. could boost the gross national product (GDP) by almost $52 billion by 2025, Rand economists calculated, and a significant fitness improvement could lead to economic gains of $219.5 billion by 2025.

Rand’s global study looked at the U.S. as one of many countries caught in an epidemic of sedentary living and conceded that getting people up and moving “is hard.”

It did suggest some progress could be made via Walkable Communities, “social support for physical activity within communities and worksites; school-based strategies that encompass physical education and classroom activities; after-school sports; active and different modes of transport; creation and improvement of access to physical activity infrastructure; community urban re-design; land use; and community-wide policies and planning.”

The Rand study is the first to attempt to link fitness, economic productivity, and health care costs on a global scale. There was, however, a 2018 Canadian study that looked at these issues in that country.

“Taking into account reductions in premature mortality, sickness absence and disability, (that) study estimates that getting 10 percent of Canadians with suboptimal levels of physical activity to exercise more would increase Canada’s GDP by $7.5 billion cumulatively between 2015 and 2040,” the Rand economists wrote.

“Our estimates tend to be higher because we are also taking into account potential
benefits of reduced presenteeism rates associated with getting people to be more physically active. Furthermore, a recent study by PJM Economics (2019) estimated that the potential benefit of improved productivity (measured as reduced absenteeism and presenteeism among workers) to UK businesses is £6.6 billion per year.”

Other, smaller studies have also found significant economic benefits from improving fitness, and a long list of studies have tied fitness to better health and lower health care costs.

“Research…illuminates the stark fact that physical inactivity is associated with more than 5 million deaths every year,” the Rand analysts wrote. “With the global rates of physical activity diminishing, and the associated costs to humankind increasing as a result, the insidious and dangerous nature of such global inactivity is becoming increasingly exposed.”

Motor country

The U.S. did not score particularly well in the report.

When men in women in 22 countries and Hong Kong were ranked for physical activity, U.S. women came in second-worst and U.S. men were sixth-worst. Forty-eight percent of American women are “insufficiently active,” the study said. The number for U.S. men was 31.7 percent.

Insufficient activity was defined by World Health Organization (WHO) standards that call for “at least 150 minutes of moderate-to-vigorous-intensity physical activity or at least 75 minutes of vigorous-intensity activity” per week.

Globally, on average, more than 76 percent of men, but only 68.3 percent of women clear that bar.

Rand’s economic analysis of a minimum increase in fitness is based on getting entire populations up to the WHO standard. The big increase is based on everyone reaching the minimum and everyone above that threshold improving their physical activity by 20 percent.

In general, the countries where more people are known to get around under their own power rather than in motorized vehicles posted higher on activity scores than the U.S.

The 58-page report – ‘The economic benefits of a more physically active population – An international analysis” – goes deep into the macroeconomic model used to assess economic and health gains tied to fitness. An ebook of the full report can be downloaded from the Rand website. 

The study suggests it may have underestimated the health-care cost savings and economic gains because of an analysis limited to “only five diseases for which the existing literature suggests moderate to strong evidence for the association with physical activity.”

The fitness, health and economic issues discussed in the report have links to climate change as part of a big picture that seldom gets discussed in total. A 2011 study funded by the European Cyclists Federation, which conceded that cycling is not a “zero emission activity, concluded that Europe could, however, cut its emissions by a quarter if all Europeans cycled as much as the Danes.

The average Dane cycles about 600 miles a year or about 50 miles per month , the study reported. The average on the continent overall is 120 miles with the mileage for residents of Britain dropping to 46 miles.

Comparable figures are not available for the U.S., but the number is likely lower than that for Britain. Some Americans say they are afraid to cycle because of the dangers posed by U.S. drivers.


The NTSB, an agency established to make transportation systems in the U.S. safer, caused a stir this week when it suggested states consider making bike helmets mandatory.

It was if the agency long credited with making airline travel the safest way to get around the country had decided to ignore design standards for airplanes and airports and simply recommended airplane passengers wear parachutes.

The NTSB Board, noted StreetsBlog NYC, voted “to recommend helmet laws even as staff members reminded panelists that such laws may reduce overall cycling, and lead to the ‘unintended consequence’ of more road fatalities because fewer cyclists will mean less pressure on local officials to build the kind of protected infrastructure that is proven to improve cyclist safety.”

Bike safety is a hot issue in New York City with bike fatalities up 170 percent.

The staff report to the NTSB had duly noted the low death rate for cyclists in the Netherlands which has huge numbers of cyclists and a low use of helmets. Staff analyst Ivan Cheung pointed out that cycling in the Netherlands is safer by design.

“The Netherlands has been committed to making bicyclists part of their complete street and part of the overall transportation strategy — and they have tens of thousands of protected bike lanes and protected intersections,” he said. “Not to shame the U.S., but we are 20 or 30 years behind. As a result, bicycling as a percentage of the mode share is very very high. … Our team thinks helmets are important, but the difference between the Netherlands and the U.S. is infrastructure.”

The lack of infrastructure contributes to both cycling and pedestrian deaths. The deaths of the former pale in comparison to the number of pedestrians killed by motor vehicles every year. The National Highway Traffic Safety Administration (NHTSA) reported motor vehicles killed 6,283 pedestrians last year, an increase of 3.4 percent.

Cyclist deaths were up 6.3 percent, but only 857 died. The NTSB staff attributed the rising deaths rates to the lack of separation between vulnerable road users and motor vehicles.

It is unknown how many of the deaths are caused by drivers simply not paying attention, but a 2016 study published in the Proceedings of the National Academy of Sciences of the United States of America pointed to the dangers of technology in automobiles today.

The studies authors used multiple onboard video cameras and sensors to gather information from more than 3,500 drivers during a three-year period and concluded that drivers were distracted more than half the time.

“Distraction was a factor in 68.3 percent of the 905 injurious and property damage crashes observed…,” they reported. “Calculating a population-attributable risk for distraction overall shows that potentially 36 percent, or 4 million of the nearly 11 million crashes occurring in the United States annually, could be avoided if no distraction was present.

“The results of this study provide hard and conclusive evidence that crashes and resulting injuries would be reduced if drivers did not use handheld cell phones, thus supporting previous recommendations that handheld cell phones be banned from moving vehicles, except in cases of emergency.”

The NTSB called for such a ban at the start of the decade. Only two states – Louisiana and Maine – have followed that recommendation although many states have been the use of phones by underage drivers. Fifteen states, including Alaska, have banned drivers from texting.












8 replies »

    • There’s some perspective for you, whether you eat nuts or meat, whether you ride a bike or walk or drive.

  1. For completeness, there is also a ‘fat & fit’ notion. It’s getting ink in various kinds of outlets that promote fitness, activity and the great outdoors. It stands to reason that pursuing fitness & active lifestyles, despite packing 20-40 pounds of emergency survival rations, would improve health & ability, and reduce costs associated with sedentism & obesity.

    ‘Competitiveness’ is a big difference between cycling in the USA vs Netherlands etc. American riders tend to be more gung-ho for hard-riding, hunched over and absorbed in their performance-metrics. Images of riders & riding in Holland, Denmark and elsewhere in Europe show a more laid-back, no-hurry cycling style … maybe an active disapproval of aggressive riding … even outright bicycle speed limits.

    Riders in many regions & contexts in the US are essentially road-racing, and regard it as normal. They are often decked-out in full competition regalia. A person in common street clothes, sitting erect on their bicycle, sticks out like a sore thumb.

    So yeah, sure … many who might like to, don’t ride because they don’t measure up. Magazines and websites are filled with articles showing how to dress & ride like it’s the Tour de France. Fat people on bikes? How gross.

    Netherlands riding is safer, partly due to better separation between traffic and cyclists (a glimmer of sanity if ever there was one). But even they have limited special bike-paths, and much riding both in city & country, shares the road with cars. They have distracted car drivers too; low-key cyclist-behavior may be making the safety-difference.

    What American cycling needs is a good Bench Seat, with tubby-butts amply filling them. Build up participation, and then things might start happening at the ballot box.

    • Great point Ted, when I traveled through Europe I remember the bicycles stacked up on top of each other in the Netherlands and they were all what would be considered old style or beach cruiser style and didn’t have a fancy paint job. They were tools for transportation, to get from point A to point B, they were not status tools, race tools, health reasons, or used expressly for fun. They were quicker than walking and cheaper than owning a car or taking the train. Of course when something is just a built in part of life it is easy to be taken for granted, the utilitarian use of a bicycle having an additional health benefit was just that…an additional benefit.

      • That’s right Steve – where bicycles actually have replaced the car to a significant degree, they clog the roads & streets, nobody goes any faster than the slowest rider, and there’s no point or romance in performance bikes or behavior.

  2. “Staff analyst Ivan Cheung pointed out that cycling in the Netherlands is safer by design.”

    Staff analyst Ivan Cheung needs to look at a map and take a History of Europe class. If everyone in the US lived in Maryland, and the majority of cities in that Maryland were originally designed and built around foot and horse-powered transportation, then maybe the US could come anywhere close to the percentages of cyclists there.

    Cross-cultural comparisons are fraught with potential for over-simplification and error, they’re even fraught-er when you’re an narrowly-focused, single subject analyst.

  3. There is no doubt that the vast majority of Americans are overweight and unhealthy but I would say that diet and the foods consumers eat is a larger and (easily mitigated) factor than just “inactivity”.
    Just spend an hour or two at Costco and watch the hotdogs, pizza, chips, hotwings and burger patties filling the carts.
    The standard American diet or (SAD) is what is killing most Americans through heart disease and cancer.
    If you really want to change your life, then change what you eat…less meat and more fruits, vegetables and whole grains with nuts and seeds.
    “For the first time, the committee is recommending that the government should consider the environment when telling Americans what they should eat, a move that could have a significant impact on the amount of meat people eat.”

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