������MAKING THE UK THE MOST ACTIVE NATION IN EUROPE�Research Summary���Prepared on behalf of the Sport and Recreation Alliance by: ��Richard Boardman, MSc – Head of Research and Development, Sport and Recreation Alliance��Karis Longden, MSc – Research and Data Officer, Sport and Recreation Alliance
INTRODUCTION�
The problem: Physical activity is broadly understood and recognised as being beneficial to individuals, communities and society. However, the specifics of this benefit, its current scale, and importantly the headroom for a greater contribution across key policy priorities has not been fully articulated.
The purpose of this research: The research seeks to begin the process of clarifying the potential for growth in physical activity levels in the UK, and the benefits of facilitating this growth for the country. The document also forms the evidence base for the National Sector Partners Group’s call to all the UK’s main political parties and leaders to commit to making the UK the most active nation in Europe.
This document is structured in three sections:
- The current position: Where physical activity levels are in the UK today, and how this compares to our nearest neighbours
- Headroom for growth: The extent to which the UK could reasonably expect to see physical activity rates increase
- Why this is important: The benefits of increasing physical activity levels to individuals, communities and society and the return on investment for doing so.
Data from the World Health Organisation’s (WHO) ‘Global Status Report on Physical Activity 2022’ is used to provide the age-adjusted prevalence of adults (over 18 years of age) that do not meet physical activity recommendations. These recommendations are at least 150 minutes of moderate-intensity aerobic physical activity; or at least 75 minutes of vigorous intensity aerobic physical activity; or an equivalent combination of moderate- and vigorous-intensity activity throughout the week.��This data is advantageous as it is standardised internationally, so all countries’ physical inactivity levels are reported universally as the same measures are used for each country. The physical inactivity rates of the top 15 European nations by population size and which are categorised by the World Bank as ‘high income’ are analysed and compared in this report.��Where possible, data from the UK is used throughout the paper. However, in the cases when adequate data is not readily available, Sport England’s Active Lives survey is used. To sense check this approach, physical inactivity levels from the two sources were compared for similarity. Active Lives measures three levels of activity: active (at least 150 minutes a week), fairly active (30-149 minutes a week), inactive (fewer than 30 minutes a week). By combining ‘fairly active’ and ‘inactive’ the proportion of those who don’t meet physical activity recommendations of 150 minutes of moderate-intensity aerobic physical activity or equivalent is identified. Sport England categorises an adult as those aged 16+ years, as opposed to 18+ for the WHO. ��In 2022, the Active Lives study found that 36.9% of those aged 16+ years in England do not meet physical activity recommendations, compared to 36% of those aged 18+ in the UK cited in the WHO report. There is a small difference of 0.9 percentage points between the two figures. Possible explanations for this slight discrepancy include Active Lives only covering England whereas the WHO figure is on the whole of the UK, and that they focus on slightly different age brackets (16+ vs 18+). Given the close similarity, we feel it is appropriate to use Active Lives data when certain data was not available for the whole of the UK, provided this caveat is kept in mind.��A full list of references is available at the end of this document.�
DATA SOURCES
25.8%
Inactive
>30mins
per week
11.1%
Fairly active
30-149mins
per week
63.1%
Active
150<mins
per week
‘Inactive’
‘Active’
Sport England’s Active Lives summary from 2022 shows 63.1% of those aged 16+ in England to be ‘active’ and 36.9% to be ‘inactive’
THE CURRENT POSITION��- How does the UK’s current inactivity levels compare to our nearest neighbours?�-Which communities are least active?
Comparing 15 similar European nations, the UK is the joint 11th most inactive with 36% of adults aged 18+ not meeting physical activity recommendations. ��The average physical inactivity rate of all countries featured in the chart is 31%, and the world average is 28%, thus the UK currently performs worse than the average for the region and globally.��There is a difference of 19 percentage points between the most active nation, Finland, and the UK. Furthermore, only three countries (Italy, Germany, and Portugal) are more inactive than the UK.
UK INACTIVITY LEVELS COMPARED TO EUROPE
WHICH COMMUNITIES ARE THE LEAST ACTIVE?
Those that live in the most deprived areas are more likely to be physically inactive and are least likely to be reaping the benefits of physical activity. The charts below show this both by independent decile of multiple deprivation index, and by decile group.
The Index of Multiple Deprivation (IMD) is the official measure of relative deprivation in England. Neighbourhoods are divided into 10 equal groups (or deciles) according to their deprivation rank, with the most deprived being in decile 1.
There are significant inequalities in inactivity levels with people living in the most deprived areas being the least active. Notably, there is a difference of 19 percentage points in inactivity levels between the most and least deprived areas in England.
Disparities in activity levels are further exacerbated when other characteristics are considered, including gender, ethnicity, education level, or having a disability or long-term health condition. It should be noted that the likelihood an individual from any social intersection being physically active or inactive is strongly influenced by the level of deprivation their home is indexed within. Therefore, deprivation has been used as the principal characteristic for sampling control in this report. More information on the intersection of deprivation with other characteristics and physical activity levels is available in the appendices of this document.
HEADROOM FOR GROWTH ��How active could the UK become?
WHERE DOES THE UK NEED TO GET TO?
The graph shows the number of currently inactive adults that would need to become active for the UK to meet the physical activity levels of other countries. This is displayed as a proportion of the current 19.2 inactive adults in the UK.
If the UK were to become as active as Finland, 10.1 million currently inactive adults would need to become active (52.6% of the UK’s currently inactive adults). The UK Government’s recently published sport strategy, Get Active, sets a target of getting 2.5 million more adults active by 2030. Assuming other nation’s physical inactivity levels do not change, were the Get Active target achieved the UK would rise two places to 9th, above Norway and below Austria.
The UK spends the smallest proportion of general government expenditure (GGE) on recreation and sport. ��In 2018 (the most recent year for which comparative figures are available), 0.4% of GGE was spent on recreation and sport.��In the same year, the Netherlands and Sweden spent the highest proportion of GGE on recreation and sport, both spending 1.1%. This is 0.7 percentage points more than the UK. ��������
GOVERNMENT EXPENDITURE
There is a clear relationship between levels of physical inactivity and the percentage of GGE (general government expenditure) spent on sport and recreation, with the most active nations allocating the largest proportions of GGE. This relationship has a strong correlation of -0.73 and is expressed by the upper dashed trendline of the chart.��However, while the UK spends the lowest proportion of GGE on sport and recreation, it is the second most 'efficient' country in converting ‘% of GGE’ into ‘% of active population’, narrowly behind Ireland and above Austria. This ‘efficiency’ is expressed in the lower trendline.��Using the two trend lines it is possible to derive an estimated theoretical range of GGE on sport and recreation that would be required in order for the UK to be on a par with the most active nation Finland.
PHYSICAL INACTIVITY AND GOVERNMENT EXPENDITURE
Using the European average ‘efficiency’ in converting spend into physical activity (the upper trendline), the chart shows the percentage of GGE on sport and recreation would need to be approximately 1.13%. Using the UK’s current outperformance of the European average level of efficiency (the lower trendline), this figure could be revised to 0.87% of GGE.
In broad terms this means to match Finland, the proportion of UK GGE on sport and recreation would need to be somewhere between two to three times larger.
WHY THIS IS IMPORTANT��Benefits of becoming the most active nation in Europe:�- Health�- Productivity�- Wellbeing
DIRECT HEALTHCARE COSTS RELATED TO INACTIVITY
The UK has the 3rd highest direct healthcare costs of non-communicable diseases and mental health (NCDs) attributable to physical inactivity* per capita.
On average, physical inactivity costs the UK £20.53 per capita in attributable direct healthcare costs.
The most active nation, Finland, has a per capita direct healthcare cost attributable to physical inactivity of £5.11. This is £15.42 less than the UK.
The average cost across the 15 nations featured in the chart is £13.31 per capita, highlighting how much greater the per capita spend is in the UK.
*These costs are for new preventable cases of coronary heart disease, stroke, type-2 diabetes, hypertension, seven cancers (breast, colon, endometrial, gastric, oesophageal, renal, and bladder), dementia and depression resulting from physical inactivity per year.
There is a clear relationship between levels of physical inactivity in a country and the direct healthcare costs attributable to physical inactivity that country bears.��The most active nations, on average, have the lowest direct health care costs of NCDs attributable to physical inactivity per capita.��This relationship has a very strong correlation of 0.84.��
DIRECT HEALTHCARE COSTS RELATED TO INACTIVITY
DIRECT HEALTHCARE COSTS RELATED TO INACTIVITY
The UK ranks 14th for the direct healthcare costs attributable to NCDs attributable to physical inactivity per inactive adult.
The figures in the graph represent the average directly attributable healthcare savings of an inactive adult becoming active.
On average, inactivity costs the UK £72.13 per inactive adult in direct healthcare costs.
The country with the smallest costs per inactive adult is Ireland with an average cost of £35.30, approximately half the costs to the UK.
There is a clear relationship between levels of physical inactivity and the direct healthcare costs attributable to physically inactive adults. ��On average, the most active nations have the smallest direct healthcare costs per inactive adult.��This relationship has a moderately strong correlation of 0.59. ��
HEALTHCARE COSTS PER INACTIVE ADULT
HEALTHCARE SAVINGS IF THE UK WAS AS ACTIVE AS…
The line of best fit from the previous graph on the relationship between healthcare costs and inactive adults was used to estimate the healthcare costs per inactive adult if the UK were as active as other (more active) European nations. This figure was then applied to the number of inactive adults there would be if the UK had the activity levels of these nations. These overall healthcare costs were then subtracted from the current estimated direct healthcare costs attributable to physical inactivity for the UK (£1.4 billion) to calculate the potential savings if the UK was as active as these nations. The chart shows potential savings of over £1 billion for the NHS regarding NCDs and mental health attributable to physical inactivity.
ANNUAL GDP GAIN IF THE UK WERE AS ACTIVE AS…
RAND Europe (2019) conducted an analysis of the potential economic benefits associated with getting people to be more physically active due to reduced presenteeism, sickness absence, and mortality.
This investigated the potential GDP uplift of every adult reaching at least the recommended 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity per week.
Under a scenario of getting 100% of the population active, after 5 years the UK’s annual GDP is projected to be £4.4 billion per year greater, with these benefits compounding further over time.
The physical inactivity rates of the most active nations in Europe were applied to this figure to estimate the potential GDP gains if the UK were as active as these nations.
For example, if the UK were as active as Finland, annual GDP is projected to be £3.65 billion per greater in 5 years’ time.
PHYSICAL INACTIVITY AND WELLBEING
WELLBY refers to a ‘wellbeing-adjusted life year’ and is defined as a change in life satisfaction of 1 point on a scale of 0 to 10, affecting one person for one year.
WELLBY is used as a measure of national social welfare and calculates average current wellbeing multiplied by the expectation of years of life.
There is a clear relationship between levels of physical inactivity and WELLBY with the most active nations having the highest levels of wellbeing. This relationship has a strong correlation of -0.70.
The dashed trendline expresses the average relationship between wellbeing and physical inactivity. The UK has higher levels of wellbeing than its rate of physical activity would predict (by 3.6%), the 4th greatest ‘over-performance’ in the sample behind Germany (+6.9%), Norway (+6.6%), and Denmark (+4.6%).
PHYSICAL INACTIVITY AND WELLBEING
The chart shows that adults living in England that are active report an average level of wellbeing 0.539 points higher than inactive adults (measured through self-reported ‘life satisfaction’ on a scale of 0-10).
As previously mentioned in this document, deprivation is significantly associated with activity levels (see ‘Which Communities Are The Least Active?’ page above and the appendices below for further information). To account for this, life satisfaction figures were controlled by level of deprivation using grouped IMD deciles.
Wellbeing is used by the UK’s HM Treasury as a means of evaluating the impact of an intervention (outlined in the ‘Green Book’, 2021).
The Green Book states that an individual UK adult would be willing to pay between £10,000 and £16,000 per year for a 1.0 uplift in their level of wellbeing on average. This is known as a Wellbeing-Adjusted Year (WELLBY). Using the mid-point as recommended by the guidance, this means one WELLBY holds an equivalent value of £13,000.
Given an average uplift of 0.539 applied to the above means that being physically active holds a value equivalent to £7,007 per active person per year.
PHYSICAL INACTIVITY AND WELLBEING
Using the metric of £7,007 of value for being active per person per year, it is possible to calculate the equivalent monetary value of ‘converting’ inactive UK adults in to ‘active’ adults. The outcomes of this analysis are provided below. This shows that if the UK was to become as active as Finland, which would require getting 10.1 million more adults active, this would be worth the equivalent of £71 billion of value in enhanced wellbeing alone.
OTHER AREAS FOR EXPLORATION
This report has modelled the potential return on investment for sport and recreation in three areas: reduced direct healthcare costs of treating NCDs associated with physical inactivity, increased GDP, and improved wellbeing. These represent the areas where sufficiently reliable data was available for international comparison and modelling.
The Social and Economic Value of Community Sport and Physical Activity in England report by Sport England and Sheffield Hallam University identifies other areas in which academic research shows physical activity produces improved outcomes. The Sport England report does not model the monetary impact of increasing physical activity rates beyond 500,000 people, which is why it has not been used as a basis for modelling uplift in this report. However, it is fair to say increases in physical activity rates to the levels of other nations would also return further benefits to the UK in the following areas:
Other Areas of Improved Mental Health and Wellbeing not covered in this report (150+mins of physical activity or equivalent…)
Individual Development
Social and Community Development
Economic Development not covered in this report
CALL TO ACTION AND SUMMARY
The sport, recreation, and physical activity sector’s leading bodies are making an urgent call to our main political parties and leaders: unlock the potential of the sector and commit to making the UK the most active nation in Europe.
The UK currently ranks joint 11th out of 15 for levels of physical activity amongst comparable European nations. Contextualised in this are significant disparities and inequalities in activity levels, with the most deprived communities often being the most inactive. This means the communities that are likely to have the most to gain from being active, are the least likely to be active. In terms of investment, the UK’s General Government Expenditure on sport and recreation is the lowest in Europe at 0.4% (2018). However, the UK’s sport and recreation sector can be said to be the second most efficient in converting General Government Expenditure into physical activity, performing above the European average (second only to Ireland and above the next most efficient nation, Austria).
Improving the UK’s levels of physical activity is worth doing, partly because it will return significantly greater value than the expenditures required to make it happen. The areas in which improved physical activity rates will provide significant returns are a reduction in the direct healthcare costs attributable to physical inactivity, improved economic productivity, and improved levels of wellbeing. If the UK were to become as active as the most active nation in Europe, Finland, this is projected to generate:
In addition to the above, improved levels of physical activity will return substantial benefits to society not explored in this document. These include:
This report is intended to be the starting point in articulating the potential benefits of the UK becoming a more active nation. By comparing the UK to its nearest neighbours in Europe, this potential is not set in the abstract notion of a fully active nation but in the reality of what is already being achieved elsewhere.
REFERENCES
APPENDIX 1:�Physical activity disparities in England
HOW ACTIVE IS THE UK?
Inactive
Latest data from Sport England’s Active Lives Survey indicates 63.1% of the population of England are physically active, leaving 36.9% inactive.
England comprises 84% of the UK’s population. As such the ‘true’ rate of physical activity for the UK is likely to closely resemble these figures.
In the main report (above), data from the World Health Organisation’s ‘Global Status Report on Physical Activity 2022’ report is used, citing 64% of the population of the UK as active and 36% inactive.
The following section provides a further analysis of the profile of physical activity in England, courtesy of Sport England’s Active Lives Tool.
DEPRIVATION AND GENDER
There are significant inequalities in inactivity levels, with women in the most deprived areas being the least active.
According to Active Lives, 34% of men are inactive, compared to 39% of women – a difference of 5 percentage points. However, data from the WHO on the UK they reports there is an 8 percentage points difference between male and female activity levels. This suggests that inequalities may be wider in the other nations in the UK.
A difference of approximately 5 percentage points is consistently found when investigating gender differences in the same IMD deciles. However, the differences are stark when comparing across deciles. Alarmingly, 47.2% of women in the most deprived deciles are inactive compared to 29.6% of men in the most affluent deciles, a 17.6 percentage point difference.
PHYSICAL INACTIVITY AND GENDER
The WHO (2022) report on physical activity also reported on inactivity levels for men and women. The differences between these levels were calculated and correlated with that country’s overall inactivity levels.
There is a moderately strong correlation between these factors of 0.67, which has been displayed in the scatter graph to the left.
On average, the most active nations have smaller gender imbalances in their levels of inactivity.
The UK has a difference of 8 percentage points compared to the average gap across all 15 countries of 6 percentage points. Therefore, the UK currently has a larger gender imbalance than the average across the region. However, the gender imbalance is aligned to the ‘expected’ imbalance based on all 15 countries, given the overall level of physical activity in the UK (as shown by the trendline).
DEPRIVATION AND ETHNICITY
There are differences in activity levels based on ethnicity, with disparities in activity levels between the most and least deprived neighbourhoods.
Overall, those of mixed ethnicity are typically the most active and people from Asian (excluding Chinese) ethnicity are the least active. The disparity in activity levels between these two groups is 25.1 percentage points, therefore a person of mixed ethnicity living in decile 8-10 is twice as likely to be active than someone of Asian (excluding Chinese) ethnicity living in deciles 1-3.
The chart shows the prevailing trend is the higher the decile group, the lower the levels of inactivity. This trend is not met by Chinese and Black ethnicities in deciles 8-10 who are less likely to be active than people of the same ethnicities in deciles 4-7 (and less likely than those in deciles 1-3 in the case of Chinese ethnicity).
DEPRIVATION AND EDUCATION
Level 1 or below: First Certificate
Level 2 or equivalent: GCSE/O Levels
Level 3 or equivalent: A Levels
Level 4 or equivalent: Higher Education/ Degree
There are significant inequalities in inactivity levels with people with no qualifications in the most deprived areas being the least active.
There is a percentage point difference of 40.4 between the most active (Level 4 and above & decile 8-10) and least active (no qualifications & decile 1-3).
Regardless of their level of education, the prevailing trend is the less deprived the area a person lives, the more likely an individual is to be active. However, a person educated to level 4 or equivalent is more than twice as likely to be active than someone with no qualifications living in the ‘higher’ deciles (8-10).
DEPRIVATION AND DISABILITY
There are significant inequalities in inactivity levels with people with a disability or long-term health condition in the most deprived areas being the least active.
Overall, 53% of people with a disability or long-term health condition are inactive compared to 32% of people without. This is a percentage point difference of 21.
These disparities are even more extreme when comparing the most active group (no disability & decile 8-10) and least active group (disability or long-term health condition & decile 1-3), with a percentage point difference of 29.7.
APPENDIX 2:�Combined economic impact of the UK becoming as active as its European neighbours
POTENTIAL HEALTHCARE SAVINGS IF THE UK WAS AS ACTIVE AS…
Country | Proportion of Adult Population that are Inactive | Number of UK Inactive Adults Needed to Become Active | Potential Healthcare Savings (Billion GBP) |
Ireland | 33% | 1,600,976 | £0.46 |
Norway | 32% | 2,134,635 | £0.51 |
Austria | 30% | 3,201,952 | £0.60 |
Denmark | 29% | 3,735,611 | £0.65 |
France | 29% | 3,735,611 | £0.65 |
Netherlands | 27% | 4,802,928 | £0.73 |
Spain | 27% | 4,802,928 | £0.73 |
Switzerland | 24% | 6,403,904 | £0.84 |
Sweden | 23% | 6,937,562 | £0.88 |
Finland | 17% | 10,139,514 | £1.07 |
POTENTIAL GDP GAINS IF THE UK WAS AS ACTIVE AS…
Country | Proportion of Adult Population that are Inactive | Number of UK Inactive Adults Needed to Become Active | Potential GDP Gains (Billion GBP) |
Ireland | 33% | 1,600,976 | £2.94 |
Norway | 32% | 2,134,635 | £2.99 |
Austria | 30% | 3,201,952 | £3.08 |
Denmark | 29% | 3,735,611 | £3.12 |
France | 29% | 3,735,611 | £3.12 |
Netherlands | 27% | 4,802,928 | £3.21 |
Spain | 27% | 4,802,928 | £3.21 |
Switzerland | 24% | 6,403,904 | £3.34 |
Sweden | 23% | 6,937,562 | £3.38 |
Finland | 17% | 10,139,514 | £3.65 |
POTENTIAL WELLBEING UPLIFT IF THE UK WAS AS ACTIVE AS…
Country | Proportion of Adult Population that are Inactive | Number of UK Inactive Adults Needed to Become Active | WELLBY Uplift (Billion GBP) |
Ireland | 33% | 1,600,976 | £11.22 |
Norway | 32% | 2,134,635 | £14.96 |
Austria | 30% | 3,201,952 | £22.44 |
Denmark | 29% | 3,735,611 | £26.18 |
France | 29% | 3,735,611 | £26.18 |
Netherlands | 27% | 4,802,928 | £33.65 |
Spain | 27% | 4,802,928 | £33.65 |
Switzerland | 24% | 6,403,904 | £44.87 |
Sweden | 23% | 6,937,562 | £48.61 |
Finland | 17% | 10,139,514 | £71.05 |
POTENTIAL BENEFITS IF THE UK WAS AS ACTIVE AS…
Country | Proportion of Adult Population that are Inactive | Number of UK Inactive Adults Needed to Become Active | Potential Healthcare Savings (Billion GBP) | Potential GDP Gains (Billion GBP) | WELLBY Uplift (Billion GBP) |
Ireland | 33% | 1,600,976 | £0.46 | £2.94 | £11.22 |
Norway | 32% | 2,134,635 | £0.51 | £2.99 | £14.96 |
Austria | 30% | 3,201,952 | £0.60 | £3.08 | £22.44 |
Denmark | 29% | 3,735,611 | £0.65 | £3.12 | £26.18 |
France | 29% | 3,735,611 | £0.65 | £3.12 | £26.18 |
Netherlands | 27% | 4,802,928 | £0.73 | £3.21 | £33.65 |
Spain | 27% | 4,802,928 | £0.73 | £3.21 | £33.65 |
Switzerland | 24% | 6,403,904 | £0.84 | £3.34 | £44.87 |
Sweden | 23% | 6,937,562 | £0.88 | £3.38 | £48.61 |
Finland | 17% | 10,139,514 | £1.07 | £3.65 | £71.05 |
������- END -������Prepared on behalf of the Sport and Recreation Alliance by: ��Richard Boardman, MSc – Head of Research and Development, Sport and Recreation Alliance��Karis Longden, MSc – Research and Data Officer, Sport and Recreation Alliance��For any questions, please contact: rboardman@sportandrecreation.org.uk��