We Should Pay People to Exercise

Health and medicine explained.
April 15 2014 7:19 AM

You Should Get a Tax Deduction for a Gym Membership

Financial incentives are a great way to encourage preventive health care.

140414_MEDEX_ExerciseUnfit
Regular physical activity treats and prevents disease in every system of the body.

Photo by D. Milovanovic/Thinkstock

April marks another tax season when millions of Americans will deduct expenses related to home ownership, children, and education from their annual tax bill. These deductions exist because of their perceived value to society; they encourage behaviors that keep the wheels of the economy turning. We’re missing a great opportunity to save money on U.S. health care expenditures and save lives from obesity-related disease: The tax code should be revised to reward preventive health.

The United States is the world’s richest and most powerful nation, yet we rank 28th in life expectancy and 70th in overall health according to the Social Progress Index. At $2.7 trillion, we outspend all other countries in health care, with nearly $1.5 trillion treating diseases related to inactivity, including obesity, heart disease, and diabetes. Seventy percent of adults age 20 and older are overweight, and more than 33 percent are obese. For the first time, according to some predictions, children in the current generation may live shorter lives than their parents. Our current health care system does little to encourage preventive health, and we continue to spend billions of dollars treating preventable diseases. It’s time to incentivize Americans to lead healthier lives.

Regular physical activity reduces the risk of death and both treats and prevents disease in every system of the body. Researchers at the London School of Economics and Stanford University School of Medicine published a faceoff trial comparing the effectiveness of exercise to drugs in decreasing mortality rates among people diagnosed with heart disease, chronic heart failure, stroke, or diabetes. That is, they tested which approach staved off death.

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Exercise was just as effective as traditional medical treatment, and in some cases, it outperformed medication. Participants who exercised had considerably lower risk of death from stroke than those who took medication. People with diabetes and heart disease who exercised had the same risk as those taking commonly prescribed drugs, with none of the costs or side effects associated with medication.

Scientists are still in the process of discovering how exercise delivers these results. Exercise aids circulation and decreases weight, but some of its effects are more subtle. The latest science centers on Interleukin 6, a glycoprotein that increases in response to muscle contraction and is secreted into the bloodstream. IL-6 stimulates an immune response that has extensive anti-inflammatory function, suggesting that general body inflammation, a factor in almost every chronic disease, is reduced by regular exercise.

Despite overwhelming data on the preventive and therapeutic value of exercise, doctors and medical students receive minimal formal education on effective prescription. Medical schools and residency training programs should include a formal curriculum to teach students how to prescribe exercise, much like those afforded other treatments.

How can we motivate Americans to exercise? The American Journal of Preventive Medicine recently published a meta-analysis of 11 studies of exercise programs in previously sedentary adults. The authors asked: “What does it take to make inactive people move?” Their conclusion: “Financial incentives increase exercise adherence.”

Humana and Kaiser Permanente are health insurance companies that encourage prevention through financial reward; participants who exercise and make healthy lifestyle choices receive lower insurance premiums. Both programs provide incentivized rewards based on collective health improvements. Participants are assessed by body mass index, blood pressure, cholesterol levels, and smoking rates. Activity is strongly incentivized, and it is measured with tracking devices: The more people move, the less they pay. With millions now enrolled in these incentive-based wellness programs, data suggests that health behavior among enrollees is rapidly changing for the better.

This model can be applied on a broader scale to the U.S. government, other health insurance companies, and private companies. Each of these entities can use similar incentive programs—including tax incentives—to encourage health and prevent disease.

For example, instead of giving a tax credit for shipping a pet, the government could credit joining a gym. While music lessons are a noble pursuit, the current tax deduction for clarinet lessons to reduce overbite seems overly specific compared to crediting regular attendance at an exercise class to improve overall health. A few simple changes to the tax code would pay off many times over.

Boston and the Boston Medical Center have the right idea. A new program gives high-health-risk, low-income patients use of the city’s bike share program for only $5 per year. The more these patients move, the lower their risks of disease.

A study published in the Journal of the American Medical Association on U.S. health care in the past 30 years concluded that the focus on disease treatment absent effective prevention strategy significantly contributes to skyrocketing health care costs.

The typical diabetic spends $1,500 per month on treatment. Type 2 diabetes is a largely preventable disease linked to inactivity, obesity, and poor diet. The cost of treating diabetes in one person’s lifetime totals millions of dollars. It makes more financial and medical sense to incentivize a prediabetic to prevent diabetes rather than pay for the expensive medical costs after the disease state occurs.

Exercise is an important part of the solution to reduce soaring health care costs, disease, and obesity rates. Incentivizing movement will save money and make the populace stronger and healthier.

Jordan D. Metzl, MD, is a sports medicine physician at the Hospital for Special Surgery in New York. His newest book is The Exercise Cure. Follow him on Twitter.

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