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Notes on Child Health Cost Savings from Physical Activity

Health Condition Chart

K-12: Kindergarten through 12th grade. PA: Physical Activity. MVPA=Moderate-to-Vigorous Physical Activity, e.g., after several minutes, children are panting, starting to sweat, & having trouble conversing while moving. BH=behavioral/mental health. Targeting total minimum of 60 minutes/day of MVPA from before, during and after school activities, per National Academy of Sciences/Institute of Medicine recommendations. ADHD & depression can improve particularly quickly, though BMI has been improving within 1-2 years with regular MVPA in both Partners for Healthy Promises and Fit Kids at School—with possible assistance from school meals being improved over the same timeframe.

Analysis based on peer-reviewed journal articles & population data from government statistics/reports (see details below & in other slides).

High levels of MVPA reduce health costs by est. $30-50/child/year among elementary students, & more among middle- & high-school students. Evidence-based preventive P-D-E framework based on Partners for Healthy Promises, Plans for, Develops, & Evaluates continuously to ensure high levels of MVPA with an at-scale cost of $10/student/year = <1 year payback, in schools with min. 30-60 PE minutes/week. (P-D-E costs per student are higher at smaller scales: ~$15-30/student/year). It often only takes ~1-2 children per K-12 class becoming healthier to pay back investment within 1 year. Also: “the cost-effectiveness of [youth] anti-obesity interventions have likely been underestimated.” (Biener et al, 2017)

Payback/ROI formula: Condition Cost x Condition Prevalence x Reduced Incidence of Condition = Treatment Cost Reduction per Average Student (across all students, not just those with health conditions, since program is implemented across all students).

Reduced incidence of obesity estimated based on reduced obesity compared to what would have been expected in that sociodemographic population at those ages; however, for bigger improvements/higher savings, some BMI reduction may have also been due to P-D-E-related higher fruit & vegetable (F&V) consumption & Obama-era increased school meal quality—not just MVPA; extra F&V & higher quality meal costs beyond what is currently offered at the school are not included in $10/child cost.

Potential longer-term ROI >10x, as health condition on-set is delayed or averted & the severity later in life is postponed & reduced, with ROI depending on number of staff added etc.

Rapid payback at all grade levels particularly by reducing: Elementary: ADHD; MS/Middle School: ADHD, obesity; HS/High School: ADHD, obesity, depression/BH.

ADHD & depression costs vary dramatically based on type of treatment. There is some possible double-counting of teen obesity/depression/BH savings, since obesity costs can include some depression/BH costs. The majority of Major Depressive Episodes are untreated (SAMHSA, 2018), as are other mental/social-emotional conditions—K-12 physical activity for all students could help youth, even when they are not clinically treated. (See PA, calming & focus time, and social/emotional/mental health slides.)

Class size assumption: 30-35 students.

References also include Yamamoto, 2013: significant costs (& savings) can start early in life: “Chronic conditions in the young (under age 30) take a higher relative toll on that population than they do for the older population. For commercial members under 30 identified with cancer or circulatory conditions…their costs were much higher on average.”

Additional more recent studies are now available & will be included over time; they indicate even higher potential health cost savings for teens, as children age with unhealthy habits.

Turner, 2016-23.

More Notes & References: see Payback Details & other slides at
(See latest notes in most recent HFUS slides.)

Notes @10/11/2023