The biggest public health problem of the developed world

Governments the world over are making leaps and bounds in the fight against smoking. Australia recently banned brand labelling on cigarette packets, the UK is running a campaign called Stoptober next month and there are increasingly fewer and fewer public spaces in which a smoker can light-up. But is smoking really the biggest public health problem of our time? Actually, no it isn’t. The biggest public health problem of today, in terms of directly attributable mortality, is physical inactivity. Lack of cardiovascular fitness accounts for twice as many deaths as does smoking.

This statistic and the graph below comes from a 2009 study by Professor Steven Blair – from the Department of Exercise Science and Epidemiogology/Biostatistics, University of South Carolina – and published in the British Journal of Sports Medicine. CRF stands for cardiorespiratory fitness and attributable fractions is an estimate of the number of deaths in a population that would have been avoided if a specific risk factor had been absent.


People spend a fortune on pills, specialists, health insurance and even surgery, yet something free and profoundly important for our health is dismissed and ignored. I imagine also that many GPs, when presented with a patient history of high blood pressure and high cholesterol, would be more inclined to prescribe pills than to encourage regular physical activity. But unlike pills, regular physical activity is free and comes without side-effects.

From the same study, Blair discovered that it is better to be fit and fat than unfit and thin. Fit, obese men had less than half the risk of dying than normal-weight, unfit men. Fat people are getting a lot of flak at the moment but from these results, we really should be dishing out the abuse to people who are physically inactive.

Physical inactivity ought to come with bold health warnings, shocking tv advertisements and huge taxes because these are all the things we do to smokers, yet physical inactivity causes more harm to health than does smoking. But of course slapping a tax on physical inactivity is very hard, perhaps impossible to do. And if you live in a car city, such as Auckland, it’s very difficult to change your lifestyle. I read recently that when people make a change to their lifestyle by incorporating an exercise regime into it, 50% have given within 6 months. This is precisely why town-planning is so important and urban sprawl so unforgiving to our health. Exercise needs to happen as a consequence of daily life – like cycling to work each day – rather than as an extracurricular activity we must make an extra effort for. And on that note, I’m going to walk the dog.