Changing Lifestyle Choices Could Cut $730B in Annual Health Care Spending

Nearly three-quarters of a trillion dollars in health care spending can be linked to modifiable health risks, such as obesity, high blood pressure, and smoking, according to a new report published in The Lancet Public Health.

The study found that for 2016, modifiable health risks were linked to more than $730 billion in US health care spending. Researchers from the University of Washington and Vitality Group worked together on the study, which found that modifiable health care costs were largely due to five risk factors: overweight and obesity, high blood pressure, high blood sugar, poor diet, and smoking. The Lancet study estimates that more than a quarter of all health care spending in the US annually is due to conditions tied to lifestyle choices—and that these conditions are to some degree preventable.

"Given that US health care expenses are almost double that of other developed nations, we set out to understand how much of these costs could be attributed to modifiable risk factors," said Francois Millard, chief actuarial officer at Vitality and one of the study's authors.

"While the relationship between lifestyle risks and medical conditions is understood, this is the first study to offer a comprehensive analysis of health spending related to these risks. This helps inform how our society is investing its resources, and why health should be at the center of all policy discussion, not just those related to sickness," Millard added. "We are seeing with COVID-19 that prevention is paramount to our own health and the health of our economies. It's time to apply the same urgency to these other preventable diseases."

Joseph Dieleman, PhD, a senior author on the study and health economist at IHME, said that while it's not possible to estimate exactly how much could be saved with a better emphasis on preventive measures, "…The findings illustrate the huge costs tied to poor diets, high blood pressure, smoking, and obesity. Moving forward, it's crucial to focus on preventing and managing these key risks before they turn into costly diseases, so that more people have the chance to live a long and healthy life," he wrote.

Many risk factors, but the biggest costs tied to five major areas

The study builds on earlier research done by IMHE, looking at spending attributable to 84 modifiable risk factors based on health condition, age group, and sex. The researchers said these findings have significant implications for public health care spending and private health insurance in both the US and other high-income countries.

Other findings from the study include:

Controllable and treatable risk were strongly related to costly US medical conditions– including cardiovascular disease, cancers, diabetes, and chronic respiratory diseases.
Costs were driven largely by five modifiable risk factors – overweight and obesity (high body mass index), $238.5 billion; high blood pressure, $179.9 billion; high fasting plasma glucose, $171.9 billion; dietary risks, $143.6 billion; and tobacco smoke, $130.0 billion.
Health care spending increases significantly with age, with the greatest proportion of risk-attributable spending associated with those aged 65 years and older (44.8%).

The context of modifiable health risks and the ongoing pandemic

In an accompanying editorial in The Lancet Public Health, written by Sandro Galea and Nason Manni, both with the Boston University School of Public Health, the new study underlines the problem posed by the ongoing lack of emphasis on preventive health measures.

"While this analysis is helpful to draw attention to the costs that the USA spends on diseases that it could avoid, it is also drawing attention to a status quo that we have long come to accept: a high proportion of illness and death is preventable, and a lot of money is spent on treatment because we do not do a particularly good job of preventing disease," the editorial said.

The authors go on to discuss the findings in the context of a global pandemic. "COVID-19 has resulted in the entire world changing its trajectory during the course of 2020, as national governments worldwide have aimed to prevent the pandemic from spreading," they write. "This has put prevention front and center. Can we not extend the lessons learned in the past year to bring about a permanent doubling down on prevention, putting it at the heart of our conversations on health, well beyond the COVID-19 pandemic? This would require us to embrace the notion that no amount of preventable illness or death is acceptable, and that the $730.4 billion could be repurposed."