Bathing Waters Conference 2015 Edinburgh The “value” of watersports … · Bathing Waters Conference 2015 – Edinburgh Mat White, Eleni Papathanasopoulou, Lewis Elliott & Lora

The “value” of watersports to the

health of the English population

Bathing Waters Conference 2015 – Edinburgh

Mat White, Eleni Papathanasopoulou,

Lewis Elliott & Lora Fleming

Lora Fleming Lewis Elliot Eleni Papathanasopoulou

Oceans & human health: A rather negative focus

RISKS

Microbial pollution Storms, Floods &

Climate Change

Fisheries Destruction HABs & Other Toxins

Man-made Chemicals

The tide is turning

Linking Oceans and Human Health: A Strategic Research Priority for Europe. European Marine Board (2014), www.marineboard.eu;

Oceans and Human Health (2014). Edited by R.E. Bowen, M.H. Depledge, C.P. Carlarne and L.E. Fleming. Wiley Blackwell, Oxford, UK.

Yes there are risks & challenges

But there are opportunities too

And it taps into a rich history…

Dr Richard Russell (1687– 1759)

Royal Sea Bathing Hospital (Est.1791)

Dr Fortescue Fox

(1934 & 1938 Lancet)

Charlier & Chaineux

(2009) Thalassotherapy

http://www.marineboard.eu/

The Blue Gym 2010 - ongoing

Method Pros (inc.) Cons (inc.) Our studies

Where people live Representative samples Some longitudinal data

Causality? Multiple confounders

- Census (N = 48 million) - BHPS (N = 12,000 x 18 yrs)

Visitor surveys Big numbers / Multiple environments (controls) Voluntary/chosen

Memory biases, selection effects

- MENE (N = 142,000) - Wembury surveys - Surfing / sailing studies

Field experiments Realistic exposure conditions with some control

Hard to randomise/blind to condition

- Marine Aquarium - Dental surgeries - Volunteering studies

Lab experiments Reduced confounds & selection effects. Increased understanding of underlying processes (e.g. physiological, emotional, cognitive).

Small Ns (convenience samples); non-ecological e.g. may miss synergistic effects

- Videos/photos/sounds - Attention processes - Delay of gratification - Risk taking - Pain

Qualitative interviews

In-depth understand of people’s motives & beliefs

Unrepresentative samples Demand characteristics

- Parent interviews - Child interviews

Imaging (fMRI) Observation of brain activity using blood flow proxy

Risk of Type 1 errors, “fishing trips”, temporal snap-shots

- Urban/green/blue images - Matched liking sets

Every method has it’s pros and cons. We use as many as possible.

Coast & health: Any evidence?

- The effects are strongest in

poorer communities a

aWheeler, White, Stahl-Timmins & Depledge (2012). Health & Place, 18, 1198-1201; bWhite, Alcock, Wheeler & Depledge (2013). Health & Place, 23, 97-103

Self-reported health

Census Data (England, n = 48 million)

Census Data & Health

Error bars:

95% CI 0

0.2

0.4

0.6

0.8

1

1.2

1.4

<1km 1-6km 6-20km 20-50km >50km

Age

sta

nd

ard

ise

d %

of

po

pu

lati

on

w

ith

"go

od

he

alth

"

Home distance to coast

ref

<1km 3 million

1-6km 8 million

- We see the same pattern

when people move home b

Controlling for area:

income, education,

unemployment & crime

Coast & health: Main pathways

< Stress

> Exercise

> Social

> Environ.

Coast & health: Main pathways

< Stress

> Exercise

> Social

> Environ.

Do people who live near the coast exercise more?

MENE n = 183,755 – “How many days a week of ≥

30mins exercise” (Recommendations: 5 or more)

White, Wheeler, Herbert, Alcock & Depledge (2014). Preventive Medicine, 69, 135-140

Controlling for area (income etc.)

and individual controls (age,

gender, dog ownership etc).

Error bars:

95% CI

ref

0.94

0.96

0.98

1

1.02

1.04

1.06

1.08

1.1

1.12

1.14

1.16

<1km 1-5km 5-20km >20kmOd

ds

Rat

io f

or

mee

tin

g p

hys

ical

act

ivit

y gu

idel

ines

Home (LSOA) distance from the coast

0

5

10

15

20

25

30

35

40

45

50

% c

oas

tal v

isit

s

What do they do when they are there?

White, Bell, Elliot, Jenkins, Wheeler & Depledge (2015). Blue Exercise in the UK; Chp.5 In ‘Green Exercise’

Water

activities

Physical

activities

Passive

activities

MENE n = 10,529 coastal visit activity details

What is the “value” of watersports for health?

1) Regular physical activity helps: a) prolong life & b) improve “quality of life”

2) Watersports are physical activity; watching TV is not a physical activity

3) Therefore: On average every minute you e.g. surf (vs. watch TV) will (all else

equal) improve the quality and length of your life

4) Health services are prepared to pay £££s for treatments that improve length &

quality of life (Quality Adjusted Life Years - QALYs)

5) If we know how much watersports (vs. watching TV) helps to improve length

and quality of life we can estimate how much it might be “worth” to the health

service in terms of health care savings.

6) We need to know: a) How much energy each activity expends; b) How many

people do them, c) How often they do them; d) How long each session is.

7) Work out the total annual energy expenditure and convert this into QALY gains

8) We can then convert QALY gains into £££s saved each year.

How much do watersports save the health service?

To do this we used:

• Health Survey for England (2012), representative sample of the English

population with over 12,000 people.

• The survey asks about various activities undertaken over the last 4 weeks,

including a range (but not all) watersports.

• The HSE is useful because it allows us to WEIGHT the data to be

representative of the entire English adult population.

• Thus the % of 12,000 people who surfed in the last 4 weeks can be used to

estimate the total number of people who did watersports in the last 4 weeks.

• I was hoping to also present results from the Watersports Survey 2012 &

MENE Survey 2009-2014 (for all coastal activities) but we are having a number

of challenges at the mo. – something for another day.

Watersports episodes per year (England)?

Papathanasopoulou, White et al (in press). Marine Policy.

Estimated # of

Ps in last 4

weeks

Freq. in last 4

weeks

Annual Freq

(/4 x 52)

Estimated #

of episodes

per year

Sailing 110,541

Kayaking/canoeing 78,945

Fishing/angling 73,708

Surfing 42,113

Rowing 31,596

Scuba diving 26,315

Water skiing 15,798

Wind surfing 10,517

Snorkelling 10,517



Estimated # of

Ps in last 4

weeks

Freq. in last 4

weeks

Annual Freq

(/4 x 52)

Estimated #

of episodes

per year

Sailing 110,541 4

Kayaking/canoeing 78,945 2

Fishing/angling 73,708 4

Surfing 42,113 5

Rowing 31,596 5

Scuba diving 26,315 1

Water skiing 15,798 2

Wind surfing 10,517 4

Snorkelling 10,517 2


Papathanasopoulou, White et al (2015 under review).

Estimated # of

Ps in last 4

weeks

Freq. in last 4

weeks

Annual Freq

(/4 x 52)

Estimated #

of episodes

per year

Sailing 110,541 4 52

Kayaking/canoeing 78,945 2 26

Fishing/angling 73,708 4 52

Surfing 42,113 5 65

Rowing 31,596 5 65

Scuba diving 26,315 1 13

Water skiing 15,798 2 26

Wind surfing 10,517 4 52

Snorkelling 10,517 2 26



Estimated # of

Ps in last 4

weeks

Freq. in last 4

weeks

Annual Freq

(/4 x 52)

Estimated #

of episodes

per year

Sailing 110,541 4 52 5,748,132

Kayaking/canoeing 78,945 2 26 2,052,570

Fishing/angling 73,708 4 52 3,832,816

Surfing 42,113 5 65 2,737,345

Rowing 31,596 5 65 2,053,740

Scuba diving 26,315 1 13 342,095

Water skiing 15,798 2 26 410,748

Wind surfing 10,517 4 52 546,884

Snorkelling 10,517 2 26 273,442

Annual watersports energy expenditure (England)


Episodes per

year

Duration

Minutes

(Median)

MET rate Total MET

mins

Est. QALY gain

per year

Sailing 5,748,132

Canoeing 2,052,570

Angling 3,832,816

Surfing 2,737,345

Rowing 2,053,740

Scuba diving 342,095

Water skiing 410,748

Wind surfing 546,884

Snorkelling 273,442

TOTAL/Average 17,997,772



Episodes per

year

Duration

Minutes

(Median)

MET rate Total MET

mins

Est. QALY gain

per year

Sailing 5,748,132 150

Canoeing 2,052,570 120

Angling 3,832,816 120

Surfing 2,737,345 90

Rowing 2,053,740 60

Scuba diving 342,095 10

Water skiing 410,748 105

Wind surfing 546,884 30

Snorkelling 273,442 60

TOTAL/Average 17,997,772 116

How much energy is expended on watersports?

0 2 4 6 8 10 12

KitesurfingCliff climbing

RowingPersonal watercraft (jetski or similar)

Sub-aquaRoad cycling

JoggingPaddle boarding

Water Skiing/ WakeboardingOutdoor Swimming

CoasteeringCanoeing/Kayaking

Coastal walkingWindsurfing

RaftingAnglingSailing

Surfing/bodyboardingPower boating

Beach leisureMotor Boating/Cruising

Assigned MET rates

Sitting still = 1MET

(3.5 mls of O2 per kg of

body weight per minute)

White, Bell, Elliot, Jenkins, Wheeler & Depledge (2015). Blue Exercise in the UK; Chp.5 In ‘Green Exercise’



Episodes per

year

Duration

Minutes

(Median)

MET rate Total MET

mins

Est. QALY gain

per year

Sailing 5,748,132 150 3.3

Canoeing 2,052,570 120 5.4

Angling 3,832,816 120 3.5

Surfing 2,737,345 90 3

Rowing 2,053,740 60 5.8

Scuba diving 342,095 10 7

Water skiing 410,748 105 6

Wind surfing 546,884 30 5

Snorkelling 273,442 60 5

TOTAL/Average 17,997,772 116 5



Episodes per

year

Duration

Minutes

(Median)

MET rate Total MET

mins

Est. QALY gain

per year

Sailing 5,748,132 150 3.3 2,845,325,340

Canoeing 2,052,570 120 5.4 1,300,065,360

Angling 3,832,816 120 3.5 1,609,782,720

Surfing 2,737,345 90 3 739,083,150

Rowing 2,053,740 60 5.8 714,701,520

Scuba diving 342,095 10 7 23,946,650

Water skiing 410,748 105 6 258,771,240

Wind surfing 546,884 30 5 82,032,600

Snorkelling 273,442 60 5 82,032,600

TOTAL/Average 17,997,772 116 5 7,283,542,792

Unpacking the QALY in terms of MET minutes activity


0.0106768 QALY = (30mins x 4 METs) x 52 weeks a year

0.0106768 QALY = 120 METminutes x 52

0.0106768 QALY = 6,2401 METminutes

1 METminute = 0.0106768 / 6,2401

1 METminute = 0.00000171102 QALY



Episodes per

year

Duration

Minutes

(Median)

MET rate Total MET

mins

Est. QALY gain

per year

Sailing 5,748,132 150 3.3 2,845,325,340 4,868

Canoeing 2,052,570 420 5.4 1,300,065,360 2,276

Angling 3,832,816 120 3.5 1,609,782,720 2,754

Surfing 2,737,345 90 3 739,083,150 1,265

Rowing 2,053,740 60 5.8 714,701,520 1,223

Scuba diving 342,095 10 7 23,946,650 41

Water skiing 410,748 105 6 258,771,240 443

Wind surfing 546,884 30 5 82,032,600 140

Snorkelling 273,442 60 5 82,032,600 140

TOTAL/Average 17,997,772 116 5 7,283,542,792 13,150

1 MET Min = 0.00000171102 QALY

Annual savings to health care budget (England)


Est. QALY gain

per year Low estimate (£7,120) High estimate (£23,886)

Sailing 4,868

Canoeing 2,276

Angling 2,754

Surfing 1,265

Rowing 1,223

Scuba diving 41

Water skiing 443

Wind surfing 140

Snorkelling 140

TOTAL/Average 13,150



Est. QALY gain


Sailing 4,868 £34,660,160

Canoeing 2,276 £16,205,120

Angling 2,754 £19,608,480

Surfing 1,265 £9,006,800

Rowing 1,223 £8,707,760

Scuba diving 41 £291,920

Water skiing 443 £3,154,160

Wind surfing 140 £996,800

Snorkelling 140 £996,800

TOTAL/Average 13,150 £93,628,000



Est. QALY gain


Sailing 4,868 £34,660,160 £116,277,048

Canoeing 2,276 £56,710,800 £54,364,536

Angling 2,754 £19,608,480 £65,782,044

Surfing 1,265 £9,006,800 £30,215,790

Rowing 1,223 £8,707,760 £29,212,578

Scuba diving 41 £291,920 £979,326

Water skiing 443 £3,154,160 £10,581,498

Wind surfing 140 £996,800 £3,344,040

Snorkelling 140 £996,800 £3,344,040

TOTAL/Average 13,150 £134,133,680 £314,100,900

1) Mental health benefits (underestimate)

2) Benefits to <18yrs of age (underestimate)

3) Other activities (swimming, walking etc., underestimate)

4) Health costs from injuries/infections (overestimate)

5) RNLI, rescue costs etc. (overestimate)

Limitations

NOT (YET) INCLUDING:

ASSUMES:

- If you weren’t doing water activities you’d be watching TV

- But it’s a start and we think the first time anyone has tried to

do this at a national level

1) The NHS is not likely to pay watersports folk for looking

after their health anytime soon…. however….

2) We’re discussing with the

Marine Management

Organisation (MMO) how this

info. could feed into their

inshore regional plans

3) Jan 2016 – ‘BlueHealth’: 5 year pan European project to

look at the broader issues of watersports & contact with blue

spaces (walks on the beach etc.) for health across the EU

and worldwide with help of the World Health Organisation.

Implications

Thanks very much for your attention [email protected]

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Green Exercise: Linking Nature, Health and Well-Being.

mailto:[email protected]

Bathing Waters Conference 2015 Edinburgh The “value” of watersports … · Bathing Waters Conference 2015 – Edinburgh Mat White, Eleni Papathanasopoulou, Lewis Elliott & Lora

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