The socioeconomic inequalities in health are large. While income inequality in the Netherlands is relatively limited, the people in the lowest income group on average live 20 years less in good health than people in the highest income group. Sport participation seems to be an important means to improve health, decrease health inequalities and reduce average health care costs, Willem de Boer’s research shows. The sports economist, who is affiliated with both FEB and the HAN University of Applied Sciences, studied different types of physical activity and the ways in which they affected health outcomes, health inequalities and health care costs.

Research carried out by De Boer and his colleagues shows that sport participation is positively associated to significantly lower risks of morbidity, type 2 diabetes, prediabetes and obesity. However, the relationship between sport participation and health differs between groups. For several health outcomes, the positive effects of sport participation were found to be significantly greater for people with a healthy weight than for obese persons.

‘Health club paradox’

De Boer – unlike many policy makers - makes a distinction between sports and physical activity in general. “While most research has focused on the importance of physical activity as a preventive medicine, little attention has been paid to the type or amount of activity. My research shows that sport participation and cycling seem to contribute more to improved health outcomes than other types of physical activity. Within sport participation, team sports seem to have the most beneficial health effects.”

While studying and comparing the effects of different types of physical activity, De Boer and his colleagues discovered a what they call ‘health club paradox’. “While improving health is the most important motive for doing fitness activities, it seems to have the least beneficial health effects of all types of sport. Although doing fitness activities is associated with improved health outcomes compared to not participating in sport at all, other sport types – especially team sports – were associated with significantly better health outcomes,” the researcher explains.

Strong socioeconomic gradient in costs

The sport economist also found that socioeconomic inequalities in sports participation (with the most vulnerable groups participating the least) seem to contribute considerably, and much more than physical activity, to the socioeconomic inequalities in health outcomes. This can be tied in with the patterns De Boer discovered in health care costs: his research shows that there is a strong negative socioeconomic gradient in health care costs in the Netherlands. Controlling for the population structure, poor neighborhoods have substantially higher costs than affluent neighborhoods. In addition, neighborhoods with a higher percentage of voluntary sports club members have significantly lower average health care costs.

The researcher also found that these socioeconomic inequalities in physical activity behavior have increased significantly in the Netherlands due to the Covid-19 pandemic and the measures to prevent the spread of the virus.

Contributing to public health policies

With his research, De Boer hopes to contribute to both the scientific knowledge and public health policies with regard to sport participation as a cost-effective means (i.e. as a preventive medicine) to improve health and decrease health inequalities. “My research is just a first step in that direction. I hope to continue doing research on public health in relation to physical activity and sport. As a sports economist at the HAN University of Applied Sciences I would like to improve the knowledge about the causal relationships between physical activity (types) and health as well as on the social costs and benefits of sport, perhaps in the future in collaboration with UG’s Aletta Jacobs School of Public Health.”

More information

Willem de Boer will defend this PhD thesis coming Thursday, 17 March. You can find his dissertation on UG’s website.