Europe’s hospitals are struggling with ageing populations and tightening budgets. Given this, many policymakers are attracted by the idea of ‘preventative’ public health interventions, an idea championed by the World Health Organization (WHO), which recommends that governments actively promote physical activity and healthy diets as a way to improve the health of citizens. After all, it’s much cheaper to care for a fit and healthy population, and risk factors such as physical inactivity can lead to a host of health issues, including diabetes, coronary heart disease, and some cancers.

The International Sport and Culture Association (ISCA) estimates that physical inactivity costs Europe over €80 billion per year. Could this money be saved if governments invested more in sports facilities, green spaces and bicycle paths? Or should it be up to individuals to keep themselves fit and healthy? Who should pay for healthcare costs if you don’t exercise and keep fit?

We had a comment sent in by Desmond, arguing that local governments in particular should be compelled and incentivised (i.e. a mixture of carrot and stick) to provide opportunities and encouragement for citizens to keep fit.

To get a reaction, we took Desmond’s questions to Jacob Schouenborg, Secretary General of the International Sport and Culture Association. How would he respond?

To get another perspective, we also took Desmond’s suggestion to Jan Rijpstra, President of the Dutch Royal Society of Physical Education Teachers. What would he say?

Who should pay for healthcare costs if you don’t exercise and keep fit? And is there anything governments can do to encourage YOU to keep physically active and stay healthy? Let us know your thoughts and comments in the form below, and we’ll take them to policymakers and experts for their reactions!

100 comments Post a commentComment

What do YOU think?

  1. Ivan Burrows


    We like our system just fine thanks & are not about to let Brussels mess it up.

    You will find hospitals are struggling because of the forced mass immigration, Increase the number of people using the system by 2 million and it will struggle, it’s not rocket science.

    • Elisabeth

      I quite agree with you ! Living in Greece , we face mass immigration . Taking into account our financial situation , our doctors are struggling to keep our hospital functioning !! Diseases like tuberculosis that had vanished for decades are nowadays reappearing… I wish we could afford to help those poor people that are escaping from war etc but very soon we won’t be able to keep up!!

  2. Stella Kontogianni

    Who is perfect for health system? If someone has already a health problem cant be accepted by insurance agencies. In this case you have to pay for your problem. I confess that I have hidden my heart disease because it is sure that nobody will accept me. I will be fired from my job, I will be ejected from insurance and I will die to help everyone continue his or her perfect life.

  3. Popescu Alin

    I will keep fit me and my family if my gov will build more parks, more sport fields(tennis, football etc). How can i keep fit if my town (200k population) has only 4 free sport fields, one running track and 3 parks?

  4. Νικολάι Κόσεβ

    Yes! The government has to monitor the quality of the food that we eat and there shouldn’t be any compromises with that. The government also should make the health system better and to put the health of the people on first place, instead of the profit. 
    What the government is doing now (at least the Bulgarian one) is to build new sport facilities where people can train themselves for free. Making more sports competitions is another thing that the government can do .
    Common cause for obesity is stress – people “eat their feelings”. The government should do everything not to stress people so much. 

  5. Mariana de Almeida

    Governments have the duty to provide their citizens with affordable healthcare, but it’s the individual’s responsability to look after him or herself. Staying fit and healthy seems like an obvious and necessary goal to me.
    Of course, I’m excluding people with illnesses which they couldn’t prevent or they find hard to treat, let’s not go there… And I’m not saying someone who’s diagnosed with lung cancer after years of smoking, for instance, should be left out to die on the streets, far from it. All I’m saying is that we now have the knowledge and resources to prevent many, many diseases – for our own sake, if nothing else. It should therefore be the government’s responsibility to promote a healthier lifestyle for their people, say, by encouraging healthier meals in schools, providing more green spaces in the cities, promoting the practice of sport from an early age and for all ages, etc.

  6. Kristaq Jorgji

    Government should even clean my toilet,remember police it has in logo “To serve and protect”

  7. Dan Florin

    Yes, by imposing drastic regulations to food producers, no GMO, no chemicals, no…no

  8. Breogán Costa

    they should, because health systems have also the responsibility of having people healty, and if people is not, that is going to be much more expensive and system is going to collapse, then, after that, many social problems and consecuences

  9. nando

    The problem of budgets has deeper roots and those need addressing:
    - budgets are depleted because money flows faster to incompetent banks than to health providing hospitals,
    - the whole demographics need to be thoroughly and courageously looked at,
    - schools are lacking funds (where the population could be taught to exercise) because governments are paying attention to “bank failures” while banks are laughing all the way to the bank,
    Governments do not have to be responsible for your fitness but they have the responsibility to budget for health, education, fitness, and not just wars, massive government buildings and bailing out incompetent banks.

  10. Victoria Deniran

    less sugary beverages….no more alcohol on the tables for lunch and dinner,i think is a good start to stop the youngs one from being a future problem for the society, alcohol has caused a lot of mentaly ill people that with time get worse

  11. σαντυ αλεξανδρου

    Due to the economic problems that countries face it’s going to be difficult to teach people to eat good nutritious food.Cheap food makes your stomach happy and your pocket even happier.Even if people want to follow a good mediterranean diet it’s going to be difficult.You can’t punish people because they are fat,it’s not democratic,you should teach them to eat properly.And of course EU chickens why don’t you ban smoking?Because you get money and because the people that have companies give you probably under the table money.You want a healthy Europe,there are better solutions.

  12. Gio Cruz

    Who cares i dont keep fit? Fit people also get sick! Plus for every 4000 euros I earn, I pay another 4000 euros in income tax which they use to give out money to the jobless. If they dont want solidarity, they should erase income tax and pension too.

  13. Ferenc Lázár

    I think is not fair that individuals who don’t smoke, do regular exercises, take care of their health throughout their life, they have to pay same health contribution as smokers and drog addicts..

    • Paul X

      2013 UK tax and vat revenue from smokers was been estimated at £12 billion whilst worst case costs to our National Health service from smokers ill health has been put at £6 billion

      The maths are simple to see and as a non smoker if they want to help ease my tax burden it’s no concern to me if they choose to kill themselves in the process.

      I would consider obesity a bigger drain as this also (in the majority of cases) comes about as a lifestyle choice but apart from a few extra pounds vat on their bigger than average grocery bill and take-away habits, they contribute nothing more to the treasury than most normal people

  14. Demetri Siskos

    You should pay for what you use. If you choose a lifestyle that causes you to consume more Heath care resources you should pay higher healthcare premiums. Just like if I am a smoker or overweight my life insurance premium will be higher. Don’t turn to the government to solve problems, you are just feeding a monster that will eventually consume us all.

  15. Toni Muñiz

    Illegal inmigrants, those who get free healthcare although they are illegal, should pay for it.

    • otilia

      Yes they should. only war refugees should have it free.

  16. LU CY

    Trust me,when you live in a big city and you need 2 hours/day to get to the job and you work for 9 hours and you have 2 children at home…I think the last thing you think off is the gym…
    And I think that everybody wants to be slim and healthy,it is just not always possible

  17. Olivier Dutreil

    funny . YOU ARE ALWAYS ASKING QUESTIONS about supporting minorities and migrants but when it comes to support european people who pay taxes all their lives you are also asking the question . YES OF COURSE ; is this site a socialist site??????

    • Paul X

      That is because the whole concept of the EU is based on socialist principles….distribution of wealth from richer countries to poorer ones and endless propaganda about “solidarity”

      ….. also anyone who dares disagrees with an EU policy is automatically branded a right wing extremist and xenophobic

      …but they claim it is democracy

  18. Ivan Vikalo

    It would be awesome if the government did so, but dont think it has the capacity to do it, unless we get taxed more, and then force people to excercise which is then also a democratic issue: governments forcing their people to do something concrete which is more direct.

  19. Ricardo Gonçalves

    O direito ao exercício está consagrado… Faz parte das obrigações dos estados da união europeia… De forma gratuita diga-se…

  20. Rui Duarte

    Insisting on stupid questions! This has already been discussed in DebateEurope and people shunned the argument. IT’S A STUPID IDEA. I am surre someone in Brussels thinks it’s a «great idea» to curtail healthcare, but it’s not. get that through your thick bruxelliot skulls!

  21. Liliana

    Yes, they should! Goverments and other state org. let population’s health to be polluted and distroyed by bad foods, water, air, etc. Seating is encouraged at work and in schools…

  22. Vella Josephine

    l iktar fl iskejjel u l kulleggi tal gvern….l anqas jezisti sports ghajr xi lezzjoni wahda jew tnejn fil gimgha….meta bhal xi skejjel godda jkollok xi ground wiehed bit turf u jinfetah ghal lezzjonijiet biss u t tfal l anqas biss ghandhom klassi taghhom fejn ihallu l basktijiet…allura jekk immorru jilghabu f xi free time jiccansjaw li jinsterqulhom l affarijiet…..x sar minnha dik il gurnata fis sena meta kellna n national sports day u konna mmorru ntelqu bil patata u l imgharfa jew l ixkejjer etc….illum bis sahha tal gvernijiet mill indipendenza l hawn l eghelieqi madwar l irhula kollha inbnew allura it tfal ma baqalhomx l eghelieqi fejn jistghu jilghabu xi loghoba football…it toroq imtlew bil karozzi u t tfal joqghodu gewwa ghax ghandhom korrikulums tqal u l genituri jkollom joqoghdu gewwa wkoll ghax ikollohm immorru jahdmu biex ilahhqu mal hajja u l privatijiet u hafna hafna stationery tat tfal li fi zmienna kien jiprovdi hafna minna l gvern

  23. Gunter Turker

    a clear YES !!! people should be inspired to keep them going with at least some sport activities every week to minimise common health problems !!! 😅😅😅

  24. Nicole Carp

    at least stop geo-engineering the climate and maybe we can breath cleaner air again…shame on them for “free riding on their grandchildren”.

  25. TJ Todorov

    The government must pay! Because the stupid government was not investing in the public health by building easily accessible playgrounds and sports facilities, and was not influencing youths in the public sports activities.

  26. EU reform- proactive

    “Do governments (which?)…………?”

    As the EU & its convenient suzerain tool, you seem to long to embed yourselves under the skin of everyone! You wish, but you are not (yet) the guardian nanny of “governments” & its people. “Governments” & voters must wake up & become mentally fit & healthy, to regain once more full sovereignty- than we deliberate!

  27. Rado Kazakov

    Not so much to keep us healthy but definitely the responsibility to open up the dialogue about public health. When there is so much money invested in public health governments have to look for ways to improve it and for the support and cooperation of people to make it happen. Human health is one of the biggest parts of common good which is the main responsibility of politics so governments have to initiate improvements with regards to it. The biggest responsibility is though with the individuals because their life is directly influenced from their health condition.

  28. Craig Farlow

    Shouldn’t you be asking the question “Do you want to live in a caring, compassionate society that encourages people to live healthier lifestyles but provides the safety net of collective insurance through social security and publicly funded health services or an individualistic, selfish, atomised society where you only get what you can afford to pay for”?

    “Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community” Aneurin Bevan-founder of the NHS

  29. Andrew Lally

    who should pay for your unemployment costs if you don’t get all As at school?
    who should pay for your chiropractor if you wear high heels?
    who should pay for your liver transplant if you’re a heavy drinker?
    who should pay for your lung transplant if you’re a heavy smoker?
    so why pick on fatties, bully?

  30. Rui Duarte

    It is DANGEROUS toDemocracy think of «governments» as paternalistically «responsible for citizens». «Governments exist to serve the public good, and as such to serve citizens: NOT to paternize them.

  31. Rui Duarte

    «Governments» are not autonomous «third party» persons; a «government» is NOT a «natural person». A «government» is just the political-administrative materialization of «The Pólis». As such, governments do NOT superimpose themselves to citizens: a democratic goverment IS THE CITIZENS. Governments must thus reflect the wishes of citizrns that regard «The Res Publica», not the other way around. Governments must reflect «the will of the people», but «the people» must not be sunjected to «the will of governments». «The Triumph of The Will» is a fascist movie.

  32. Rui Duarte

    In order for citizens to be FREE, governments must plan their lives too minutely. Planning peoples’ «fitness» is a bit «hypermanaging»…

  33. Fernanda de Oliveira

    Those who must pay are politicians that don’t take efective measures to allow people to keep fit: to end GMO crops, school programs that teach how to grow your own organic food, not to eat meat and milk and so much more. The question itself sounds so hypocrit…

  34. I Am Doan

    Good Health is The basis for a Healthy system.
    Responsibility cuts both ways. Governments to safeguard/ secure food and nutrition. Environmental Health. Work less & Play more. Keep everything in balance. Transition towards an pro active life. We all have a choice in this. Over regulation can be inflicting with personal/ private choice. This seems an easy question but with many internal/ external factors.

  35. Yanni Sfyrides

    Governments may not have the responsibility to keep you fit.But they have the responsibilty through the food code legislation to inform and warn you about the ingredients of ;industrial” food etc/

  36. Rita Cortis Coleiro

    Make sure real healthy food is Cheaper and not more expensive, that should tempt people to eat healthier! and Why is Organic food more dear than any other ?

  37. Consuelo Fogante

    I agree we do not need a nanny but there is a more critical issue: governments CAN reduce or better, delete some evil and unnecessary instruments such as slot machines which every one knows that provoke addiction, or junk food from primary schools. Just two examples!

  38. Vinko Rajic

    YES ! Schools should teach young people what to eat and how to keep them fit and healthy. EU should have tax on fat food and remove all taxes from fruits and vegetables. EU should make it possible to get fruit and vegetables direct from farmers for price farmers sell it for , also remove those between taking 80% of money .

  39. Nigel Daff

    I strongly believe its time in The World 2015 – to start giving a fine. of some sort to the parents of very young children who are fed so much of the wrong food and drinks. they are obese through no fault of their young lives. We must bring back more exercise sport into primary schools – sitting at the tv and computer too long does not help – obesity is an illness and must be treated more seriously – just my meaning

  40. Irena Leibovici

    We will propose more than sport, a scanning of the population and based on the results, advise how to MAINTAIN the well being! This is the most important!

  41. Tony Kunnari

    Yes and no. Local government should only provide the availability of professional practitioners. Let the comprehensive global society promote the practitioners to carry their liabilities.

  42. Joseph Bartolo

    Lower Prices of all organic food, especially real health foods and beverages and make sports clothing and gym, plus sports complexes affordable for everyone.

  43. Costin Halaicu

    Governments should attempt to promote good living standards, including fitness of citizens, not impose it.

    • EU reform- proactive

      really- politicians? Name this paradise! And the “people” carry on regardless?

      “Assured” by MOTHER government from cradle to grave- like in the crashed USSR empire, its lost paradise & former satellites, or maybe oil rich Saudi Arabia?

      Since “government” in (western) Europe are its “people”- not so long ago- it remains financially the “peoples” primary responsibility. Is that understandable?

      A skilled & competitive economy, a low unemployment rate (< 5%) & a broad tax base, would allow a continuation of the accustomed "social security" of the past- enjoyed by all its contributors. However, not achievable in a 28 EU melting pot with stagnation & unemployment rates of up to 25%, (or average of ~10% plus).
      Please draw your own conclusion……………….. if you can!

  44. Ott Toomet

    Government definitely carry some responsibility. One cannot make people to eat healthy and to exercise, but one can facilitate it in ways individual decision-makers cannot. It includes making available large health-related projects like parks, sporting facilities, etc; ensuring that information about food quality is available; fighting pollution; setting up a functioning healthcare system; and to fund some medical research. I would also add urban design issues here like encouraging active lifestyle by making it convenient to walk/cycle in the areas we live.

  45. Ariste Arvanitides

    Governments have the duty to provide the opportunity for all ages to have proper diet and exercise in order to be healthy, and cultural activities to keep the mind in shape as well. Healthy Mind, Healthy Body — the Greek way of life.

  46. Desmond Whyms

    …Glad to see my ranting of a few years ago has prompted this debate! Though it is disappointing so little real progress is being made in the battle against obesity, despite all the fine words and promises.

    I am all for carrots and sticks, but not to be used on the victims of our poor policies. Clearly there is huge amount of damage being done by our diets which are over-refined, over-sugared and unhealthy, but much evidence shows that caloric intake has been level or even declined in the last 40+ years. What has declined much more is our levels of physical activity, and that is where governments have a massive responsibility.

    In so many countries we are not helped to make healthy life choices – bad town planning and transport policies make doing ordinary everyday physical activity either unpleasant or dangerous (I live in Brussels, and it feels like the authorities have a vendetta against walkers and cyclists!)

    Look at the difference in cycling and walking levels between UK and Netherlands; if given intelligent planning for a safe and pleasant infrastructure, it results in high levels of physical activity – people don’t need the carrot, they just need the stick to be removed – people WANT to be more active!

  47. ironworker

    Do governments have a responsibility to keep you fit and healthy?

    In theory, yes. In real world, the country I reside cannot afford it, or at least that’s the official excuse. But in the meantime they afford many other “priorities” like increase the budget with more 10% over the previous year for internal secret services (undisclosed number of employees), Justice Department, The Parliament, Presidential Administration, High rank government officials, Foreign Affaires, Air Force, Navy, Army, and allot others. In the end the average Joe get nothing, not even a small bread crumble, he’s just the humble taxpayer after all, what you expect. Let millions of average Joe’s live in austerity, eventually they will get used to and probably will turn quiet.

  48. catherine benning

    Every government, no matter which they pledged to lead, have a duty to keep their citizens safe and healthy and that includes being safe from invasion as a first requirement. Europe has failed to do this for the last twenty years. And conitnues to refuse to even acknowledge the threat European gvernments have imposed on us all and to the European culture and lifestyle. We do not pay taxes for our countries leaders to be led by the nose from outside Europe who have no interest in their own populations heath and safety or that of Europeans.

    We now see from this article link below, that more and more of our individual states are becoming aware they are betraying the people who voted for them as well as themselves by following this assault on them.


    Are the people of Greece being taken care of health and safety wise? With many facing starvation and mass invasion from outside Europe, I don’t think so. In fact, are they worse off being part of the EU with its current policies of utter madness? Doesn’t look that way to me. Is the UK better off, or, Sweden, Norway, Denmark, the Netherlands? Doesn’t look like it does it?

    So, yes, governments do indeed have a responsibility to keep their citizens fit and healthy. But that remit far exceeds a simple exercise regime and chemical free food to eat. It means defending their life and cultural heritage form open abuse by those who profess the cause of Globalism.

  49. Adrian Limbidis

    Oh this is rich.
    Well the EU just voted on…hold on..oh here we go

    Oh you did not hear about it?
    Eh, probably not important right?Yeah poisonous food at chemically ladden products are very “safe” heh heh.

    40 lobbyists to one EU MEP.
    More than on / HOURS of EVERY DAY !

    And we are “debating” here about “sports team” and other trivial bull.

    Pardon my french but UKIP may have a point here !
    EU crushed Greece to fatten the BANKS.
    EU passes TTIP to fatten the CORPORATIONS.

    What is this?
    This is not Europe !!

    • catherine benning

      @ Adrian Limbidis.

      This morning we read in our UK papers the most appalling move being taken by Globalists against the Greek people. Here it is.


      This move affects every single European citizen. It is an attack on our right to choose and our right to question. In fact, it removes our right to remain individual democratic states.

      What should happen in Greece and perhaps some other countries, who are suffering a similar fate to the Greek people is, for them to set up a non convertable currency. Which means it cannot be converted to any other currency. It cannot be traded in shares or borrowed or lent not used to buy shares. Not used in any form of credit. Restricted only to the real economy buying and selling. It cannot be used to buy insurance or stocks or anything that would be convertable. It can only be used for direct purchase within the borders of a country producing it. To transfer within its domain only to be used for goods and services. It must have no artificial use. It cannot be passed to those who are not citizens, like tourists or visitors.

      This would instantly solve the immediate crisis of starvation and stagnation within their society. It could then be expanded upon as events improved.

    • Paul X

      Unfortunately it is exactly the Europe the EU is creating, one where the wishes of the people is never allowed get in the way of their elitist ambitions…they are happy to take our taxation off us and blow it on expenses and business lunches but we are apparently not “educated” enough to have an opinion worth listening to

  50. Adrian Limbidis

    @Catherine Benning:
    The problem of the euro now is that Germany sees it as a system to benefit the deutsche mark and France sees it as an uniting symbol.
    Germany needs to let the euro fluctuate more to make ALL eurozone countries competitive.
    As it is now, ONLY Germany benefits and the rest lose.
    Even France.

    Creating another currency would be the implementation of a de-facto “two tier Europe” and that’s a no-no.
    If Europe wants to move forward, they should just tell the banks:
    “You risked and LOST – have a nice day !”
    You’re not getting your money – EVER !

    Good night thanks for playing.

    And move on.
    Life does not end with a default.

    Let Greece DEFAULT and then Europe can pump the money that we ARE pumping now for NOTHING to rebuild Greece.
    Right now we are simply throwing money down the hole – I mean literally, this is not even a metaphor anymore

  51. mohsen behzad karimi

    I believe governments has health responsibility for keeping youngster fit and healthy by monitoring children in school and if necessary gives adequate advice and raise awareness.after that there is no obligation. yet is financially wise for NHS and health insurances to some work in the filled for adults too.

  52. Andrew Lally

    who should pay for your unemployment benefit if you don’t work at school?
    who should pay for your cancer care if you smoke?
    who should pay for your car accident if you text and drive?
    who should pay for your street lighting if you only go out during the day?
    who should pay for your tarmacked roads if you don’t own a car?
    who should pay for your liver transplant if you never drank alcohol?
    More rightwing bull philosophy from Debating Europe and a rightwing Commission.

  53. Giovanni Rizzalli

    Fit? Oh come on, isn’t it enough just trying to be healthy? It’s everyone’s choice to be fit or not, we shouldn’t be required to 😓

  54. Wendy Harris

    No, people must have the freedom to live and die as they choose. It is the government’s duty to inform not to dictate.

  55. Dirk Schönhoff

    They do in terms of laws protecting people of food that makes them sick. The EU Parliament must keep more distance to lobbyists of the food industry.

  56. Paulo Neves Cortesao

    In Europe usually we says: “Prevent is better than treat”. But actually not every EU countries are following this concept.
    It’s a question of social, economical and health education. We need to teach the next generations to doesn’t do ours mistakes…
    A biology teacher one time said to me, our body was make to move and resist to hungry. Actually we tend to moves less and eat more and not natural stuff and after we increase our probability to have a lot of new millennium diseases…

  57. Tony Kunnari

    No, government should not have the actual responsibility over my health no matter how bad my choices are. Responsibility in this area is mine alone to keep. If you give responsibility to an entity that does not belong to it, there’s a chance that it will be abused. Government should only make sure that I am able to carry my responsibility, not dictate how to live my life because the optimal balance of my life may and is not the exact of the rest. We have common nominators, that is true, but our foundation is obviously different. We are equal, but we are not equivalent.

  58. Wendy Harris

    It’s a harsh fact that it’s healthy people living very long lives that has created the current problems with the health service because the older they get the more treatments they need. We should be looking at euthanasia for those who are merely existing or are terminally ill. Advanced old age is itself an epidemic that we are failing to address.

  59. Stefania Portici

    con tutta questa austerità dove la gente mangia cose che costano poco tipo il pane e la disoccupazione alta per cui non fa movimento , l’obesità è assicurata

  60. Bart Vd B

    it has the responsability to keep it’s people well informed on what is good and bad, and offer easy accesible facilities for people to keep/get fit

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