This week Fiona Bull from the School of Population Health, University of Western Australia recently spoke to the British Journal of Sports Medicine about the research done by the Global Advocacy for Physical Activity. The discussion was broadcast as a podcast, which is linked below.
Physical inactivity is now the 4th leading cause of death from a non-communicable disease (NCD) i.e. conditions such as cancer, heart disease, diabetes, stroke, as opposed to viruses and bacterial infections. Inactivity is still on the rise. Why are people less active than they used to be? A report published by the Global Advocacy for Physical Activity in February 2011 answers this, and sets a framework for making positive changes in society.
Regular daily activity benefits health, both physical and mental health. But today people are less active than ever. Why is this so, and how can the trend be reversed? The Global Advocacy for Physical Activity have described 7 key areas that need to be invested in to help promote more physical activity. These are closely linked with the concept of the obesogenic environment, which we have discussed in our article on The Global Obesity Crisis.
The 7 Investments
- Transport Policy
- Urban Design
- Health Care
- Public Education
While the concept of the obesogenic environment includes exposure to food, food advertising and peer pressure to consume, this framework is focused solely on increasing activity. The urban landscape and private car ownership is largely to blame, but society and culture also play a vital role.
Fiona Bull mentions that a lot of good things are already being done in Europe, but a lot more is needed, especially in Australia. Australia suffers many of the same problems as the USA – dispersed populations out-of-town mean that walking and cycling is rarely an option, and in town the urban landscape means that walking is often not required, or at times, perceived is being unsafe. Here is a brief review of the 7 “investments“:
1. Education: ‘Whole-of-school’ Programs
A whole school approach is needed to promote physical activity. Fiona Bull says that good quality, mandatory physical education is a bedrock of good health and good quality physical education is needed, plus more support for the teachers and parents. School facilities and more active travel are also highly important.
We discussed the role of physical education in schools today during the summer in our article Why It’s Time To Bring Back Old School Physical Training. Exercise needs to be taught in the same way that reading, writing and arithmetic is taught. Children need to be able to demonstrate that they can do the work by themselves to properly understand and learn how to exercise effectively.
2. Transport Policy
Too many short trips are done by car today. Until the latter part of the 20th century most people travelled by a combination of public transport and walking. Most people worked relatively close to where they lived so there was little need for commuting. People could walk, ride a bicycle or public transport to get to work or the shops. Women tended to still mostly be housewives and would walk to the local shops daily to buy bread, groceries, meats and dairy. Nowadays people commute longer distances to go to work, making walking or cycling impossible. The retail environment has changed too, with more out-of-town shopping centres which are only accessible by car.
A new transport policy needs to encourage both walking and cycling. Mayor Boris Johnson’s bikes in London are a good example of a simple initiative where the private sector can invest in healthy transport. However, while some people do use them they have made very little impact on the larger population of London.
Are The Roads Safe for Cyclists?
However, there is the growing concern that some roads are become less safe for cyclists. The Royal Society for the Prevention of Accidents report that 19,215 cyclists were either killed or injured on British roads in 2011. Scotland has seen a rise in the number of people injured while cycling. Many people feel that cycling is simply not safe. Only after the Tour de France and Olympic Champion Bradley Wiggins was knocked from his bike did ministers start to take the matter more seriously.
3. Urban Design
The built environment need to be improved. In many city areas there are no facilities for children or adults to be active. Many parks are too far from homes to be of any use. And as already mentioned, most jobs are now, also, too far from homes to allow people to walk or cycle. Changes will need to include the construction of new networks to connect urban areas with safe routes for cyclists and walkers.
Healthcare focuses on prevention of chronic disease through education and promoting activity. Patients need to be assessed and given better advice – i.e. not just “you need to lose some weight” but a structured plan and support network.
4. Primary Healthcare
Primary Healthcare must take a more active role in suggesting and prescribing exercise as a way to reduce risk of NCDs. Doctors should be educated better in basic fitness instruction and always encourage patients to get active and lose weight. GP’s are notorious for giving poor advice regarding exercise, possibly to protect themselves. People are often advised to stop exercising by a doctor to help recover from a minor injury or illness.
5. Public Education
Public education needs to leverage mass media to transmit consistent and clear messages about fitness and health. Tabloid newspapers tend to control much of the health news and report the more controversial stories.
“How can we keep healthy? They change the rules every week!” – A mother’s response to the most recent health revelation in the mass media.
The report says:
“Public education can involve print, audio and electronic media, outdoor billboards and posters, public relations, point of decision prompts, mass participation events, mass distribution of information as well as new media such as text messaging, social networking and other uses of the internet.”
Currently public information in the UK is mostly restricted to doctor’s waiting rooms. All other messages come from the private sector and tend to have some form of commercial incentive or objective.
6. Community Wide Programs
An integrated approach working with schools, public sector and private sector, to promote and encourage activity. Leveraging the Olympic Games Legacy is certainly an option in the UK. The key is mobilizing large number of people from all parts of society. Brazil, Colombia and Hawaii have all had some success in these areas.
7. “Sport For All”
Sport must be promoted as something that can be suitable for all. Many people never play a sport of any kind after leaving school, often thinking that it is simply “not for me“. There is a perception that only the children from school who were good at sport continue to exercise once they leave. Most people do have the potential to do well in sports. The biggest challenge is often finding a suitable one to pursue.
The Global Advocacy for Physical Activity (GAPA) believe that if each of these 7 investments are accomplished on a great enough scale then they will make a “significant contribution to reducing the burden of non-communicable diseases and promote population health“, as well as improving the quality and enjoyment of life.
- “Global Advocacy for Physical Activity (GAPA) the Advocacy Council of the International Society for Physical Activity and Health (ISPAH). NCD Prevention: Investments that Work for Physical Activity”. February 2011. Available from: www.globalpa.org.uk/pdf/investments-work.pdf
- “Fiona Bull on seven investments for physical activity” 19 Nov, 12 | by BMJ Group. Podcast.
The Global Advocacy for Physical Activity report also provides many of its own references, here are a few that related to points mentioned above:
- World Health Organisation. School policy framework: Implementation of the WHO global strategy on diet, physical activity and health. Geneva: World Health Organization; 2008.
- World Health Organization. The world health report 2008: primary health care now more than ever. Geneva, Switzerland: World Health Organization; 2008.
- Wakefield M, Loken B, Hornik R. Use of mass media campaigns to change health behaviour. The Lancet 2010;376:1261-1271.
- National Institute for Health and Clinical Excellence (NICE) Promoting and creating built or natural environments that encourage and support physical activity. London, UK 2008. www.nice.org.uk/nicemedia/live/11917/38983/38983.pdf
- Baumann W. The Global Sport for All Movement: Achievements and Challenges. International Council of Sports Science and Physical Education Bulletin No 50 May 2007. www.icsspe.org.