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Creating A More Active EnglandLGA Culture, Tourism and Sport Board

Dr Will Cavendish

Director of Health and Wellbeing

Department of Health

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Activity has many health benefits

• Disease and disability caused by physical inactivity can cause serious and unnecessary human suffering and impaired quality of life

• 20-30 per cent reduced risk of premature death and up to 50 per cent reduced risk of major chronic disease

• Can reduce the risk of developing type 2 diabetes by up to 64 per cent in those at high risk of developing the disease.

• Helps control body weight, and in combination with a healthy diet, contributes to weight loss

• Is effective in the treatment of clinical depression and has positive benefits for mental health

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And a positive effect on disease risk

Childhood Adolescence Youngadulthood

Middleadulthood

Oldadulthood

Impaired growth & development

Risk factors

Diseases and disorders

Death

RISK

ACTIVE

INACTIVE

(Source: “At Least Five a Week” CMO 2004)

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We know that the cost of inactivity is high

• Costs to the NHS are increased by £1.06 - 1.78 billion by physical inactivity.

• The costs of lost productivity to the wider economy have been estimated to be £5.42 billion from sickness absence and £1.04 billion from premature death of people of working age.[1] [2] Taken together, these costs may total £8.24 billion.

• The economic benefits of physical activity extend beyond health to other sectors of the economy such as our industrial competitiveness, transport and environment

•[1] MEDTAP Dec 2002

[1] Allender et al, The burden of physical activity-related ill health in the UK, 2007[2] Ossa and Hutton, The economic burden of physical inactivity in England, MEDTAP International,2002

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And there are direct health care costs attributable to inactivity

Disease Relative Risks (RR)

PAR (%)

Osteoporosis 1,700.00 1.60 29% 495.00

Angina pectoris 564.67 1.90 38% 215.28

Myocardial infarcation 234.44 1.90 38% 89.38

Hypertension 374.44 1.40 21% 80.50

Stroke 278.33 1.40 21% 59.84

Type 2 diabetes 262.77 1.40 21% 56.49

Breast cancer 243.10 1.20 12% 29.28

Colon cancer 35.86 1.40 21% 7.71

Total direct health care costs

Total direct health care costs

(£m)

Direct cost attributable to inactivity (£m)

1,033.48

Table 3. Direct Health Care Costs Attributable to Physical Inactivity in 1998 (Primary Prevention)

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The CMO recommendations for Active Living are

• ….at least 30 minutes a day of at least moderate intensity physical activity on 5 or more days of the week”

• Children and young people should achieve a total of at least 60 minutes of at least moderate intensity physical activity each day.

• These can be achieved either by doing all the daily activity in one session, or through several shorter bouts of activity of 10 minutes or more.

• Older people should take particular care to keep moving and retain their mobility through daily activity. Additionally, specific activities that promote improved strength, co-ordination and balance are particularly beneficial for older people

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5

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%

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Proportion achieving physical activity guidelines (5 x 30 mins moderate activity)

Men

Women

However in 2006 only 40% of men and 28% of women achieved the CMO recommendations

2HSE 2006

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allages

16-24 35-44 55-64 75+

Proportion achieving physical activity guidelines (5 x 30 mins moderate activity), 2006

Men

Women

Men reported higher levels of physical activity than women with participation generally decreasing with age

2HSE 2006

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70

61

70

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2002 2006

Proportion with high activity (recommended) levels (60 mins for 7 days)

Boys

Girls

And trends have remained static for children’s activity levels

2HSE 2006

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% high level of physical activity

(achieving guidelines)

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Men

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We know there are inequalities in participation

2HSE 2006

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How do we compare with other nations?

•International comparisons are difficult, but not impossible

•Whilst activity levels reflect stages of economic development, for example rates of car ownership, some countries have made significant progress in improving activity levels of their population

•Nevertheless, the maximum rate of increase in activity through concerted action has been limited to 1 percentage point

•Finland, Canada and New Zealand stand out as case studies for what can be achieved

•The Netherlands also appear at the top of the league table of active nations

•Early analysis carried out on our behalf suggests that the England is placed two thirds down the league table so we have much to do

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The Netherlands has been successful in maintaining high levels of physical activity by embracing active travel policies.

• The Netherlands – and Amsterdam in particular – has a worldwide reputation for catering for bicycles as the dominant form of urban transport.

• 27% of all trips are undertaken by bike in the Netherlands, compared to 1% in the UK[i].

• Even more remarkable is that cycling is a mode of everyday transport enjoyed equally by women and men, young and old, rich and poor.

• Key aspects of policy have included the provision of separate bike paths along busy roads, combined with traffic calming of most residential neighbourhoods.

• Extensive cycling rights of way are complemented by ample bike parking, full integration with public transport, comprehensive traffic education and training of both cyclists and motorists, and a wide range of promotional events to generate enthusiasm and wide public support for cycling.

•[i] European Union (2002). EU Energy and Transport in Figures, 2000. Brussels, Belgium: European Commission.

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Are we getting the true picture?

• Health Survey for England captures physical activity across all domains for adults and children

• However, children (or their families) have a tendency to over-report their physical activity.

• Increasing evidence that accelerometry provides and objective, practical, accurate, and reliable means of quantifying amount and volume of physical activity.

• 2008 Health Survey for England is therefore using accelerometers in all under 11s and samples of 11-15 and the adult population.

• Objective fitness measure (step test) being used across the adult population.

• Data to be published in late 2009

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Other surveys such as Sport England Active People Survey measures sport and active recreation

• Largest survey of sport and active recreation in Europe

• Reports only sport and active recreation (but measures all walking and cycling)

• Main metric used for NI8 and LAP target of 2 million people more active – 3 x 30min

• But does not measure sub-30 minute bouts of activity

• 3 x 30 min target for sport and active recreation should not be confused with CMO recommendation

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Healthy Weight, Healthy Lives focuses on reducing the rising tide of obesity and overweight…….

“Our ambition is to be the first major nation to reverse the rising tide of obesity and overweight in the population by ensuring that everyone is able to achieve and maintain a healthy weight. Our initial focus will be on children: by 2020, we aim to reduce the proportion of overweight and obese children to 2000 levels.”

• Theme 1 - Children: healthy growth and healthy weight

• Theme 2 - Promoting healthier food choices

• Theme 3 - Building physical activity into our lives

• Theme 4 - Creating incentives for better health

• Theme 5 - Personalised advice and support

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By building physical activity into our daily lives

Promoting participation in physical activity A supportive built environment

Invest £30m in a ‘Healthy Community Challenge Fund’

Invest in training for planners, architects and designers on health implications of local plans

Develop and promote a toolkit which draws together the ways in which planning policies and powers can be applied to promote physical activity.

“Walking into Health” campaign

Work with the entertainment technology industry

Use the 2012 Olympics to inspire people to become more active

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High profile initiatives being delivered by Local Authorities include – Healthy Towns

• HCCF was developed to provide revenue funding for local areas to change their physical infrastructure whilst working with local communities to encourage healthier food choices and increased levels of physical activity.

• Over 150 expressions of interest were received

• The towns, which have been through a rigorous selection progress, will match the Government funding and have set out pledges around how they will encourage healthy living.

• A representative from IDEA was on the advisory group and panel

• The successful “Healthy Towns” were announced yesterday - Dudley, Halifax (Calderdale), Sheffield, Tower Hamlets, Thetford, Middlesbrough, Manchester, Tewkesbury and Portsmouth

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Their plans include……

• a Points4Life loyalty scheme in Manchester which will reward people with free activities or healthy food when they take exercise;

• a ‘Cycle Recycle’ project in Thetford which helps people to cycle more and maintain their bikes;

• a new ‘urban garden’ in Tewkesbury which will help residents keep fit and rebuild green spaces in the wake of last year’s floods;

new signage to help walkers, runners or cyclists time themselves when exercising in Portsmouth.

• a new award scheme for healthy food in fast food outlets, cafes, restaurants and shops, targeting those on ‘High Street 2012’ – the route that leads to the Olympic Park – in Tower Hamlets;

• a “Let’s Go Outside” project in Dudley which will transform parks and play areas into family health hubs;

• urban farms and junior health trainer programmes in Middlesbrough;

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We are also investing £75m into an integrated marketing campaign

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With support to deliver already pledged from several multi-national companies

• Tesco, whose stores serve 20 million customers per week and employ 280,000 people, will spread the word on the benefits of a healthy lifestyle amongst its customers and workforce. Tesco will run themed Change4Life promotional activity in store on healthier products under the banner Change4Life 4 Less.

• ASDA, which serves 16 million customers a week and employs 165,000 people, will be actively supporting Change4Life in communications to customers and colleagues and will run promotions that encourage healthier eating. ASDA have also committed to supporting Bike4Life to promote cycling as a fun, safe activity that all the family can do.

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We set out further commitments within the Legacy Action Plan

Getting more people more active: help at least two million people in England to be more active by 2012

Initiatives are structured around a variety of themes

1. Healthier families

2. Targeting the least active

3. Removing the barriers and creating incentives to be more active

4. Creating a better environment for physical activity

5. Better coordination with Primary Care Trusts

Action to achieve the target will be driven by a range of government departments and overseen by the 2012 Programme Board

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Building on the success of the Wigan approach - Free Swimming

• Local Authorities to deliver Free Swimming for those aged 16 and under & 60 and over

• Huge interest in the scheme with over 80% of LAs signed up to deliver Free Swimming for those aged 60 and over

• Designed with input from OGDs, Local Authorities, Sport England the ASA

• Supported by a package of Free Swimming coordinators

– Learn to Swim– Culture Change e.g. pool programming, training for reception staff

Wigan Council became the first in England to offer free swimming lessons for older people to help promote healthy living. Children under 16 have also been swimming for free since 2005

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We know that activity levels fall after age 16 and want to address this through

• Fit for Future

• Pilot offering 5,000 16-22 year olds subsidised gym memberships linked to frequency of use

• Bulk purchasing deal with the FIA means participants will pay a nominal monthly fee as long as they average a set number of visits

• Targeted at sedentary and those at risk of inactive lifestyles in and those living in areas of deprivation

• Pilot to run for 12 months commencing in April 2009

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Going further still our new Physical Activity Plan will set out how we will deliver a more active nation by

• Showing how physical activity includes ‘everyday’ forms of activity, such as active travel, recreation, social dance, gardening or simply parents playing with their children

• How local authorities and Primary Care Trusts can determine and respond to the needs of their local populations

• Bringing together a much broader church of stakeholders

• Demonstrating the costs of inactivity for local health economies

• Supporting the seamless delivery of sport and physical activity at the grass roots

• Building upon the established delivery system for sport and physical activity

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We also want to develop local leadership of physical activity & the contribution of the private sector

• Central government does not directly deliver programmes intended to increase physical activity on a significant scale

• Programmes intended to increase physical activity on a significant scale need regional/local input

• Strong local partnerships (CSP’s are a key building block)

• Partnership with the Private Sector

• National Coalition for Better Health

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Local Government is a key partner for us in delivering a more active nation

• Local Area Agreements, NI8

• County Sport Network and Partnerships

• Healthy Towns – October 2008

• Free Swimming – April 2009

• Fit for Future – April 2009

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There are some great examples of best practice already we can draw upon

Blackburn and Darwen - £6 million of investments (over 3-years)

• Free access to all the Council’s leisure facilities for all residents

• Sessions include the, at present ‘paid for’, sessions of aerobics, volleyball, indoor and crown green bowling, badminton and more, in a bid to enable residents to engage in ‘everyday sport’.

• Learning sessions to educate people in what benefits can be gained through regular exercise and other diet and lifestyle changes, however gentle.

• More health trainers – new workers introduced in each neighbourhood.  There role being to work with local people and support them in making lifestyle changes

• New community coaches and instructors to provide sport and fitness in local communities.

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Alongside structures designed to support local delivery

• The creation of a cross-government Physical Activity Programme Board, jointly led by DH and DCMS will oversee delivery of this plan and co-ordinate the regional/local delivery of physical activity and sport

• Support for the existing delivery structure e.g. local sport and physical activity partnerships and networks – CSPs

• A new National Alliance drawn from across the physical activity sector will provide the tools and grow capacity to support local delivery.

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Summing up, Our new plan will………

• Bring together existing government commitments including Healthy Weight, Healthy Lives and the 2012 Legacy Action plan

• Drive up local leadership in physical activity

• Set out how we will contribute to the ambition of 2 million people more active by 2012

• Use local, regional and national levers for physical activity

• Set out how we intend to develop Change 4 Life and the incorporation of activity into our everyday lives