Leading on physical activity and public health the opportunities and challenges

1
Leading on physical activity and public health -
the opportunities and challenges

• Paul Billington
• Sheffield City Council

2
Outline

• NHS prevention and physical activity
• The opportunity for local government and sport
  services to lead on public health and physical
  activity
• The challenges of leadership

3
NHS and prevention

• Wanless (2004) our health services must evolve
  to promoting the maintenance of good health
• NHS Improvement Plan (2004) The NHS will be
  prioritising preventative public health measures
• Choosing Health (2004) The NHS will
  increasingly become a health improvement and
  prevention service

4
NHS and physical activity

• Chief Medical Officer At Least Five A Week
  (2004) inactivity impacts on up to 20 diseases
  or disorders and being active is equally
  important to smoking and diet
• Choosing Activity (2005) an active lifestyle
  is key to improving and maintaining health
• Caroline Flint (August 2006) the biggest gains
  to health will be made by encouraging more
  physical activity

5
A slow shift to prevention

• Public/political expectations of NHS to tackle
  illness
• Individuals must take responsibility for their
  own health
• Public health impacts often go beyond political
  timeframes
• Public health is already under-resourced and
  further threatened by the upcoming PCT
  restructure
• Choosing Health funding spent on waiting lists

6
A low priority given to physical activity

• Extremely crowded public health agenda
• Complicated exercise messages
• Much depends on individual interests of GPs
• Poor evidence of effective activity interventions
• No must do physical activity targets

7
A leadership opportunity

• NHS will remain focused on healthcare
• 2008 and beyond major spending pressures in NHS
• PCT restructure period of paralysis
• Many in NHS are looking to others to lead or at
  least joint lead

8
A shared agenda

• Only 25 of the variation in health is due to
  health services
• 60 of variation is due to socio-economic
  differences and environment
• Ottawa Charter (1986) whole systems approach
  to health, of which, only part is healthcare
• Trend towards joint appointments and resource
  pooling

9
Local governments leadership claim

• Key influence on wider determinants of health
  environment, education, housing, transport,
  access to exercise, urban design, social
  integration etc
• Power to promote and improve well being
• Lead role in LSPs and LAAs where health is
  central
• CPA community leadership role
• Still spend more than 50 of total sport spend

10
Lets rediscover and renew

• Until 1974 public health was part of local
  government
• Public Health Acts led to parks and pools
• Health and welfare philosophy till CCT
• However, challenges of leadership ahead.

11
What business are we in?

• Sport, recreation or physical activity?
• Can lead to confusion, fuzzy policy, disjointed
  planning and difficult partnership working
• Big tent approach - Canada
• Embrace activity across different settings

12
(No Transcript)
13
Reposition to capture health

• Build wider community and political support
• Show benefits beyond individual user
• Focus on evidenced outcomes
• Health service front line
• Do new things or present in new ways

14
Go beyond service delivery

• Service delivery is easily done by others
• Restricts capacity for strategy and partnerships
• Limits our focus to selected aspects of only one
  activity setting
• Infiltrate corporate and partnership priorities

15
Get strategic

• Upstream population wide measures e.g. land
  use, urban design, travel infrastructure
• Midstream community/neighbourhood measures e.g.
  facility programmes, outreach work
• Downstream tailored measures aimed at
  individuals or small groups e.g. exercise
  referral
• Work across all three simultaneously!

16
Importance of everyday activity
17
Importance of individual activity
18
Importance of informal activity

• Carter report (2005) majority of activity is
  already done informally
• 5.5M swim 5M do keep fit 150K play rugby
• More 5-aside than 11-aside football
• Reflects time pressures and social change
• Future growth
• Differentiated policy and practice?

19
More than school

• Children spend only 9 minutes of every waking
  hour at school
• Family and community influence is often stronger
  especially pre-school years
• PE largely based on group/team sports its not
  what most adults do
• What about jogging, cycling, swimming, keep fit,
  yoga, individual sports?

20
More than PE
21
Target markets

• 1 annual increase in activity levels!
• Inactive or nearly active?
• NHS wants to focus on the inactive and especially
  older people
• CPA will push local government towards the active
  and nearly active

22
Obesity activity as prevention not cure

• Significant weight loss requires 60-90 minutes
  exercise per day
• 15,000 steps or 7 miles a day (National Obesity
  Forum)
• Promote physical activity as a preventative
  measure for the majority of the population
• Activity is a health priority in its own right
  impacting on up to 20 diseases/disorders

23
Social marketing not just service marketing

• Low public awareness of key messages and benefits
• Finland, Canada and NZ top of activity leagues
• Sustained, non-medicalised campaigns with bottom
  up input
• Consistent message 5 X 30?

24
The limits of self help and the market

• Only around 20 of population will respond to
  behaviour change or self help approaches
• Urban design, environment and sports investment
  are often the greatest predictors of activity
  levels
• Cant afford to leave service delivery to the
  commercial sector with councils left providing
  a sink service for the poor!
• Pro-active government leading, joining up,
  commissioning and delivering

25
2012

• Sydney Games no increase in participation and
  for some, reinforced the couch potato syndrome
• No evidence of mega-event impact on participation
  (Game Plan, 2002)
• Media led, role model led or investment led?
• Active Nation not just sporting nation
• Legacy NOW!

26
Make partnerships work

• Sport regional, county, district/city, schools
  and sometimes community or area
• Local Strategic Partnerships, LAAs, LPSAs
• Cultural Consortia regional to city
• Physical activity groups regional to city
• Whats best done in partnership and best done
  individually?
• Added value versus added cost?

27
Investment not subsidy

• Must maximise investment in healthcare but
  minimise subsidy on physical activity and
  sport?
• Why free museums, arts and libraries but not
  sport?
• Government spend on sport (21 per person per
  year versus 112 France) and 30 fall in spend by
  councils since 1990s
• Reposition and argue the wider benefits beyond
  the individual user

28
The politics

• We are all localists now - David Cameron says
  he plans to empower councils to do "great things"
  (July 2006)
• David Milliband double devolution
• Strengthen local government or bypass it?
• Must reach out, build public support, initiate
  partnerships, promote and sell ourselves

29
Conclusions

• Re-define our business
• Capture and lead the public health and physical
  activity agendas
• Go beyond service delivery and be strategic
• Assert the case for pro-active government
• Make partnerships really work
• Press the case for investment
• Catch the tide of localism!

30
Thank you for listening