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Leading on physical activity and public health the opportunities and challenges

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Title: 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
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