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Leading on physical activity and public health the opportunities and challenges


Sheffield City Council. Outline. NHS prevention and physical ... e.g. walking to work, digging the garden, washing the car, cycling to school. Active Living! ... – PowerPoint PPT presentation

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Title: Leading on physical activity and public health the opportunities and challenges

Leading on physical activity and public health -
the opportunities and challenges
  • Paul Billington
  • Sheffield City Council

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

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

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

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

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

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

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

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
  • CPA community leadership role
  • Still spend more than 50 of total sport spend

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

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

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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

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

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
  • Work across all three simultaneously!

Importance of everyday activity
Importance of individual activity
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?

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?

More than PE
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

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
  • 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

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?

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
  • 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

  • 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!

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
  • Added value versus added cost?

Investment not subsidy
  • Must maximise investment in healthcare but
    minimise subsidy on physical activity and
  • Why free museums, arts and libraries but not
  • 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

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

  • 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!

Thank you for listening
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