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Title: ACTIVITY PATTERNS YOUNG PEOPLE Aged 518 Years


1
ACTIVITY PATTERNS YOUNG PEOPLE Aged 5-18 Years
2
General Trends2
  • 70 of boys 61 of girls aged 2-15 years
    reached the recommended levels of physical
    activity to benefit their health
  • For girls, activity levels started to
  • decline around the age of 8-10 years
  • By 15 years, 50 girls reached
  • HEA activity recommendations
  • For boys, activity levels remained relatively
    stable through to age 15

3
Active Play
  • 68 of boys and 60 girls participated in active
    play on 5 or more days of the week.
  • The time spent in active play decreased steadily
    with age for boys and girls but most markedly in
    girls.

4
Sports and Exercise Participation2
  • 58 of boys 56 of girls aged 5-10 years
    participated for at least 15 minutes on at least
    1 day
  • 66 of boys 57 of girls aged 11-15 years
    participated for at least 15 minutes on at least
    1 day
  • 50 of females aged 15 years
  • 43 of females aged 12 years did not participate
    in any active sports on a weekly basis

5
Travel Patterns5
  • The proportion of 5-16 years olds walking to
    school has decreased since 1989/91
  • 51 of primary age children walked to school in
    2002 compared with 38 of secondary age children
  • About 2 of trips to school by 11-16 year olds
    were made by bicycle

6
Physical Education in Schools6
  • 49 of young people (6-16 years) were spending 2
    or more hours a week in PE lessons
  • In 2002, only 29 of 6-8 year olds and 32 of
    9-11 year olds spent 2 hours or more per week in
    PE.
  • In 2003, around half of all young people were
    still not receiving 2 hours of PE a week

7
Sedentary Behaviours78Young People spend
considerable amounts of leisure time in sedentary
pursuits
  • Approximately 5 hours a day of young peoples
    leisure time is accounted for by multi-media
    activities
  • 50-60 of this time is devoted to watching
    television
  • Media-use alone did not displace physical
    activity behaviours

8
Inequalities in Activity2 Socio-Economic Status
  • Participation rates in Active Play, Walking and
    Housework/Gardening did not vary by
    socio-economic group
  • Sport Exercise were related to socio-economic
    category.
  • Sport Exercise participation rates were higher
    for boys and girls aged 2-10 years in the least
    deprived group compared with the most deprived
    group (14 v 11)

9
Inequalities in Activity9 Disabled People
  • Proportion of disabled children young people
    participating in sport exercise was lower than
    young people in the general population
  • Disabled young people educated at special schools
    were more likely to participate in sport and
    exercise than those in mainstream schools
  • Young people with a mobility disability and those
    with a self-care related disability are least
    likely to be active

10
Inequalities in Activity10 Minority Ethnic Groups
  • Indian, Pakistani, Bangladeshi and Chinese young
    people had lower participation rates compared to
    young people in the general population
  • Irish and Black Caribbean young people had
    similar participation rates to young people in
    the general population

11
Summary
  • Growing public health concern over the effects of
    sedentary lifestyles
  • Overweight and obesity in young people is of
    particular concern
  • Reducing the time spent being INACTIVE is
    important because physical inactivity appears to
    track from childhood to adolescence and from
    adolescence to early adulthood

12
References
  • Biddle, S., Sallis, J. Cavill, N (1998). Young
    and Active? Young people and health enhancing
    physical activity evidence and implications.
    Health Education Authority.
  • Department of Health (2004). At Least Five A
    Week Evidence on the impact of physical activity
    and its relationship to health. A Report from the
    Chief Medical Officer. London DoH.
  • Sproston, K. Primatesta (2002). Health Survey
    for England The Health of Children Young
    People. London HMSO.
  • Food Standards Agency. (2000). National Diet
    Nutrition Survey Young People Aged 4-18 years.
    London Stationary Office.

13
References
  • Department for Transport (2003). Travel to
    School in GB. Personal Travel Factsheet 2.
    London Department for Transport.
  • Department for Transport (2004). National Travel
    Survey 2003 Provisional Results. Transport
    Statistics Bulletin. London Office of National
    Statistics.
  • Sport England. (2003). Young People and Sport in
    England Trends in participation 1994 2002.
    London Sport England.
  • Project STIL (Sedentary Teenagers and Inactive
    Lifestyles). Loughborough University
    URLhttp//www.lboro.ac.uk/departments/SSES/about/
    newsboard/couchpots.html.

14
References
  • Marshall, S. Project STIL Systematic Literature
    Reviews. Loughborough University Unpublished
    Report.
  • Biddle, S., Gorely, T. Marshall, S., Murdey, I.,
    Cameron, C. (2004). Physical activity and
    sedentary behaviours in youth issues and
    controversies. Journal of the Royal Society for
    the Promotion of Health. 124 (1) 29-33.
  • Marshall, S., Biddle, S., Gorely, T. Cameron, N.,
    Murdey, I. (In press). Relationships between
    media use, body fatness and physical activity in
    children and youth a meta-analysis.
    International Journal of Obesity.

15
References
  • Sport England (2001). Disability Survey 2000
    Young people with a disability and sport
    headline findings. London Sport England.
  • Joint Health Surveys Unit (2001). Health Survey
    for England The health of minority ethnic groups
    1999. LondonHMSO.
  • Malina, R.M. (1996). Tracking physical activity
    and physical fitness across the lifespan.
    Research Quarterly for Exercise and Sport. 67
    (3) 48-57.
  • National Association for Sport Physical
    Education (2004). Physical Activity for
    Children. A Statement of Guidelines for Children
    Ages 5-12. Second Edition. Reston, VA NASPE.

16
ACTIVITY PATTERNS ADULTS Aged 16-to-54 Years
17
General Trends3
  • According to the Health Survey for England (HSE
    98)
  • Only 46 of men 31 of women aged between
    16-to-54 years met the recommended levels of
    physical activity to benefit their health.
  • 29 of men 38 of women aged between 16to-54
    years were insufficiently active
  • A quarter of men just under a third of women
    aged between 16to-54 years were deemed to be
    totally inactive

18
The proportion of men and women who do NOT meet
the 5 x 30 recommendation is highest in women,
but increases with age in men
19
Sports Exercise Participation3
  • 44 of men 53 of women aged 16-54 years did
    not participate in any form of sports or exercise
    4 weeks prior to the HSE
  • Young men aged 16-24 years were more likely to
    participate in some sports and exercise of at
    least 15 minutes duration in comparison to
  • Older men (45-54 years)
  • Young females

20
Travel Patterns6
  • The average time spent walking or cycling per
    person is decreasing and is now as little as 11.6
    minutes per day
  • The total distance walked per year has fallen by
    19 since 1989/91
  • The proportion of trips to work made on foot has
    fallen by 6
  • Shopping trips made on foot have decreased by 16
    since 1985/6

21
Occupational Activity
  • According to the Health Survey for England
    (1998)
  • 28 of men aged 16-54 years were classified as
    moderately active at work compared to 16 of
    women of a similar age

22
Sedentary Behaviours7
  • Approximately 5 of men and 6 of women do no
    physical activity at all.

UK Time Use Survey, 2002
23
Inequalities in Activity Socio-Economic Status3
  • Participation in sport and exercise and walking
    was strongly related to social status

24
Inequalities in ActivityDisabled People8
  • According to Sport England (2002)
  • Participation rates in sport (including walking)
    for disabled adults were 24 lower than for
    non-disabled adults
  • 51 disabled adults participated in some form of
    sport in the last four weeks compared to 75 of
    adults without a disability

25
Inequalities in ActivityMinority Ethnic Groups9
  • According to HSE (1999)
  • Men women from BME groups based in England are
    6 less likely to participate in physical
    activity compared with the indigenous population.
  • Only 18 of men 7 women in Bangladeshi
    community meet the recommended physical activity
    levels

26
Summary
  • The current evidence on sport, exercise and
    physical activity patterns of adult men and women
    aged 16-to-54 years highlights that the majority
    do insufficient levels to benefit their health

27
References
  • Department of Health (1996). Strategy Statement
    on Physical Activity. London DH
  • Department of Health (2004). At Least Five A
    Week Evidence on the impact of physical activity
    and its relationship to health. A Report from the
    Chief Medical Officer. London HMSO.
  • Joint Health Surveys Unit (2004). Health Survey
    for England 2003 Trends Commentary. London The
    Stationary Office (In Press) www.dh.gov.uk
  • Joint Health Surveys Unit (1999). Health Survey
    for England. London HMSO

28
References
  • National Statistics Office Medical Research
    Council of Human Nutrition (2004). National Diet
    and Nutrition Surveyadults aged 19-64 years.
    London Stationary Office. Joint Health Surveys
    Unit (2002). Health Survey for England The
    Health of Children and Young People. London HMSO
  • Sproston, K. Primatesta, P. (2003). Health
    Survey for England 2002 The Health of Children
    Young People. London The Stationary Office.
  • Department for Transport (2004). Transport
    Trends. Seventh Edition. DfT London.
  • Department for Transport (2004). National Travel
    Survey for Great Britain 2002. HMSO London.

29
References
  • National Statistics Office. (2002). The UK Time
    Use Survey 2000. London NSO
  • Sport England (2002). Adults with a disability
    and sport National Survey 200-2001. London
    Sport England. HMSO
  • Joint Health Surveys Unit (2001). Health Survey
    for England The Health of Minority Ethnic Groups
    1999. London HMSO
  • Department for Culture, Media and Sport and the
    Strategy Unit (2002). GAME PLAN A strategy for
    delivering Governments sport and physical
    activity objectives. London HMSO

30
ACTIVITY PATTERNS ADULTS IN LATER LIFEAged 50
Years and Over
31
General Trends3
  • 81 of men and 87 of women aged 55 years and
    over do not reach the recommended levels of
    physical activity to benefit health
  • There is a sharp decline in activity levels with
    age
  • 32 of men aged 55 to 64 years were reaching the
    recommended levels
  • This figure decreased by 15 for men aged 65-74
    years and a further 9 for men aged 75 years and
    over.

32
Functional capacity declines with age 3,4
  • 1 in 4 women 1 in 14 men aged 50 years and over
    did not have the strength and power in their legs
    to perform general activities of daily living
    without assistance
  • 20 of women 14 of men aged 50 years and over
    did not have the flexibility to wash their hair

33
Sports Exercise Participation3
  • Participation in sporting activities of an
    intensity likely to produce health benefits
    declines with age

ADNFS HEA Survey of Activity Health (1999)
34
Sports Exercise Participation3
  • Few men or women aged 50 years and over
    participated in sports and exercise more than
    once or twice a week
  • Only 3 of men and 2 of women aged 50 years and
    over participated at least five times a week at
    an intensity to produce a health benefit

35
Travel Patterns5
  • According to the National Travel Survey for GB
    (2001)
  • Total distance walked cycled per year by men
    women showed a decline after the age of 60
  • Men women aged over 60 years walked a total
  • of 201 miles and 147 miles per year
    respectively
  • After the age of 60, men made more walk only
    journeys than women, men also made about twice as
    many bicycle trips than women

36
Sedentary Behaviours6
  • Men women aged 65 years and over, spend
    approximately three and three quarter hours a day
    on sedentary activities
  • Over 75 of this time is spent watching TV or
    videos

37
Inequalities in Activity6,7
  • Little data is available on socio-economic status
    and physical activity patterns in later life
  • Participation rates in sport among
  • disabled adults decreases with age

38
Inequalities in ActivityMinority Ethnic Groups
  • Health Survey for England (2001) revealed
  • The proportion of inactive black and minority
    ethnic men women increased with age
  • Within the Bangladeshi community 85 of men 92
    of women aged over 55 years were sedentary
  • Older Indian, Pakistani and Chinese men women
    also displayed low physical activity levels
  • Older Black Caribbean men women had similar
    activity patterns to the indigenous population

39
Summary
  • In later life physical activity has an important
    role to play in
  • the maintenance of functional ability
  • in the prevention of disability, immobility and
    isolation.
  • Physical INACTIVITY in later life is a major
    public health burden

40
References
  • Department of Health. (1996). Strategy Statement
    on Physical Activity. London DH..
  • Department of Health (2004). At Least Five A
    Week Evidence on the impact of physical activity
    and its relationship to health. A Report from the
    Chief Medical Officer. London DH.
  • Joint Health Surveys Unit (2004). Health Survey
    for England 2003 Trends Commentary. London The
    Stationary Office, In Press. www.dh.gov.uk

41
References
  • Joint Health Surveys Unit (2002). Health Survey
    for England The health of older people. London
    Stationary Office Publication.
  • Skelton, D.A., Young, A., Walker, A. and
    Hoinville, E. (1999). Physical activity in later
    life Further analysis of the Allied Dunbar
    National Fitness Survey of Activity and the
    Health Education Authority National Survey of
    Activity and Health. London HEA.
  • Skelton, D.A. and McLaughlin, A.W. (1996).
    Training functional ability in old age.
    Physiotherapy. 82 (3) 159-167.

42
References
  • Department of the Environment, Transport the
    Regions (2001). National Travel Survey for Great
    Britain. HMSO London.
  • Department for Transport (2004). National Travel
    Survey for Great Britain. HMSO London.
  • National Statistics Office (2002). Adults with a
    disability and sport National Survey 2000-2001.
    London Sport England.
  • Sport England (2002). Adults with a disability
    and sport. London Sport England.
  • Joint Health Surveys Unit (2001). Health Survey
    for England The Health of Minority Ethnic Groups
    1999. London HMSO.

43
PHYSICAL ACTIVITY AND HEALTHKey Facts and Figures
44
Opportunities for Physical Activity
  • At work
  • For transport
  • In domestic duties
  • In leisure time
  • The majority of people do very little or no
    physical activity in any of these domains1

45
Health Risks of Physical Inactivity 1,2
  • Has a substantial negative impact on individual
    and public health.
  • Leading causes of disease and disability
    associated with physical inactivity
  • Coronary Heart Disease (CHD)
  • Stroke
  • Obesity
  • Type II Diabetes
  • Hypertension

46
Health Risks of Physical Inactivity
  • 6. Colorectal cancer
  • 7. Stress and Anxiety
  • 8. Osteo-arthritis
  • 9. Osteoporosis
  • 10. Low back pain
  • 37 of CHD deaths can be attributed
  • to physical inactivity
  • Britton McPherson (2002)

47
Health Benefits of Physical ActivityPremature
Mortality
  • 134, 611 men 89,756 women died prematurely
    from all-causes in 2000 in England
  • Moderate-to-high levels of physical activity are
    associated with lower all-cause mortality rates
  • Sedentary people experience a 1.2
  • to a 2- fold increased risk of dying prematurely

48
Health Benefits of Physical ActivityCardiovascula
r Disease (CVD)
  • 35 of premature deaths in men 27 of premature
    deaths in women are from CVD in England
  • CHD accounts for 22 of premature deaths in men
    13 of premature deaths in women
  • Individuals who are active are 1.9 times less
    likely to have a heart attack than inactive
    people 7

49
Health Benefits of Physical ActivityCancer
  • Colo-rectal cancer accounts for 3 of premature
    deaths in men and women
  • Over 7000 women died prematurely from breast
    cancer in England in 2000
  • Regular physical activity is associated with a
    decreased risk of developing colon cancer by up
    to 50

50
Health Benefits of Physical ActivityType II
Diabetes
  • 1.35 million people have been diagnosed with type
    II diabetes
  • Regular physical activity lowers the risk of
    developing non-insulin dependent diabetes
    mellitus by 50
  • Risk may also be reduced in groups of people with
    impaired glucose tolerance

51
Health Benefits of Physical ActivityHypertension
  • 14 of deaths from CHD in men and 12 in women
    are due to raised blood pressure
  • 37 of men 34 of women have hypertension in
    England
  • Regular physical activity prevents or delays the
    development of high BP
  • It also helps to reduce systolic
  • diastolic BP by 6-7mmHg

52
Health Benefits of Physical ActivityOsteoporosis
  • 1 in 3 women 1 in 12 men, over the age of 50,
    in the UK will sustain a spine, hip or wrist
    fracture due to osteoporosis
  • 1 in 3 over 65s and 50 of over 85s fall each
    year
  • Regular weight bearing physical activity is
    essential for normal skeletal development
  • Strength training and other forms of exercise in
    older women reduces the risk of hip fracture by
    50

53
Health Benefits of Physical ActivityWeight
Control
  • 46 of men and 32 of women are overweight
  • 17 of men and 21 of women are obese
  • Regular physical activity reduces
  • the risk of becoming obese by
  • 50 compared to people with
  • sedentary lifestyles

54
Health Benefits of Physical ActivityPsychological
Well-being
  • Mixed anxiety and depression is experienced by
    9.2 of adults in Great Britain
  • Regular physical activity appears to
  • Relieve symptoms of depression and anxiety
  • Improve mood
  • It may protect against the development of mild
    forms of depression
  • It is associated with improved self-esteem

55
Health Benefits of Physical ActivityBrain
Function
  • 18,500 people with dementia are
  • aged under 65 years
  • Physical activity enhances and protects brain
    function
  • It may delay age-related neuron dysfunction and
    degeneration responsible for cognitive decline
    and personality changes 6

56
Health Benefits of Physical ActivityPainful
Conditions
  • Physical activity
  • Is essential for maintaining the health of joints
  • Controls the symptoms of arthritis and
    osteoporosis
  • Helps to improve stamina in people with
    disabilities
  • Can help to prevent lower back pain
  • Can help to manage lower back and knee pain

57
Health Benefits of Physical ActivityHealth
Related Quality of Life
  • Physical activity improves health-related quality
    of life through
  • Enhancing psychological well-being
  • Improving physical functioning
  • Enables individuals to maintain independence and
    mobility in later life

58
Health Risks of Physical Activity2,4
  • Most musculo-skeletal injuries sustained during
    physical activity are likely to be preventable
  • Injuries sustained during competitive sports have
    been shown to increase the risk of developing
    osteoarthritis
  • Serious cardiac events can occur with physical
    exertion, HOWEVER, the overall benefit of regular
    physical activity is lower all-cause mortality

59
Inequalities in Health
  • Mortality rates among men and women are 3 times
    higher for those in social class V than those in
    I
  • There is a marked social gradient in many of the
    leading causes of disease and disability in the
    UK
  • Physical Inactivity mirrors the health
    disparities seen among men and women in social
    class IV V
  • Ethnic differences exist in mortality rates.

60
Summary
  • Physical inactivity is estimated to cause 1.9
    million deaths globally
  • The proportion of deaths attributed to physical
    inactivity is about 5-8
  • Physical inactivity is one of the top 10 leading
    causes of death and disability in the developed
    world
  • Health benefits of physical activity are
    particularly important for individuals in
    socio-economic groups IV and V

61
  • Summary
  • There are few public health initiatives that
    have greater potential for improving health and
    well-being than increasing the activity levels of
    the population in England.
  • Chief Medical Officer, 2004

62
References
  • Department of Health (2004). At Least Five A
    Week Evidence on the impact of physical activity
    and its relationship to health. A Report from the
    Chief Medical Officer. London DH.
  • World Health Organisation (2002). The World
    Health Report Reducing risks, promoting healthy
    life. France WHO
  • Britton and McPherson, K. (2002). Monitoring the
    progress of 2010 target for CHD Mortality
    Estimated consequences on CHD incidence and
    mortality from changing prevalence of risk
    factors. London National Heart Forum

63
References
  • British Heart Foundation (2004). Coronary Heart
    Disease Statistics BHF Statistics Database.
    London British Heart Foundation.
  • US Department of Health and Human Services,
    Centres for Disease Control and Prevention,
    National Centre for Chronic Disease Prevention
    and Health Promotion, The Presidents Council on
    Physical Fitness and Sports. (1996). Physical
    Activity and Health A report of the Surgeon
    General. Pittsburgh CDC.
  • Blair, S.N. et al. (1992). How much physical
    activity is good for health? Annual Review of
    Public Health, 13 99-126.

64
References
  • Joint Health Surveys Unit. (1999). Health Survey
    for England 1998. London.
  • Department of Health (2002). Health Survey for
    England 2002 Trend Data. See DH website
    www.publications.doh.gov.uk/stats/trends1.htm
  • National Osteoporosis Society (2002). Primary
    Care Strategy for Osteoporosis and Falls. A
    Framework for health improvement programmes
    implementing the National Service Framework for
    Older People. www.nos.org.uk/PDF/PCGDoc2002.pdf

65
References
  • Spirduso (1996). Physical Dimensions of Ageing.
    Illnois Human Kinetics.
  • Office for National Statistics (2000). London
    Office for National Statistics.
  • Cotman, C.W. Engesser-Cesar, C (2002).
    Exercise enhances and protects brain function.
    Exercise Sport Science Reviews. 30 (2) 75-79.

66
YOUNG PEOPLES HEALTH TRENDSAGED 5-18 YEARS
67
Prevalence of Obesity
  • Over a fifth of boys and a quarter of girls are
    overweight or obese
  • The number of obese children has almost doubled
    among boys between 1997 and 2002.
  • Obese children have a 20-25 chance of becoming
    obese adults3
  • More than 60 of overweight children have at
    least one additional risk factor for
    Cardiovascular Disease CVD4
  • More than 20 of obese children have 2 or more
    risk factors for CVD4

68
Inequalities in Obesity
  • Obesity prevalence is more common in boys than
    girls (7.9 v 6.7)5
  • Overweight and obesity is more common in children
    from most deprived areas.
  • Boys were 12 times more likely to be obese if
    they had 2 obese parents.

69
Type II Diabetes
  • Overall prevalence of Type II Diabetes is unknown
  • Children of some ethnic groups are more
    susceptible to type II diabetes
  • At least 4 white English adolescents, aged 13-15
    years, are known to have developed type II
    diabetes9 as a direct consequence of obesity9

70
Mental Health9
  • Among children aged 5-15 years, 10 had one or
    more mental health disorders
  • More common among boys than girls, and older
    rather than younger children
  • Nearly 10 of white children and 12 of black
    children have been diagnosed as having some form
    of mental health problem

71
Inequalities in Mental Health10
  • Family characteristics
  • Children of lone parents are twice as likely to
    have a mental health problem than those living
    with married or cohabitating couples
  • Children from a lower socio-economic background
    are more likely to have mental health problems
    than those from a higher socio-economic background

72
Asthma10,11
  • The number of new cases of Asthma is now 6 times
    higher in children than it was 25 years ago
  • 1 in 8 children are currently being treated for
    asthma
  • For every 100,000 patients in a primary care
    organisation, there will be at least 4000 with
  • asthma, 50 visiting their GP at least
  • once per year

73
Summary
  • The current health trends of Young People are
    cause for concern
  • Overweight and obesity in young people is
    increasing
  • Recently cases of type II diabetes in white,
    English adolescents have been reported
  • 1 in 10 children experience some form of Mental
    Health problem
  • The UK has one of the highest prevalence rates of
    asthma in the world

74
References
  • Chinn, S Rona, R.J. (2001). Prevalence and
    trends in overweight and obesity in three
    cross-sectional studies of British children,
    1974-1994. British Medical Journal. 322 24-36.
  • International Obesity Taskforce and European
    Association for the Study of Obesity (2002).
    Obesity in Europe the case for action. London
    International Taskforce and Association for the
    Study of Obesity.
  • Sproston, K. Primatesta, P. (2002) Health
    Survey for England The Health of Children
    Young People. London HMSO.
  • New South Wales Childhood Obesity Secretariat.
    (2002). Childhood Obesity Background Paper. NSW
    Center for Public Health Nutrition.

75
References
  • Freedman, D.S., Dietz, W.H., Srinivasan, S.R.
    Berenson, G.S. (1999). The relation of
    overweight to cardiovascular risk factors among
    children and adolescents The Bogalusa Heart
    Study. Pediatrics. 1031175-1182.
  • Department of Health. (2004). At Least Five a
    Week Evidence on the impact of physical activity
    and its relationship to health. A report from the
    Chief Medical Officer. London Department of
    Health Publications.
  • Armstrong, J., Reilly, J.J. Child Health
    Information Team Information Statistics
    Division, Edinburgh. (2001). Assessment of the
    National Child Health Surveillance System as a
    tool for obesity surveillance at national and
    health board level. www.show.scot.nhs.uk

76
References
  • Saxena, et al. (2004). Ethnic group differences
    in overweightand obese children and young people
    in England cross-sectional survey. Archives of
    Disease in Childhood. 8930-36.
  • Barrett, T.G., Ehtisham, S., Smith, A.
    Hattersley, A.T. (2002). Pediatric diabetes
    survey shows type 2 diabetes prevalence 0.4,
    distinct from type 1, and associated with
    overweight, puberty, female sex and ethnic
    minority status. Endocrin Abstracts. 3108.

77
References
  • Howdle, S. Wilkin, T. (2001). Type 2 diabetes
    in children. Nursing Standard. 15 (18) 38-42.
  • Drake, A.J., Smith, A., Betts, P.R., Crowne, E.C.
    Shield, J.P.H. (2002). Type 2 diabetes in
    obese white chidlren. Archives of Disease in
    Childhood. 86 207-208.
  • American Diabetes Association (2000). Type 2
    diabetes in children and adolescents.
    Paediatrics. 105 671-680.

78
References
  • Office for National Statistics. (2000). The
    mental health of children and adolescents in
    Great Britain Summary Report. London NSO.
  • National Asthma Campaign (2001). Asthma Audit
    2001. The Asthma Journal. 6 (3).
  • National Asthma Campaign (2002). Starting as we
    mean to go on An audit of childrens asthma in
    the UK. The Asthma Journal. Special Supplement. 8
    (2).

79
PHYSICAL ACTIVITY, SPORT EDUCATIONTheir Value
to Education
80
School as a Setting for Promoting Physical
Activity Sport
  • Schools provide the opportunity to address the
    full range of individuals in a population - a
    captive audience3
  • Any positive impact from schools has the
    potential to have an immediate and lifetime
    effect4
  • Schools have the responsibility to develop young
    peoples physical skills and to encourage them to
    recognise the importance of a healthy lifestyle 5

81
Schools as a Setting for Promoting Physical
Activity Sport 6, 7
  • All children, whatever their circumstances or
    abilities, should be able to participate in and
    enjoy physical education and sport
  • (DfES DCMS 2002 p1)
  • The schools role in promoting physical
    education, sport and physical activity is
    increasingly important given the rising obesity
    problem in children 7

82
Academic Achievement8
  • Participation in regular physical activity and
    sport has been linked to improved academic
    performance in several studies
  • Shephard (1997) found academic performance was
    maintained or even enhanced through an increase
    in physical activity levels
  • When curricular time was allocated to physical
    activity learning seemed to proceed more rapidly
    per unit of classroom time
  • Academic development is not compromised by an
    increase in time spent on PE (Shephard, 1997,
    p113)

83
Academic Achievement 9,10
  • A project called Fit to Succeed found scores in
    government S.A.T.s were highest among children
    who reported exercising hard at least 3 times per
    week 9
  • Improved numeracy and literacy scores have been
    reported in the latest independent review of the
    Government Initiative Playing for Success10

84
Academic Achievement,11, 12
  • Successful PE and school sport contribute to
  • Higher levels of participation and achievement 11
  • Higher levels of attainment 11
  • Relaxed and focused pupils12

85
Social Inclusion 11,13
  • Sport and physical activity may be a tool to
    engage the most vulnerable young people 13
  • PE and school sport contribute to11
  • Lower levels of truancy and improved behaviour
  • Reduced negative behaviour
  • A decline in exclusions

86
Social Inclusion 14
  • There are strong theoretical arguments for the
    potential positive contribution sport can make to
    reduce the propensity to commit crime
  • 25 of males 15 of females, aged 12-17 years,
    admitted committing at least 1 offence 14
  • 50 of these offenders committed persistent
    and/or serious offences 14

87
Social Inclusion 15
  • Programmes focusing on outreach approaches and
    non-traditional, local provision appears to have
    the best chance of success
  • Sport is most effective when combined with
    programmes that address personal and social
    development

88
The Environment 3,16
  • During 2001 there were 2,608 road accidents
    involving pedestrians aged 5-7 years across Great
    Britian16
  • 18 of cars in urban areas at the morning peak
    times are taking children to school 16
  • School environments and policies are not always
    conducive to physical activity 3

89
Summary
  • Cross-sectional and longitudinal studies have
    shown that the rate of academic learning per unit
    of class time is enhanced in physically active
    students
  • Lack of curricular time is not a valid reason for
    denying children daily quality PE
  • Active children tend to be healthier, happier and
    better learners than their sedentary peers

90
References
  • Department of Health (1999). Saving Lives Our
    Healthier Nation. London HMSO.
  • Acheson, D. (1998). Independent inquiry into
    inequalities in health report. London HMSO
  • Cale, L. (2000). Physical activity promotion in
    secondary schools. European Physical Education
    Review. 6 (1) 71-90
  • Fox, K.R. (1996). Physical activity promotion and
    the active school. In N. Armstrong (ed.). New
    directions in physical education. London Cassell
    Education. pp. 94-109

91
References
  • Department for Education and Employement,
    Qualifications and Curriculum Authority (1999).
    The National Curriculum. London Stationary
    Office. P11
  • Department for Education and Skills and
    Department for Culture Media and Sport. (2002).
    Learning through PE and sport A guide to
    physical education, school sport and club links
    strategy. London DfES
  • Reilly, J.J. Dorosty, A.R. (1999). Epidemic of
    obesity in UK children. The Lancet. 354 Nov 27
  • Shephard, R.J. (1997). Curricular physical
    activity and academic performance. Pediatric
    Exercise Science. 9 113-126

92
References
  • To view the Fit to Succeed report and
    associated dpress releases visit
    http//www.sheu.org.uk/fts/fts.htm
  • Department for Education and Skills (2003).
    Playing for Success 4th Evaluation Report.
    Nottingham National Foundation for Educational
    Research.
  • Qualifications and Curriculum Authority (2001).
    Survey into Physical Education and School Sport.
  • Health Education Board for Scotland. (2001).
    Evaluation of Class Moves!. Scottish Council for
    Research in Education Edinburgh.

93
References
  • Sport England (1999). The Value of Sport. London
    Sport England.
  • Home Office (1999). Aspects of Crime Young
    Offenders. London HMSO.
  • Collins, M.F. (2002). Sport and Social Exclusion.
    London Routledge.
  • Department for Transport (2001). School Travel.

94
ECONOMIC COSTS OF PHYSICAL INACTIVITY
95
Cost of Physical Inactivity1
  • Estimated costs are 8.3 billion per year in
    England
  • Includes direct costs of treatment for major
    lifestyle related diseases
  • Includes indirect costs through sickness absence

96
Health Risks of Physical Inactivity 2,3
  • Physical inactivity is a major risk factor for
    CHD 3
  • Individuals who are inactive are 1.9 times more
    likely to have a heart attack 3
  • 37 of CHD deaths can be attributed to physical
    inactivity 3
  • 19 are attributed to smoking 4
  • 13 are attributed to high blood
  • pressure4

97
Healthcare Costs of Diseases Associated with
Physical Inactivity 5-8
  • CHD costs the UK health care system 1.73
    billion5
  • Stroke accounted for 1.8 billion of NHS
    expenditure6
  • Direct costs of obesity are at least 500 million
    per year7
  • Diabetes treatment accounts for
  • approximately 5.2 billion8

98
Healthcare Costs of Diseases Associated with
Physical Inactivity9,10
  • Osteoporosis results in over 200 000 fractures
    each year, costing the NHS over 940 million8
  • Approximately 1,632 million was spent on back
    pain in the UK10
  • 6.5 billion was spent on mental health services
    in the NHS last year in England alone

99
Economic Costs of Diseases Associated with
Physical Inactivity 5-7
  • CHD cost the UK economy 5.33 billion through
    informal care and lost productivity5
  • Stroke resulted in 7.7 million lost working days
    about 459 million in lost production6
  • Obesity costs to the individual and industry are
    approximately 2 billion per year7

100
Economic Costs of Diseases Associated with
Physical Inactivity 10,11
  • Type II diabetes costs industry around 564
    million per year11
  • Insulin dependent diabetes costs a further 231
    million11
  • Back pain cost the economy 10,700 million from
    lost production and informal care10

101
Potential Savings
  • Northern Ireland Physical Activity Strategy aims
    to
  • Reduce sedentary population from 20 to 15
  • This will result in
  • At least 121 saved lives per year among under 75
    years
  • An associated economic benefit of 131 million

102
Potential Savings
  • Physical Activity Strategy for Scotland
  • Estimated that 85.2 million could be saved if
    levels of inactivity were reduced by 1 each year
    for the next 5 years
  • These economic benefits are associated with the
    number of life years saved through
  • preventing premature death from
  • CHD, strokes and colon cancer

103
Potential Savings
  • 9 of CHD could be avoided if sedentary and
    lightly active became more moderately active4
  • Regular moderate physical activity has the
    potential to reduce half the incidence of hip
    fractures in over 45 year olds12
  • Risk of death in men who walk more than 1 mile a
    day is 1.8 times that of men who walk less than 1
    mile a day16

104
Potential SavingsDiabetes 13
  • A landmark clinical trial (RCT) found that diet
    exercise were significantly more effective than
    metformin in the prevention of diabetes in
    glucose intolerant patients
  • Lifestyle intervention group reduced incidence of
    diabetes by 58 compared with the placebo,
    metformin reduced incidence by 31
  • To prevent 1 new case of diabetes need to treat
  • 6.9 persons for 3 years with lifestyle
    intervention
  • 13.9 persons for 3 years with metformin

105
Potential SavingsFunctional Decline
  • 50 of all fallers who fracture their hips are
    never functional walkers again
  • 1 in 5 will die within 6 months
  • It is possible to reverse age- and
    activity-related decline relatively quickly with
    physical activity

106
Summary
  • Physical inactivity costs the economy an
    estimated 8.3 billion
  • The total cost of all CHD related burdens was
    7.06 billion in 1999
  • If the current obesity trends are not reversed
    then diabetes healthcare costs will increase by
    15 over the next 20 years
  • Developing public policy to create a supportive
    environment for physical activity has the
    potential to save lives, healthcare resources and
    industry lost production costs.

107
References
  • Department of Health (2004). At Least Five a
    Week Evidence on the impact of physical activity
    and its relationship to health. A Report from the
    Chief Medical Officer. London DoH.
  • World Health Organisation (2002). Report on the
    global burden of disease from 22 health risk
    factors. Geneva WHO
  • Blair, S.N. et al., (1992). How much physical
    activity is good for health? Annual Review of
    Public Health. 13 99-126
  • Britton, A. McPherson, K. (2002). Monitoring
    the progress of the 2010 target for CHD
    mortality Estimated consequences on CHD
    incidence and mortality from changing prevalence
    of risk factors. London National Heart Forum.

108
References
  • Liu, J.L.Y., Maniadakis, N., Gray, A. Rayner,
    M. (2002). The economic burden of Coronary Heart
    Disease in the UK. Heart. 88 597-603.
  • Bosanquet, N. Franks, P. (1998). Stroke care
    reducing the burden of disease. London Stroke
    Association.
  • National Audit Office (2001). Tackling Obesity.
    London NAO.
  • Diabetes UK (2003). London Diabetes and Lip
    Centre.

109
References
  • Dolan, P Togerson, D.J. (1998). The cost of
    treating osteoporotic fractures in the UK female
    population. Osteoporosis International. 8
    611-617 Manaiadikis, N. Gray, A. (2000). The
    economic burden of back pain in the UK.
  • Gray, A., Fenn, P., et al. (1996). Economic
    analysis of diabetes. Journal of Diabetes and Its
    Complications. 10 149-150.
  • Nicholl, J.P., Coleman, P. and Brazier, J.E.
    (1994). Health and health care costs and benefits
    of exercise. Pharmoeconomics. 5 (2) 109-122.

110
References
  • Knowler, W.C., Barrett-Connor, E., Fowler, S.E.
    et al., (2002). Reduction in the incidence of
    type 2 diabetes with lifestyle intervention or
    metformin. New England Journal of Medicine. 346
    (6) 393-403.
  • Tuomilehto, J., Lindstorm, J., Eriksson, J.G.
    et.al. (2001). Prevention of type 2 diabetes
    mellitus by changes in lifestyle among subjects
    with impaired glucose tolerance. New England
    Journal of Medicine. 344 (18) 1843-1350.
  • Pan, X.R., Li, G.W., Hu, Y.H. et al. (1997).
    Effects of diet and exercise in preventing NIDDM
    in people with impaired glucose tolerance.
    Diabetes Care, 20 (4) 537-544.

111
References
  • Hakim, A.A., Petrovitch, H., Burchfield, C.M. et
    al. (1998). Effects of walking on mortality among
    non-smoking retired men. New England Journal of
    Medicine. 338 94-99.
  • Spirduso, W. (1996). Physical dimensions of
    ageing. Illnois Human Kinetics.
  • Skelton, D.A. McLaughlin, A.W. (1996).
    Training functional ability in old age.
    Physiotherapy. 82 (3) 159-167.
  • Sainsburys Centre for Mental Health.

112
HEALTH POLICY STATEMENTSRelevance to sport
physical activity
113
Saving Lives Our Healthier Nation (1999)
  • Cancer To reduce the death rate in people under
    75 by at least 1/5th
  • CHD StrokeTo reduce the death rate in people
    under 75 by at least 2/5th
  • Accidents To reduce the death rate by at least
    1/5th and serious injury by at least 1/10th
  • Mental Illness To reduce the death rate from
    suicide and undetermined injury by at least 1/5th

114
Potential Influence of Physical Activity I
  • Physical activity reduces the risk of
  • Death from heart disease/stroke
  • Developing heart disease and colon cancer
  • Helps to prevent/reduce the risk of osteoporosis
  • Hip fracture in women
  • Promotes psychological well-being

115
NHS Plan (2000)
  • Section 1.5 of the plan states that NHS will
  • provide a growing range of products and services
    to help people adopt healthier lifestyles
  • Advice on diet and exercise will be accepted as a
    routine service at the local surgery
  • Section 13.21 of the plan requires
  • Local action to tackle obesity and physical
    inactivity by 2004

116
Priorities and Planning Framework (2003-2006)
  • Update practice-based registers so that people
    with CHD and diabetes receive appropriate advice
    on physical activity.
  • By 2005, all general hospitals and all health and
    social care systems will have established an
    integrated falls service
  • A national reduction in death rates from
  • CHD of at least 25 in people under 75

117
Potential Influence of Physical Activity II
  • Physical activity has a protective effect against
    developing type II diabetes
  • Lowering the risk of developing non-insulin
    dependent diabetes by 50
  • Effective against falling and fractures among
    adults in later life (by up to 50)

118
National Service Frameworks (NSFs)Mental Health
(1999)
  • HIMPs should demonstrate links between NHS
    organisations and partners to promote mental
    health in schools, individuals at risk and groups
    who are most vulnerable (April 2000)
  • Protocols should be agreed and implemented
    between Primary Care and specialist services for
    the management of several mental health disorders
    (April 2001)

119
NSF CHD (2000)
  • Standard One
  • Quantitative data about the implementation of
    policies on promoting physical activity
  • Implemented plans to evaluate progress against
    national targets associated with Saving Lives
    Our Healthier Nation
  • Standard Three
  • Every practice to offer advice about each of the
    specified effective interventions to all those in
    whom they are indicated

120
NSF CHD (2000)
  • Standard Four
  • Clinical audit data that describes the relevant
    effective interventions should be available
  • Standard Twelve
  • More than 85 of people discharged from hospital
    with a primary diagnosis of AMI are offered
    cardiac rehabilitation and 1 year after
    discharge, at least 50 are non-smokers, regular
    exercisers and have a BMI lt30kg/m2.

121
NSF Older People (2001)
  • Standard Five
  • Every GP can identify and treat patients
    identified as being at risk of high blood
    pressure or other risk factors
  • Standard Six
  • Local health care providers should have put
  • in place risk management procedures to reduce
  • the risk of falling
  • All local and social care systems should have
  • established an integrated falls service

122
NSF Older People (2001)
  • Standard Eight
  • Local health systems should be able to
    demonstrate ongoing improvements in
  • measures of health and well-being
  • E.g. blood pressure management

123
NSF Diabetes (2003)
  • Standard One
  • Strategies to reduce the risk of developing Type
    2 diabetes and to reduce the inequalities in risk
    need to be developed, implemented and monitored
  • Standard Three
  • All children, young people
  • adults with diabetes will receive a
  • service that helps them to adopt and
  • maintain a healthy lifestyle

124
NSF Diabetes (2003)
  • Standard Four
  • Support to optimise the control of blood glucose
    and blood pressure and other risk factors for
    developing complications
  • Standard Five
  • Children and young people will be supported to
    optimise the control of their blood glucose

125
NSF Childrens Service Framework (2003)
  • Standards for Hospital Services
  • Child-Centred services an active role to
    improve health and tackle inequalities
  • A basic need for play and recreation that needs
    to be met through offering a variety of play
    interventions

126
Childrens NSF Core Standards
  • Standard 1 promoting health and well-being,
    identifying needs and intervening early
  • Standard 2 supporting parenting
  • Standard 3 Child, young person
  • and family-centred services
  • Standard 4 Growing up into
  • adulthood

127
National Cancer Plan
  • The National Cancer Plan recommends
  • Providing ongoing guidance on supervised
    programmes of exercise for people whose health
    may benefit

128
Chief Medical Officer Annual ReportThe State of
Public Health
  • Leisure and Sports Industry
  • Market participation in sport and exercise as
    cool
  • Local Government
  • Use the facilities provide in the area,
    addressing needs of all
  • Policies that encourage active
  • transport should be a priority

129
Chief Medical Officer Annual ReportThe State of
Public Health
  • PCTs
  • work with partner organisations on exercise
    referral for high risk groups
  • GPs and Primary Care
  • Take action to prevent and tackle obesity in
    their practice populations
  • Health Professionals
  • Identify early signs of obesity in children and
    offer interventions at an early stage

130
General Medical Services Contract (2003)
  • Essential Services
  • Management of patients who are ill with
    conditions from which recovery is expected,
    including relevant health promotion advice and
    referral as appropriate
  • Management of 10 chronic diseases CHD, stroke,
    hypertension, diabetes, chronic obstructive
    airways disease, epilepsy, cancer, mental health,
    hyperthyroidism and asthma.

131
General Medical Services Contract (2003)
  • Recommendations for Primary Care Sector
  • Supporting non-GP based chronic disease
    management schemes helping to manage ongoing,
    and develop new secondary prevention initiatives
  • Promote education of young people about
    management of health, maintaining health and how
    to use health services responsibly

132
National Healthy SchoolStandard (NHSS)
  • Guidance Criteria for Physical Activity
  • A whole-school approach to the promotion of
    physical activity
  • Offers a minimum of 2 hours of physical activity
    a week within and outside the National Curriculum

133
National Healthy School Standard
  • Aware of a range of relevant initiatives and
    networks and takes advantage of appropriate
    opportunities to promote and develop physical
    activity
  • Encourages people to become involved in promoting
    physical activity and develops their skills,
    abilities and understanding through appropriate
  • training

134
Tackling Obesity in England
  • Set realistic milestones and targets for
    improving nutrition and diet, promoting physical
    activity and for arresting the rising trends of
    overweight and obesity
  • Build on the plan in the NSF for CHD for a full
    assessment of risk factors to be carried out in
    general practice
  • Encourage other potential partners to adopt local
    targets for cycling and walking

135
Tackling Obesity in England
  • Work with local agencies to help them develop
    targets to increase the number of school journeys
    made on foot, by bicycle or public transport
  • The adoption of joint performance targets for
    increasing the number of people participating in
    sport and physical activity
  • Continue to encourage all schools to achieve at
    least 2 hours of physical activity a week for
  • all pupils

136
Department of Health (2000) Improving Working
Lives
  • 3 Stages to achieving the IWL Standard
  • Pledge organisations need to put in place the
    policies, procedures and plans to achieve
    accreditation
  • Practice provide a portfolio of evidence over a
    wide range of policies and procedures that
    improve working lives of staff
  • Practice Plus awarded when all the gaps have
    been remedied

137
Independent Inquiry into Inequalities in Health
Report (1998)
  • The further development of health promoting
    schools
  • Further measures to encourage walking and cycling
    as forms of transport
  • Policies to improve the health and nutrition of
    women of childbearing age and their children
  • Priority to the elimination of food poverty
  • and the prevention and reduction of obesity

138
Independent Inquiry into Inequalities in Health
Report (1998)
  • Physical and psychological health needs of
    looked after children are to be identified and
    addressed
  • Policies that promote moderate intensity exercise
    are recommended

139
Independent Inquiry into Inequalities in Health
Report (1998)
  • Policies that promote the maintenance of
    mobility, independence and social contacts
  • The needs of ethnic minority groups need to be
    specifically considered in needs assessment,
    resource allocation, healthcare planning and
    provision
  • Recommends alternative methods of focusing
    resources for health promotion and public health
    care to be considered

140
Tackling Health InequalitiesSummary of the 2002
Cross-Cutting Review
  • Priority narrow the gap in life expectancy by
    area, by 2020, to be achieved through
  • Early identification and intervention of physical
    inactivity, obesity and hypertension

141
Tackling Health InequalitiesSummary of the 2002
Cross-Cutting Review
  • Physical inactivity is a significant causal
    factor for socio-economic differences in the
    incidence of heart disease
  • Recommend policies that give people the skills,
    information and support to make and sustain
    healthy lifestyle choices

142
Tackling Health InequalitiesA Programme for
Action
  • School Sport Coordinator programme expanded
  • Health needs of young people who spend time in
    prison need to be assessed and comprehensive
    health promotion put in place
  • Raising physical activity levels to reduce risk
    of illness
  • Safer local environments for young people to
    engage in social and physical activities in
    public places

143
Wanless Report (2002)
  • More success in public health to reduce
    projected overall resource requirements
  • Focus on health promotion and disease prevention
  • Change in the way public health is viewed,
    resourced and delivered, therefore supporting a a
    public that is more engaged in maintaining health

144
Department of Health (1996) Strategy Statement on
Physical Activity
  • Recommendations
  • Those already taking vigorous activity maintain a
    total of 3 periods of vigorous activity of 20
    minutes a week
  • Those doing irregular activity should try to
    accumulate 30 minutes of moderate intensity
    physical activity on most days of the week
  • Those engaged in promoting physical activity need
    to consider how to assess the impact of local
    policies in particular areas and for special
    groups

145
Overview and Scrutiny Committees Health
Scrutiny Regulations (2003)
  • A lever to improve the health of local people
  • Focus on health improvement
  • Matters to be reviewed and scrutinised
  • Arrangements made by local
  • NHS bodies for public
  • health in the authoritys area

146
At Least Five A Week (DH, 2004)
  • At least 30 minutes on 5 or more days of the
    week, of at least moderate intensity physical
    activity for general health in adults.
  • Children and young people should participate in
    at least 60 minutes of at least moderate
    intensity physical activity a day.
  • 45-60 minutes of moderate intensity physical
    activity is necessary to prevent obesity in
    adults.

147
NHS Improvement Plan
  • Reinforces the flexibility given to GPs in the
    GMS contract.
  • Encourages the development of partnerships
    between NHS organisations and alternative service
    providers.
  • Encourages collaborative work at a local and
    national level.

148
Wanless Report (2004)Securing Good Health for
the Whole Population
  • The need for action is too pressing for the lack
    of a comprehensive evidence-base to be used as an
    excuse.
  • Future resource allocations should be conditional
    on proper evaluation of initiatives to build up
    the evidence-base.
  • Lower-medium term physical activity targets
    should be set.
  • PCTs and Local Authorities should agree joint
    local targets considering national objectives and
    local needs.

149
Choosing Health (DH, 2004)
  • 3 underlying principles informed choice,
    personalisation and partnership working
  • 6 overarching priorities
  • Decrease number of people who smoke
  • Decrease obesity
  • Increase number of people who exercise
  • Encourage and support sensible drinking
  • Improve sexual health
  • Improve mental health

150
References
  • Department of Health (1999) Saving Lives Our
    Healthier Nation. London HMSO.
  • Department of Health (2000) The NHS Plan A plan
    for investment, A plan for reform. London HMSO.
  • Department of Health (2002) Improvement,
    expansion and reform The next 3 years.
    Priorities and Planning Framework 2003-2006.
    London HMSO.
  • Department of Health (1999) National Service
    Frameworks Mental Health. London Department of
    Health Publications.

151
References
  • Department of Health (2000) National Service
    Frameworks Coronary Heart Disease. London
    Department of Health Publications.
  • Department of Health (2000) National Cancer Plan.
    London Department of Health Publications.
  • Department of Health (2001) National Service
    Frameworks Older People. London Department of
    Health Publications.
  • Department of Health (2003) National Service
    Frameworks Diabetes. London Department of
    Health Publications.

152
References
  • Department of Health (2003) National Service
    Frameworks Childrens Services - Part 1.
    London Department of Health Publications.
  • Department of Health (2003) Health Check on the
    state of the public health. Annual Report of the
    Chief Medical Officer. London Department of
    Health Publications.
  • Department of Health (2003) The new General
    Medical Services Contract. London Department of
    Health Publications.
  • Department for Education and Employment and
    Department of Health (1999) National Healthy
    School Standard Guidance.

153
References
  • National Audit Office (2001) Tackling Obesity in
    England. London The Stationery Office.
  • Department of Health (2001) Improving Working
    Lives Standard. London Department of Health
    Publications.
  • Department of Health (1998) Acheson Independent
    Inquiry into Inequalities in Health Report.
    London The Stationery Office.
  • HM Treasury Department of Health (2003)
    Tackling Health Inequalities Summary of the 2002
    cross-
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