Monday, 3 November 2014

Are we killing with kindness?

Our places of work and play are encouraging inactivity, risking our future health argued Public Health England (PHE) (everybody active, everyday) earlier this month.

“The design of schools, public buildings and urban spaces prioritise convenience and speed ahead of walking or cycling. People sit all day in offices where it is often easier to find the lift than the stairs. Concerns about vandalism and maintenance have left public spaces without the benches and toilets that allow older or disabled people to venture out. Cars and other vehicles dominate, not the needs of pedestrians.”

The new report points to a strong and growing evidence base that proves that physical activity is good for us. Yet it also points out that lots of us aren’t doing enough of it. Almost half of all women and one third of men are damaging their health through a lack of physical activity. This physical inactivity is costing the UK around £7.4bn a year. In historic terms, we are now 20% less active than in 1961. Much of the evidence isn’t new but it is very useful having it in a single place.

Everybody active, everyday, is interesting in its emphasis on the importance of interventions across the lifecourse. PHE state that “Being active at every age increases quality of life and everyone’s chances of remaining healthy and independent”.

The report notes that “physical activity declines with age to the extent that by the age of 75 years only one in ten men and one in 20 women are active enough for good health”. At the other end of the age spectrum they PHE that “between 2008 and 2012, the proportion of children aged two to 15 years meeting recommended physical activity levels fell from 28% to 21% for boys and 19% to 16% for girls.”

The report argues that we need to “embed physical activity into the fabric of daily life, making it an easy, cost effective and ‘normal’ choice in every community in England”. They emphasise the importance of everyday activity (cycling and walking), active recreation and (to a lesser extent) sport.

PHE point to the potential of the move of public health to local authorities by highlighting the successes witnessed by Finland over the past 40 years:

“Once the world record holder for heart disease, Finland started a nationwide campaign for change 40 years ago. The government shifted money to local authorities, a move similar to the transfer of public health responsibilities to a local level in England. Authorities responded by creating heritage and conservation trails, building active outdoor play and exercise spaces, and encouraging sport at all levels, formal and informal. They developed innovative approaches for distinct groups, such as the elderly or the persistently hard-to-reach, that directly addressed their problems. Change has run across all age groups: young people, working age and older people are all much more active.”

ILC-UK will next month publish a new think-piece (Public health responses to an ageing society) which explores the extent to which local authorities are making the most of the new public health powers they have. Without a doubt, the new powers could provide a major opportunity.

But without breaking our own embargo, it is fair to say that we have yet to be convinced that local authorities are making the most of the potential. PHE mention the importance of public toilets in public spaces, for example, yet the new powers does not appear to have reversed this trend.

If we want people as active road users (cyclists/pedestrians), we need to ensure these spaces are safe. Older people remain disproportionately likely to be killed on the roads yet road safety doesn’t seem to have adequately hit the agenda of public health.

The focus within PHE on active environments is extremely important. As is their emphasis on interventions across the life-course. But do we need to go further? If local authorities are to make a difference in this area do they need more power to make a difference? Yes they need to encourage and inform, and yes planning needs to be more holistic. But perhaps they also need more powers to influence the environment which has contributed to such inactivity?

Much of the emphasis in the report is in encouraging ‘good’. But sadly there is little if any emphasis on whether we might need to ban ‘bad’. If we want to get people to get on a bike or walk to the shops, for example, we may need to reduce the reliance on the car. This is an area we need evidence. But it is also one where we need a grown up conversation which isn’t immediately shut down on the grounds of “personal freedom”.

David Sinclair

‘Public health responses to an ageing society’ will be published by ILC-UK on 17th November 2014.