We know
more about children and young people’s participation and
views of sport in the ABM area through the Sport Wales School Sport
Survey[3].
The strength of these surveys is the large sample size. As they are
self reported there are weaknesses including recall and social
desirability bias. Additionally the School Health Research Network
(SHRN)[4]
provides robust health and wellbeing data for schools, regional and
national stakeholders[5].
However no valid population level indicator of physical activity
for children aged 0 to 4 in Wales exists, and we would advocate
this being developed, including lower level data in order to inform
service delivery.
Our local
knowledge has also been informed by the SwanLinx project of Swansea
University[6]
where over 800 children aged 9 to 11 years have participated in a
fitness assessment day and completed a survey to provide both
objective and self report information about their health, fitness,
physical activity levels, sleep and nutrition. The results are
given to schools as personalised reports. As the project includes
objective measurements it would be beneficial to replicate in other
Local Authorities so that this useful data can be used and
compared. SwanLinx is incorporated into the HAPPEN Project[7].
Data collected through SwanLinx is linked to other data sources
such as educational achievement, attendance, GP and hospital
records in the SAIL database.
Our
understanding could be improved if a system was established for
data collection that is available at Local Authority or lower level
area, providing intelligence that would be useful for stakeholders
in order to inform service delivery and interventions
around:
·
Pre-school
children meeting physical activity guidelines.
·
Children
meeting physical activity guidelines.
·
Active
travel to school.
·
Use of
green natural spaces and environments for informal play and
activity.
·
Qualitative
views and perspectives around these issues.
2.
Differences
in gender-based attitudes towards, and opportunities for,
participation in physical activity in Wales.
Attitudes
are important as they are predictors of behaviours including
physical activity. Currently we are not aware of any gender based
attitudinal data/information available at a local and/or national
level, only participation levels. Our knowledge on
gender-based difference in participation is based on national
surveys which indicate:
·
20% of
males self-report being physically active every day in the last
week, compared to just 11% of females2
·
52% of
males are hooked on sport compared to 44% of females3
·
There are
differences in the types of settings that males and females
access3
Further
consideration should be given to:
·
gathering
insight of gender based attitudes towards physical activity not
just participation levels, and interpretation of findings to inform
service delivery. This understanding would enable us to identify
the barriers and enablers and in turn what action needs to be
taken, for example:
o
Communication:
How do we communicate the concept of physical activity? Type
of activities: Is it heavily sport focused which might be less
attractive to females, therefore less opportunity for
them?
o
Role of
settings, peer pressure, role modelling have an impact on the
different levels of participation seen in males and
females
o
Are
current surveys placing too great an emphasis on organised sport as
a measure of physical activity? Therefore are we capturing
the true picture?
3.
The
extent to which Welsh Government policies are aimed at whole
populations and/or particular groups, and what impact that approach
has on addressing health inequalities.
Welsh
Government Physical Activity Policies such as Creating an Active
Wales[8]
had a focus on whole populations. This policy
aimed ‘to shift activity levels across the whole population
to increase the average number of days that people in Wales are
active’. There were actions for specific population groups
such as children and young people. In response, local physical
activity partnership policies and action plans developed approaches
encompassing whole populations and particular groups. Whole
population polices are important, however there is potential to
inadvertently impact negatively on segments of the population or
vulnerable groups, and widen inequalities.
The
physical activity agenda is cross cutting. Evidence demonstrates
that action to increase physical activity will fall across Welsh
Government departmental policies such as Planning, Transport,
Communities, Economic, Education and Early years. There
however needs to be significantly more engagement between WG
policies, departments and organisations. We advocate that all
policies undertake a health impact assessment as advocated in the
Public Health Act (Wales) 2017[9]
to understand and mitigate unintended outcomes on health
inequalities. We also advocate that policies and actions are
considered in the context of real life situations.
This is
supported by trend survey data from the HBSC2 Survey and
the Welsh Health Survey1 that has shown:
·
no change
in the participation in physical activity in Wales of
girls
·
intermediate
and routine and manual workers have consistently been the most
active
·
the never
worked or unemployed are 20 percentage points more likely to be
sedentary
·
area
based policies have also not had an impact as the most deprived
areas have consistently been more inactive than the least
deprived.
Natural Resources Wales identify in their Welsh Outdoor Recreation
Survey[10]
that there is a socio-economic factor in who accesses parks and
beaches – the likelihood of visiting these settings is
increased by those earning above £31,200 pa.
This
emphasises the need to continue to address inequalities and
increase activity across the life course, with action being taken
at population level to benefit public health.
4.
Barriers
to increasing the levels of physical activity among children in
Wales, and examples of good practice in achieving increases in
physical activity, and in engagement with hard to reach groups,
within Wales, the UK and internationally.
Barriers
to increasing levels of physical activity among children and
families are a part of everyday life and are inter-related. Our
experience tells us that these include:
·
The
skills, confidence, motivation to be physically active.
·
The
knowledge and understanding of how to be physically active as part
of daily life and of the available opportunities.
·
Perceptions
such as fear of traffic and strangers, violence in the community or
personal safety.
·
Social
norms and role modelling of behaviour play a key role
·
Access to
opportunities - in and out of schools as well as well
maintained parks
·
Raising
awareness e.g. through health services that take every opportunity
to talk about activity.
·
A built
environment that provides green space and prioritises active
travel.
There is
a need to better communicate the concept of physical activity to
make it more accessible; achievable and enjoyable.
We
suggest that a full literature review including the grey
literature, is undertaken to inform the committee and that a
framework or theoretical model (such as COM-B)[11]which
is advocated in NICE guidance[12][13],
is used to explore the relationships between barriers, and we
understand more fully the inter related components that contribute
to positive behaviour change.
In order
to identify examples of good practice within Wales we recommend
that programmes are routinely evaluated and the
findings are widely shared using a vehicle such as Public Health
Network Cymru[14].
There is much learning that can be taken from programmes such
as Communities First, Mentro Allan and Us Girls.
Nationally
the Daily Mile[15]
is a positive example of increasing physical activity levels in a
fun and achievable way within the school setting. Locally Best
Start Swansea[16]
and Swansea Healthy City[17]
programme are holistic examples that include physical
activity. Further programmes of this type could potentially
be beneficial.
Sustrans
research[18]
is supportive of the Active Living Research[19]
findings on the benefits of activity-friendly
environments.
5.
Physical
activity guidelines and how we benchmark physical fitness in
children.
The
UK Chief Medical Officers’ Guidelines[20]clearly
show that the role of physical activity is important throughout the
life course. During the early years and for children there is a
focus on physical and emotional development. There
however needs to be much better links to mental and emotional
health and wellbeing - happy children are much more likely to
engage in physical activity and be less withdrawn and isolated -
“Clinicians, school-based professionals, policy makers and
parents should encourage physical activity in children, not only
for the physical health benefits, but for the positive mental
health outcomes as well”[21].
The
guidelines for the age group ‘children and young
people’ need to be more holistic – more in line with
the physical activity guidelines for the ‘early
years’[22].
Helping parents, children and young people to see how they can make
their day physically active – the ‘every movement
counts’ concept.
Whilst
these guidelines are available, their awareness could be
improved. Our local insight with health professionals and
organisations that work with children, young people and families
have highlighted that more can be done to raise awareness of
physical activity guidelines for the early years. In line with
national policy development, we would advocate a national
communication strategy that targets the general population,
segmented groups, health professionals and
organisations.
Guidelines
however do not themselves change behaviour. Communication and
awareness raising needs to be matched with concerted and committed
action to create supportive environments, and enabling policies
that make it easier for people to be more active and less
sedentary.
SwanLinx
project of Swansea University6 provides an example of
benchmarking physical fitness. This provides robust data locally,
and learning could be gained to scale this approach across Wales
for benchmarking at population level. However it is important not
to lose sight of physical activity as a holistic measure of healthy
behaviours.
6.
Measurement,
evaluation and effectiveness of the Welsh Government’s
programmes and schemes aimed at promoting physical activity of
children.
We do not
feel able to comment on the effectiveness of the Welsh Government
Programmes aimed at promoting physical activity of children as we
have not seen evaluation data. It is suggested that the Welsh
Government Programmes should ensure that work aimed at promoting
physical activity is outcome focused, reduce inequalities, be
informed by the latest evidence and contributes to the evidence
base; and adopts all of the principles of prudent health
care.
In order to monitor the progress, a system of qualitative and
quantitative data collection, analysis and feedback against a set
of national indicators for physical activity should be put in
place. Indicators in line with those being used internationally
would allow Wales to benchmark against other UK and EU nations, and
would need to reflect measurement of outcomes and progress towards
outcomes. Equally qualitative approaches to evaluation and
effectiveness are needed to demonstrate the differences
interventions are making to people’s lives.
Also,
adapting and flexing schemes over time to suit need and demand.
Programmes and schemes are often introduced with extensive funding
and support which diminish over time or the programmes become
out-of-date and often don’t appear to be re-visited to make
them more current.
7.
Value for
money of Welsh Government spending to promote exercise in
children.
We do not
feel able to comment on the value
for money of Welsh Government spending, however PHW Making a
Difference report[23]
advocated the best buys to increase physical activity include: mass
media campaigns, setting based approaches, supporting active
transport strategies and providing primary care advice and support
(Brief Intervention). Also nationally or locally funded
programmes/initiatives should be robustly evaluated and measured in
order to judge value for money.
8.
The role
of schools, parents and peers in encouraging physical activity, and
the role of Sport Wales,NHS Wales
and Public Health Wales in improving levels of physical
activity.
We agree
with the statement in Getting Wales Moving[24]
that ‘no single agency in Wales can deliver the large scale
increases in physical activity that are urgently needed in
Wales’. Therefore, all the agencies outlined in the question,
and Local Authorities and the voluntary sector have an important
role to play. As example of this partnership agenda in addressing
the breadth of physical activity at local level is the ABM Physical
Activity Alliance and its strategy for a more physically active
population of ABM. Furthermore, the evidence from the Public Health
Wales Transforming Health Improvement Report[25]
indicates the interventions that work are multi-component in nature
and as a result will require partnership working and collaboration.
Such a vehicle to drive change at the strategic level locally will
be through the Public Service Boards, where partners have an
important role to shape and create enabling and supporting
environments for physical activity.
Physical
activity levels of young children and families cannot be seen in
isolation from wider parenting approaches so there is the need to
consider the whole family when designing policies and interventions
to enable daily physical activity. Targeting the factors that
parents and children believe to be important may enhance
intervention tailoring[26].
Using a COM-B11style
approach to understand the context and issues related to the
behaviour would help with identifying and targeting of action
needed. The role
of schools, parents, children and peers is also crucial during
evaluative thinking processes – to provide consistent, robust
and honest feedback on programmes; schemes and incentives to
increase physical activity.
With
pressures on the system it is important to ensure that decisions do
not result in the unintended consequence of undermining the efforts
to improve physical activity levels. We
advocate that all policies and programmes undertake a health impact
assessment as advocated by the Public Health Act (Wales)
20179 for this
reason.
Concluding remarks
The cross-cutting nature of the physical activity agenda means that
successful delivery of any large scale change in physical activity
levels to improve population health and wellbeing, as shown in the
findings of Getting Wales Moving24 heavily dependent on
government, public, private and voluntary sector organisations
working with each other and with the public in co-productive and
more outcome focused ways, at local, regional and national
levels.
Importantly it is about the process which underpins the delivery of
this agenda and the accountability for the changes needed which
will require leadership, co-ordination, joint planning and
performance management; and concerted effort for public bodies to
act and think differently in line with the vision and principles of
the Well Being and Future Generations Act.
