Select Committee on Health Minutes of Evidence

Examination of witnesses (Questions 600 - 626)



  600. A lot of those have grown out of local initiatives. I am a Charlton man, and we were one of the pioneers, in terms of co-operation with the local authority, in all sorts of ways, but I have not seen, in the past, anyway, any encouragement from the funding and organisational bodies actually to encourage that to happen where it is not happening?
  (Mr Worthington) I am talking now about the academies. As I say, it has come through from the FA, a combination of FA and sports Lottery funding was originally how the centres of excellence and the academies were set up. So I think the funding bodies are getting involved in promoting that message quite strongly.

Siobhain McDonagh

  601. Just my last question; sorry we are going to keep you talking. Under your `More People' agenda, you aim to establish measurable sports equity targets to ensure that girls and young women, black, Asian and other ethnic minority communities, disabled people and people from deprived communities, do not miss out. How might the targets work?
  (Mr Worthington) I think primarily it is going to have to be based, and I have to accept that it is going to be difficult to establish those targets, but I think basically they will be numerical ones, based on a good grant-aided project. We will have to look at the base data, as you actually start on the project and monitor it as the project proceeds and is concluded, and then look at what the impact has been in terms of attendance by ethnic minorities. I think it is perhaps the only way it can be done.
  (Mr Almond) Can I respond to both those questions, please. What I find interesting is that, certainly, in terms of rugby, Halifax Rugby Club have launched a health project—


  602. Rugby League Club?
  (Mr Almond) The Rugby League Club, yes, I beg your pardon.

  603. There is a distinction, you know; careful.
  (Mr Almond) That has been very, very successful, in terms of promoting health with men from that background. A number of football clubs, and, for example, one I am familiar with, Leicester City, established a health promotion unit within the club, and what they tried to do was to raise the profile of football to interest people in health issues. We had information in match day programmes about activity, we had activity sessions during `family fun nights' and on match days as well. I think there are a number of good examples where this is beginning to have a telling effect. What is also interesting, over the past year, a number of governing bodies have now put into their development plans how their sport can play a significant contribution to health. At the present moment, in my experience, six governing bodies have approached us to say, "Can you help us to put health onto our sporting agenda?". So I think that people recognise the significance and are actually going to do something. It is very important. Going back to the previous question about exclusion, one of the problems, in terms of the tension between more people and more medals, is the fact that we have a number of barriers, in terms of promoting physical activity; one barrier is, our culture does not support physical activity, we tend to denigrate physical activity really, and it goes back to a number of quite significant people, who have said, "The best way of being active is to lie down and forget about it." I think that the culture is one we have got to change. Secondly, the environment does not promote more walking and more cycling, I think we have to move on and develop that initiative over the next few years. I think people's perception of activity, particularly women, you are absolutely right, in the past, physical education teachers put women off physical activity for ever. I think that is changing. I think the Nike `Girls in Sport' project has demonstrated, quite clearly, that there are important ways of promoting activity for girls and generating a very positive image. I think that is very, very important, and will impact more over the next few years. I think the other factor is people's will; we have not really convinced people that they can put physical activity into their lives in the way that Professor Biddle mentioned. Instead of going up the escalator, walk up the escalator; instead of taking the lift, why do you not take the stairs; on the bus why not get off one stop before and walk. Dr Press recalls an incident where the bus stop is only six minutes from the railway station yet the waiting time for that bus is 15 minutes. People will still wait 15 minutes when they can walk six minutes. I would say, that illustrates both the problems of motivation and the culture, so we have a long way to go to promote more physical activity. What depresses me about students is that they will get on a bus for 600 metres. Students who are supposed to be impoverished will pay money to travel 600 metres on the bus, rather than walk. The culture of convenience, of cars and transport, is making it very difficult for some people to recognise the importance of walking and physical activity.

  604. Can I come back to Siobhain's question about the involvement of women, and particularly girls, in sport, because the evidence that we have before us is, in terms of obesity, it shows it being far worse with girls, the increasing obesity, than with boys, and clearly the connection there with school sport is important. I saw a report recently, I cannot remember where I read it, about the attitudes of girls and young women to sport and relating to what they had to wear at school. I have got a daughter who is 13 and she detests sport; she broke her ankle at Christmas and, one of the positives coming out of it, she is out of PE for two months, which is sad for me. And, I think, it is not just the way it is presented in her school but it is the way sport as a whole is presented to females, that we have got a macho image of sport. How do you address that image in a way that brings on board females, in terms of improving their health, in ways that at the moment we are not doing?
  (Mr Almond) Professor Biddle was involved in a project, the Nike girls project, which is at Loughborough University,—

  605. I am not familiar with that, I am sorry.
  (Mr Almond) I think I can provide you with the evidence about that, and Professor Biddle was involved in the study.

  606. Some written evidence would be very useful on that, if you have got some?
  (Mr Almond) Yes, I will certainly provide you with that. What it does is demonstrate ways in which schools can promote a better image of physical activity, but also ways of encouraging young people to be involved in activity. And so I think that project is a particularly important one; it has only been running one year, the case studies last year and now moving it further down to many more schools. I think you have to recognise one factor that is very significant, and that is, in terms of activity, boys' activity increases and then declines, girls', from a very young age, until they are 55, remains relatively stable; so, in other words, our starting-point to promote activity for girls has got to start very much earlier, to raise the number who become much more active, whereas, with boys, it definitely increases. So we have not convinced women to take part in activity; but those who do stay active. That is a very important factor. So I think we need to go much further back to a very early age to find out why we are not encouraging young girls to be far more active than boys, and I do not think anybody knows the answer to that yet.

  607. But there are some important trends, but clearly your active sports programme includes women's football, there are far more girls involved in soccer. I see it in my own sport of Rugby League, there are lots of women now involved, it might sound surprising, but there is a very active and progressive league for women. Why is this happening now, why have we made that progress, I know it is only relatively small, in overall terms, but we are making some important strides?
  (Professor Biddle) I think it is a wider cultural and social set of factors. Sport, traditionally, has been associated with males and masculinity, and historically that is very well documented; and so there was only a minority of girls who felt comfortable coming out of role, if you like, and doing something that was perceived as masculine and not being threatened by it. And, of course, this is true in other domains of life.

  608. Politics, for example?
  (Professor Biddle) Maybe, I cannot comment. More recently, I think, we have started to break down those barriers, nowhere near enough, of course, and there are certain activities that are still considered rather stereotypically masculine, or indeed feminine, if we look at certain aspects of dance and ice-skating, or whatever, some of the boys might feel pressured to avoid that. The evidence we found, from the Nike project, which was a national project across 50 schools and 3,000 children, was that the slightly older girls, and we were looking just at 12-15 year olds, were much more likely to be represented in a group, that were reflected in terms of being demotivated and basically disaffected by physical activity, they did not know why they should do it, and what is the point; but I think it is the social and cultural barriers. And if you look at things like aerobics, and these kind of more health-related pursuits that have gone on in the last 20 years, that previously did not exist, then girls and young women have got more involved, because they see it as appropriate; so I think it is structuring the kind of climate.
  (Mr Worthington) Could I add just a quick point to that, and it is to support what Stuart has been saying there. Certainly, at the local level, there are activities that are attractive to women, and we find that with all our gyms, our health suites, in our leisure centres, we actually have more women using them than we do men, ironically enough, and, particularly in the age group that we are talking about, it is cool to go to the gym, there is a fashion thing about it as well. I think we have got to make the activities much more attractive, it is a marketing exercise, so things like dance are areas where I think we have got to be much more imaginative in the way in which we get the message across to young women, and that is what we have got to do.

  John Austin: I am glad you mentioned dance because I was going to ask you a question about that, because, depending on how you define sport, if we have got synchronised swimming and ice-dancing in the Olympics, some people would say that dance could be considered a sport.

  Siobhain McDonagh: Not forgetting ballroom dancing.

John Austin

  609. But, clearly, dancing is a very good form of exercise and a very healthy activity, and one which is attractive to many girls and young women, but also attractive, as Professor Biddle said, increasingly, I think, to a number of boys, particularly when addressing some of the issues relating to ethnic minorities. We have got a sports organisation foundation and we have got a Football Foundation, but is there a body which is supporting and encouraging and funding the development of dance?
  (Mr Worthington) No doubt, the Arts Council would take some—

  610. Are you suggesting we might ask the Arts Council?
  (Mr Worthington) Dance, essentially, I think, in its artistic expression, would be supported, ballet, and so on, and would be supported by the Arts Council, but I am not sure whether Sport England has got involved in dance, per se, but what they will have done, they have grant-aided facilities over the years, leisure facilities, that have dance studios as part of the facility. But I fully agree with this. And actually it takes me to another point, that we spend a lot of time trying to determine what the actual physiological impact of exercise is, we spend a lot of time navel-contemplating, proving that sport does have an impact on health. I think the evidence has been there for years, if people want to look and see it. And I think it is exemplified by something like the "Billy Elliot" film, if you have seen "Billy Elliot"; if anyone looks at that film and sees that guy at the end and does not say his life has been transformed, his community has been impacted by it, he himself has a future, in terms of a career, and, in terms of his own health benefits, they are huge, and that is the kind of thing that we have got to get hold of and evangelise.

  611. Can I ask a couple of other questions. I think I share Mr Worthington's view, that excellence in sport, maybe it is different with Rugby Union, does encourage other people to participate. I think we have seen, when a country has been successful in their sport, for example, when Sri Lanka unexpectedly won the World Cup, every kid in Sri Lanka picked up a cricket bat and got involved, and when we win a tranche of medals at something in the Olympics then interest here grows. But there is the question of accessibility, apart from the lack of provision of, say, swimming facilities in this country, I think somebody said if you live south of London the nearest Olympic modern facility is probably in France. But there is the price factor; for many people whom I represent, going to a swimming-pool is not an easy option, because of cost. So to what extent do we have to address this issue about accessibility? I would raise another issue, related to that; kids who go to university will have a wealth of sporting and recreational facilities available to them for free, and they will tend to be not the socially excluded, more likely to be the socially included, whereas the unemployed kids whom I represent do not have such access, there are not those facilities, even if they go to an FE college, they do not exist. So to what extent do we have to address that issue of the disparity in provision of resources?
  (Mr Worthington) I am sorry to go back and repeat stuff, but I think that is the point I was trying to make about perhaps addressing this issue of cost, because, you are quite right, if it costs £2.50 to visit the pool, you can go once a week perhaps, if you can afford that, but you cannot go three or four times a week, not if there are four people in the family, or five people in the family. And many authorities do have discretionary schemes, passport schemes, where you give 50 per cent reduction for people who qualify under certain headings of the socially excluded. The point I was trying to make was, in the context of what an authority spends, and if I refer to my own again, I think the local authority spends about £300 million plus, the health authority similar, then a sum of £500,000 to actually underpin completely free use of facilities, I think, has to be explored. There are all sorts of reasons why we should not do it, and I think that it is just one of those things, a simplistic approach but one which is so simple we have never actually thought about it.


  612. So you are saying we need to look at the wider picture, we need to look at the impact of that kind of policy, of help flowing through, and that is not happening at the moment?
  (Mr Worthington) Yes; exactly. And, at the same time, I think, and it is moving onto a slightly different arena, but I would want to make the point, if we are going to do more research and get more evidence about the impact of sport on health, I think what we have to do, somebody has got to undertake a major piece of research, if it is not already out there, and it may be out there, which analyses the economic benefits of sport through health. If you look at the dividend, if you like, by investing a million pounds in promoting sport and activity, what is the saving to the Health Service, what is the saving in crime and vandalism, what is the saving in terms of other areas within the community; and that is a job which must be done, in my view. If you look at, I think, the submission that we have put to you, there were some examples in there of evidence in America, where they are actually suggesting it costs £150 billion a year, in terms of days lost through sickness and absence, this is for people who are not active, inactivity causes that, and the costs of inactivity on medical care are 30 per cent greater for those people who are inactive. So there needs to be some sort of research which gathers that evidence, and I think that would be far more persuasive perhaps than saying, here is a piece of research that solves it, five times a week, 30 minutes, it is going to have this sort of impact on your cardiovascular performance.

John Austin

  613. One final question, in relation to minorities. One of the most popular sports in my locality is Kabady, and the difficulty that the community has had in the past in getting recognition for it, or getting funding to stage it, to what extent do you feel that there is a lack of recognition of minority sports, in that sense?
  (Mr Worthington) I would not want to speak particularly about Kabady, but I do know that there have been problems in the past over sports which are emerging and brand new, they need recognition, and so on, but I guess that if they were to apply for grants they would be treated by the Sports Council and Sport England as fairly as anybody else. I do not understand why they have not been recognised, if we are talking about them not being recognised at the national level, or is it at local level?

  614. I think their experience is, if local football clubs or local athletic clubs apply to their local authority for funding for something then it is much more readily available than if the local Kabady Federation applies to the local authority?
  (Mr Worthington) I think perhaps they just need a bit of help from local members to put pressure on the local authority; they are entitled to it and it should be available to them.


  615. Can I just pick up a point that struck me, Mr Worthington, when you were speaking a moment or two ago, before I bring in John Gunnell, because John wants to talk to Mr Laventure about your work with older people in particular. Would you argue that there is merit in considering, within wider health funding allocation, the possibility of ensuring that health allocations, funding locally, underpins free use of sports centres, in an effort to encourage much greater activity than happens at the present time? Is that anything that either yourself or any of the other witnesses have looked at as a possibility in respect of improving the nation's health? Because, clearly, this is an area that we may look at, as a Committee, in our report. It just struck me, when you were talking about half a million quid and how that might be used, looking at the overall local health budget, and I am in a Health Action Zone, part of my patch is a Health Action Zone, that there could well be merit in looking at how we do underpin the costs of sport and exercise for local people?
  (Mr Worthington) I think it is something that should be examined. I acknowledge there are huge complexities in it, the whole business about the issue of fairness, because, inevitably, in an area which has quite a range and diversity of communities, that money would be going towards the urban side of the community, and the more residential areas clearly would begin to say, "Why can't we get part of the action?".

  616. And, additionally, (it would be worse for ?) the existing participants in those sports centres?
  (Mr Worthington) That is right. So I think that there are amazing complexities about it, but I do not think they are so complex that they could not be unravelled, and they do need to be investigated. We have been talking, in very embryonic terms, to our local health authority about this, but it is not just about health authorities, we have to look at the whole funding structure, at a time when Revenue Support Grants to local authorities are being squeezed. If you look to the local health authority actually to invest but the local authority itself is perhaps having reductions on its budget, it is difficult to manage. But I think we should be looking very seriously at it, yes.

  Chairman: Perhaps, if we actually combined health and local government, that might make it easier; anyway, that is another issue.

Mr Gunnell

  617. A question to Mr Laventure, to start with. You have been engaged in various projects which have involved increasing activity amongst older people, so it is a change of the emphasis that this discussion has had for some while. I wonder if you can tell us what the issues are in respect of involving older people in exercise, and, in particular, I think you have got a project on increasing the levels of physical activity of elderly people in care homes, and perhaps you can tell us what the particular challenges are, of that, as a task?
  (Mr Laventure) I think, when we think of older people and physical activity, there is an important policy distinction that we need to make. Much of public health policy is disease-driven, exemplified by things like the coronary heart disease National Service Framework, and so forth. I think, in relation to older people, perhaps we need to shift some of our thinking, that much of the evidence around older people, in addition to decline in activity and increase in sedentary behaviour, also points us very clearly towards a decline in functional capacity; that means that, as we age, we naturally lose our shoulder mobility, leg strength, endurance, and so forth. There is ample evidence that, first of all, that naturally occurs with age, and disease may have some effect, but there is a vast amount of evidence, particularly from people like Professor Archie Young and Dr Dawn Skelton, who have previously worked in London, that physical activity can play a major part in either slowing that decline, or even, with types of programmes, reversing the decline. And there is plenty of evidence to say we can make substantial increases in functional capacity of older people in a relatively short space of time, so programmes that may be 12 to 14 to 16 weeks have been shown to improve muscular capacity, and so forth. I think that has got an important implication for health policy, because, with the increase in the ageing population that we already have, I think we perhaps need to look perhaps not so much more towards where we have been before but more towards policies that address the independence of older people, mobility, the opportunity to live their own lives in their own home, and to enjoy a better quality of life, and I would include things like mental health benefits, and socio-psycho benefits in that as well. So I think, first of all, there is an important thing here about the focus of work with older people. I think the second thing I would highlight is, in terms of issues, I think it is reflected perhaps in some of the conversation this morning, that older people's work in activity has not received a lot of attention in the past, and I think there are a number of reasons for that. But I think one of the problems we have with that is that it has meant there is a lack of skills both in terms of front-line people who work with older people themselves, and also I think within the people who work strategically at a local level; so our fitness development officers, our exercise officers, or our sports development officers, are not necessarily either experienced or skilled or even trained to work with older people. There has been a recent study by the British Association of Sport and Exercise Sciences, and they have looked at the training in first degree level of students, 33,000 at the moment, currently, in institutes of higher education, and we might expect that less than 30 per cent of them would have any experience or curriculum looking at the older person. I think the other thing is the experience and skills of front-line staff, so those, for example, who work in the caring services, in residential settings, who have some limited experience of working in this. But I think there is an important issue about safety there, and many of the people that I have worked with, in trying to develop this work, have pointed to a concern that older people may damage themselves through becoming more active, rather than improving their health or their capacity; and I think that can only be overcome with some form of training, and that is some of the work that we have been looking at. The other important, final point I would make is that, as well as the general active living message about independence, I think the functional capacity issue is also exceedingly important for the prevention and management of falls amongst older people; there is, increasingly, strong evidence that both physical activity alone but also physical activity within a multi-faceted intervention can seriously reduce the risks of falls and reduce the prevalence of falls as well. And, back to Andy's point about economic benefits, although we have not got figures on how much we can save at the moment, the last DoH paper on falls and hip fractures showed us that spending, that the cost of those is now almost in excess of £1 billion a year. So I think with older people we need to think differently about independence, mobility, and so forth, rather than just simply disease prevention.

  618. Yes, and it is obvious that in the sort of training programmes that we have got we have got to have a greater emphasis on what can be done for older people, and, presumably, on getting them gradually to build up their functions by exercise?
  (Mr Laventure) Some of the work I have been involved in involved a Department of Health commissioned scheme, which was recently launched and disseminated, last November, and there are some new programmes emerging, which, first of all, are evidence-based, and I think the important thing is, if we are looking at a quite clear Government target, like the reduction of risk factors on falls, and so forth, then it is important that the programme is quite specific and quite tailored to bring about that desired outcome. And I think that is quite a different set of training and a different type of programme that, if you want something that is more interactive, highlights the social benefits, maybe movement to music and other types of activities; so that, first of all, it was using evidence to inform practice and the design of programmes. I think the second thing is that, the exercise industry itself, although the private sector is moving towards recognising the relatively young and mature market, particularly in fitness centres, there is a lot of work going on there with people over 50, but our exercise teacher, generally speaking, does not work with the older person, for a number of reasons. So the strategy I think we have to think about is how we can educate and train people who work in care settings and in older people settings, through day centres, through organisations like Anchor Trust and Age Concern, to develop their capacity to be able to work safely and effectively with the older person on exercise programmes.

  619. Thank you. If I brought Mr Worthington in as well, because clearly you would be involved here; what the emphasis has been on your work so far has been on young people, and one wonders to what extent there is a danger that by concentrating too much on young people we tend to be ignoring the sedentary adults that are around in the middle and older age, and I wonder if you feel that that could be a charge which is levelled against you, or would you also be well aware of the needs of older people?
  (Mr Worthington) I think, Sport England, through its programmes, if one were to analyse all the programmes that they operate, that you would find a significant proportion of the funding going into areas which do underpin activity for elderly people. If one thinks about the number of elderly people that use swimming-pools, for example, that is a clear opportunity for elderly people, and a lot of money from Sport England has gone to support the development of swimming-pools around the country. The support of leisure centres alone, when one looks at what goes on in leisure centres, you go into your own local leisure centre any time of the day, you will probably find far more elderly people in there actually than there are young people; so I think that one could say that there is a lot of support there. Some of the community grant schemes, through the Lottery Fund; there are a lot of bowls clubs that have actually received awards; in fact, there does tend to be a little bit of a criticism, that perhaps more bowling clubs have received grants than perhaps should have done, from certain quarters of the community. So I think that they can say justifiably that Sport England does support programmes for the elderly. But, I think, inevitably, because we believe that the emphasis needs to be with young people, it is the old story of catch them young and you will have them throughout their life; there has to be perhaps a greater bias towards that in the programmes and the funding regimes that currently operate.
  (Mr Almond) Two points. The first point is that Sport England, and Active Communities Programme, are discussing with us the role of the older adult, and I think we will expect to see some developments in the future on that one. The second point is that people may not be aware that something like 85 per cent of a person's time in a care home is spent either sitting or sleeping; that is quite substantial. We have got to find ways of showing institutions and care homes and residential settings how they can make changes themselves; so instead of saying, "Right; this is how you do it," we show them a range of possibilities and they can choose the ones that are appropriate to their locality. What we must not do is say, "This is what you have to do," we must provide them with ways and means of recognising that some things are possible, some things are not. I think there is a great move. What we are trying to do is develop a volunteers programme. We are also trying to encourage family members, because if a person goes into a residential care home and they receive physiotherapy treatment and occupational health, within a very short space of time they are back again, because their family members will cosset them far too much and they stop being active, whereas they would be more active in a residential care home setting. Therefore, you have to train volunteers and family members to be able to reinforce a message that being active is far more important than just sitting down doing absolutely nothing. I think that is beginning to get through, but we have to provide the training for that, and Bob is very instrumental in setting that up at the moment.
  (Mr Laventure) I would make a point about investment of resources, and I support Andy in Sport England's level of commitment to that work. What I would also point to is perhaps a greater inequality than that, which if you look at local authority investment in working with older people then I think we might see a different picture. So, for example, we would rightly see, across the country now, a significant network of people we would call useful development officers, with a professional remit to work with schools and clubs and sports bodies to increase levels of participation; and that has already been referred to and will be augmented by these 1,000 school sport co-ordinators. The best estimate of people with the remit to work with older people in the community, either through a health authority or a local authority, is probably about 50, so there is significant investment in some areas but in other areas there is not a similar sort of investment. And that seems to me to be crucial if we are to raise the level of skills and capacities of people throughout the health care social sector to be able to work with older people with effective programmes.

  620. Presumably, it is a question of attracting people, because it is, in a sense, less of a challenge for people to work with older people than to work with young people, the level of satisfaction which they may get out of it is quite different?
  (Mr Laventure) That may be a view about how we view older people in society. It is interesting that if you look at the type of work you could do with an older person, one view might be it is almost identical to young people, because it is about developing their skills, their co-ordination, their balance, as well as their strength and functional capacity. And, in fact, some of the work on falls prevention that we have done recently is literally a physical education model but working with older people, it is a very rounded model, it is not just exercising muscles, it is a very broad remit.
  (Mr Worthington) To support what Bob says and also perhaps to defend local authorities a little bit, but I think that perhaps what Bob is suggesting is a good idea, and that is, we tend, in local authorities, not to look at promotion of sport with sports development officers for the elderly, and I think that is something that we should pick up. But what does tend to happen is that a lot of activity, informal activity, might be promoted through another part of, say, the leisure department; my park rangers, for example, will take hundreds of elderly and middle-aged people on walks, on the Dee Estuary or around our country parks.


  621. And take them back as well?
  (Mr Worthington) Yes. So that will be from another part of the organisation, not necessarily the sporting element, and, similarly, we will run arts and crafts programmes through the arts programmes for elderly people. So I think we need to pull all that together.

John Austin

  622. I was pleased that Mr Laventure mentioned slips, trips and broken hips, because I wanted to raise the issue of osteoporosis, in particular, and I see that, in the evidence that you have given to us, you have shown this alarming increase in sedentary activity, particularly in women; there is a general issue here. It was suggested somewhere else in the evidence that when we were looking at GP referral schemes, very often these were exercise referral schemes, these were as treatment rather than prevention. Do you think that there is a major change in shift that we need to give the evidence that we have about exercise and about fractures and about falls, that there should be a much more proactive role for GPs in prescribing exercise referral and in provision—
  (Mr Laventure) In relation to osteoporosis and fractures, and I think I would defer to Len Almond on this, but I think it is important about what type of activity, but more importantly when, leads to bone mineral density sufficient to help with that. And the evidence suggests that it is at the early stages of school age and teenage years; preventing osteoporosis and osteoporosis fractures at a later age is more dependent upon preventing the fall itself rather than dealing with osteoporosis. But I think I will leave that with Len, because he has more experience of osteoporosis particularly than I have.
  (Mr Almond) I think the window of opportunity is by 17, 80 per cent of bone strength and bone health is actually achieved by the age of 17; a further 20 per cent occurs over the next ten years. Therefore, I think it is vitally important to get over the role of promoting activity with young people, young women, in particular. However, I think what we also ought to recognise is that, for post-menopausal women, it is absolutely vital that we provide them with ideas and encourage activity; remember, it is only a third of women are active in terms of promoting health, therefore we have still got a long way to go, and osteoporosis is clearly one area we can do work with. In terms of older people, absolutely right, and I think the programme that Bob has outlined will start to address that issue.

  623. On the other one, about who can become involved, there are a lot of people a lot younger than me who have got a lot of time on their hands, who are already retired, but the issue of using older people to organise and train, and what facilities are there for training the older generation to become trainers and organisers?
  (Mr Laventure) I think there are some exciting examples appearing at the moment. We are developing some work with Age Concern England in a partnership, which highlights the role of senior peer mentoring, which is a fairly well established health peer mentor process, and we are at the early stages, in the next six months, of trialling and piloting this work that relates specifically to senior peer mentors, using things like activity and exercise as a mode of intervention. And based on that, we are then looking at what other training opportunities there are for the older person to be more actively engaged in themselves taking a role; now this may link to, for example, recent announcements about volunteering with older people. It may be, a very good local authority example, in East Sussex, where older people themselves have been trained to be sports leaders, and right across East Sussex, they have been responsible for setting up, in church halls and local community venues, a whole range of opportunities for older people. We have also seen in the pilot stage of this work peer mentors coming back and saying, "We'd like to do some more training; we'd like to be an exercise teacher ourselves," or it may be that the older person may become, for example, a walk leader, leading local walks. So I think there are, first of all, some very exciting opportunities, and they are beginning to materialise.

Mr Burns

  624. Mr Almond, time is running out, so I have got two questions, and if you could answer them briefly I would appreciate it. What assessment have you made of the economic impact of physical inactivity in the UK, and how does this compare with other countries, because I know you have done a report?
  (Mr Almond) Yes, we did a review of Australia, North America and Northern Ireland, and actually there is very little real information available in this country, but the British Heart Foundation, with the Countryside Agency and ourselves, are doing an investigation, because there is a very substantial document, a very important document, in Australia, that we are going to replicate over here, on the cost of illness, and the role of inactivity. If I just summarise that one, I would say that inactivity is a risk factor comparable to back injuries, we are talking about those kinds of costs. In terms of saving, if we can increase the population of active people by 1 per cent we are going to have a saving of £2.6 million just in terms of coronary heart disease, never mind bowel cancer, never mind diabetes, or stroke. So there is a great deal there. If I quote American figures, the Americans reckon that 1 per cent will save $1 billion a year; Australia, $293 million a year in savings, if they can encourage the population to increase its activity levels by 1 per cent. That is substantial. I think what we have to do is to provide you with the evidence in this country, and that means sitting down and working through all the statistics and producing a report, and that has not been done for the United Kingdom. The only one that has been done is in Northern Ireland, and we are talking about saving £2.37 million in health care costs in Northern Ireland alone, if we increase the population of active people by 5 per cent. So these are very substantial figures. I think what we have got to do is to use British data, English data, to show clearly where the advantages are for coronary heart disease, diabetes, obesity, colon cancer, and so on and so on and so on. I think we are talking about very excessive amounts of money, in terms of savings; and that saving may very well provide us with the opportunity for making some facilities free to poorer people. But I think the real way of encouraging activity is through walking; that is the most realistic and feasible way of increasing the active population of this country.

  625. Do you think employers should be doing more, and, if so, how?
  (Mr Almond) We are producing for the British Heart Foundation an active workplace resource, to demonstrate how workforces can do this; and I had a meeting only yesterday with one particular company, which is in customer care, and they have increased the number of people active by something like 25 per cent in the past year, particularly by identifying ways in which this generation can get involved in activity. And when I acquainted them with how much they could save and what the benefits were, they were absolutely amazed at the possibility, but they are clearly one company that has taken the first step, they really have done something. What we are going to do with the active workplace resource is to show how other workplaces can take the initiative and do it for their own workforce, small and medium businesses.

  Mr Burns: Thank you very much.


  626. Can I ask you, Mr Worthington, the information we had given to the Committee was that the active sports scheme involves nine sports; am I right in thinking it is ten now?
  (Mr Worthington) I will have to seek advice on that. Yes, Rugby League has just been added, I am advised.

  Chairman: I am just checking. Gentlemen, can I thank you for what has been a very, very interesting session. We are most grateful for your help. Thank you very much.

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