Examination of witnesses (Questions 600
THURSDAY 18 JANUARY 2001
LAVENTURE and MR
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.
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
(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
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
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
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.
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
610. Are you suggesting we might ask the Arts
(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
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.
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
(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.
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
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
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
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.
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
(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.
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.