Oral evidence

Taken before the Health Committee on Thursday 6 November 2003

Members present:

Mr David Hinchliffe, in the Chair

Mr David Amess

John Austin

Mr Keith Bradley

Mr Simon Burns

Mr Paul Burstow

Mr Jon Owen Jones

Siobhain McDonagh

Dr Doug Naysmith

Dr Richard Taylor

__________

Memoranda submitted by UK Sports Trust, Sustrans and Living Streets

Examination of Witnesses

Witnesses: DR ALAN MARYON DAVIES, Faculty of Public Health, Royal College of Physicians, MR JOHN GRIMSHAW, Executive Director and Chief Engineer, Sustrans, PROFESSOR CHRIS RIDDOCH, Middlesex University, DR SUE CAMPBELL CBE, Chief Executive Youth Sport Trust and Chair, UK Sport and MR TOM FRANKLIN, Director, Living Streets, examined.

 

Q485  Chairman: May I welcome you to this session of the Committee. Before I ask our witnesses to introduce themselves, may I particularly welcome Keith Bradley and Jon Owen Jones to their first meeting of the Committee. We are very pleased to see you both and we are sure you will be excellent members of the Committee and we look forward to working with you. May I welcome our witnesses and place on record our thanks to you for coming along today and for your written evidence which has been extremely helpful. Would you each briefly say a word or two about your own background and interests in this area, starting with Mr Franklin?

Mr Franklin: My name is Tom Franklin and I am Director of Living Streets, formerly called the Pedestrians' Association. We have been around since 1929 campaigning for better streets and public spaces for people on foot, so we have a general interest in public space and making sure that people have the opportunity to walk if they want to.

Dr Campbell: I am Sue Campbell. I am the Chief Executive of the Youth Sport Trust and the Youth Sport Trust has been engaged over the last nine years in trying to develop physical education and sport programmes specifically targeted at school age youngsters. I am also Chairman of UK Sport at the moment.

 

Q486  Chairman: Did you not have a very important role as liaison between certain government departments?

Dr Campbell: I still do. I am a cross-government adviser between DCMS and DfES on PE and school sport.

Professor Riddoch: I am Chris Riddoch. I am at Middlesex University, formerly of Bristol University. I have been researching and teaching in exercise and health science for about 12 or 13 years.

Mr Grimshaw: I am John Grimshaw. I am the Director of Sustrans which is a charity which builds walking and cycling routes. I have been building cycling routes for 30 years. I am a civil engineer.

Dr Maryon Davies: I am Dr Alan Maryon Davies. I am the Convener of the Cardiovascular Working Group at the Faculty of Public Health. The Faculty is a professional body which is affiliated to the Royal College of Physicians. Its aims are to promote the advancement of knowledge in the field of public health and also to develop public health with a view to maintaining the highest possible standards of professional competence and practice and to act as an authoritative body for consultation in matters of education or public interest concerning public health. It works through professional standards and professional advocacy contributing to policy. My personal background is about 25 years in helping to promote healthy lifestyles.

 

Q487  Mr Burns: During the course of our inquiry so far we have heard a great deal about the importance of healthy eating and exercise. I was wondering whether Professor Riddoch and Dr Davies could tell us how strong the evidence is that physical activity can help prevent obesity.

Professor Riddoch: On the one hand it is a done deal that if you exercise you burn calories, so whatever you are trying to do to lose weight, if you are attacking that side of the energy balance equation, it has to have an effect. The question is how much you need to do in relation to your diet to have a marked effect. The second level to look at it is really all about whether you stick to doing it, which is the issue.

Dr Maryon Davies: I would add to that by saying that there is a massive amount of evidence, increasing all the time. The Chief Medical Officer is producing a report putting out all this evidence in great depth, and we are expecting that in the New Year. Where the gaps are in the knowledge is not so much in terms of the benefits of exercise reducing obesity but in terms of how you persuade people to take up exercise. How do you actually implement that to make it happen in practice. That is where we need more research, more information.

 

Q488  Mr Burns: We have been told that society in recent times has become increasingly more sedentary. Can this be quantified and if so how? Is it possible to disaggregate the particular factors which are underlying this growing trend in society?

Professor Riddoch: From the transport statistics, looking at the trends for how much we walk, it has been quantified at 60 something miles a year less. That is quite substantial and that alone would explain the changes we have seen in overweight and obesity in the last ten or 20 years. Just that one statistic is powerful.

 

Q489  Chairman: The information we have from our evidence is that the National Travel Survey indicates that the average person now walks 189 miles per year. I was very surprised. I had done a quick calculation of how far I walked last week wearing my pedometer and it came to 30 miles and that was an average week, so in a year it would 1,560 miles. I do not class myself as super fit; nearly super fit but not quite. Is that correct? I find 189 miles a year incredibly low.

Mr Franklin: That is certainly the figure from the National Travel Survey and I have to say that the way some of the information on walking is collected leaves a lot to be desired. Some of the statistics do need to be improved. What is clear is that we are walking less than we have probably ever done in history. For every five steps we took ten years ago, the average person is now taking four steps and that is bound to have an effect on our lifestyles. The reasons for that are firstly, local choice, that people are choosing to walk less and they have not thought about it. Their opportunities to walk have gone down as well. Local facilities are now further away. We think that above a fifteen-minute walk the choice of walking goes down dramatically. People will not walk after about 15 minutes and the schools, the hospitals, the local doctors, the local shops are moving so far away that people will then go into their cars instead.

 

Q490  Mr Burns: The next question I should like to ask you has been slightly touched upon but I should like to ask you all. How good is the data on physical activity that we have at the moment? If the answer is not very, why?

Professor Riddoch: Traditionally we ask people how much exercise they do, how much physical activity they do and people will report what they remember doing. They tend to remember the things they plan to do. If they went for a walk with the dog they will remember that. What they do not remember are all the incidental things they do like nipping up the stairs to the office on the floor above. Self-report measures have a fairly large amount of error built into them. We do now have much more advanced methods of measuring physical activity where we put little instruments on people and they give us a much more valid measure. Obviously they are more expensive than a piece of paper, a questionnaire, but if we are going to try to achieve this target of 70 per cent of Britons active by 2020, we really do have to measure it properly.

 

Q491  Mr Burns: I am sorry, could you say that target again?

Professor Riddoch: It is 70 per cent of the UK population to be active at health related levels by 2020.

 

Q492  Mr Burns: What is the definition of active?

Professor Riddoch: The current level is 30 minutes walking five days a week. That is the global target everyone seems to be aiming for at the moment, but we really do have to measure physical activity properly to find out whether that target is achieved or not.

Dr Maryon Davies: An important issue is that whatever tool we devise, it has to be something which is very practical at the local level in terms of trying to get a measure, a base line for where we are at at the moment, say at borough level, and then also to have a look at the progress we are making over the years. Whatever tool it is, it has to be relatively simple, relatively cheap, relatively easy to put into practice so that we get useful measures of progress.

Dr Campbell: In the work we are doing in schools we are beginning to gather much more quantifiable data. One very interesting piece of data around this whole area is actually the playground and playtime and how less active young people are now in terms of the use of that playground opportunity. We do quite a lot of studies now using pedometers to look at the kind of activity levels pre some kind of intervention and post some kind of intervention. There is no question now that young people are far more sedentary by nature almost and we are creating young people who are very computer literate, who are very engaged with other forms of learning and have almost forgotten how to learn physically. There is a huge job to do, right from the moment young people are born, in a sense to restimulate and re-engage this physical learning, learning through doing rather than learning through watching and thinking. That is a massive issue and it is going to take a long time to change attitudes towards the way young people learn.

Mr Franklin: We found a lot of people have not really thought about the amount of physical exercise that they do. There are the global figures which are very useful for policy trends and so on, but in terms of an individual one of the most useful things is giving them a very simple pedometer. It only gives them a rough estimate of the sort of exercise they are doing, but for the first time they think about it. They think about their lifestyle choices and how they can make very small changes to their life and as a result of that can massively increase the amount of exercise they are doing. For individuals, the message is: keep it simple with the measurement.

 

Q493  Mr Amess: I do not think there are many Committee members who, following our trip to America, have any doubt at all that this whole question is a very, very serious issue. Anything that happens in America is bound to happen over here. Although I have been studying human beings in a different way than before the trip, we are not as heavy yet as they are in America, but it is a very, very serious problem there. I want to share a couple of my prejudices with you all. This is going to lose me a ton of votes, but by and large youngsters, young people, are absolutely bone idle. The area I represent has mainly elderly people. They walk everywhere. Youngsters are so damn lazy that if their parents could drive the car into the classroom they would do that. They do not walk anywhere. Would one or two of you like to comment on the fact that we are always going to have this scheme, roll out that programme and all the rest of it? We are playing at it. It is not happening. When I left my flat this morning, all I could see was a sea of young people on these mobile phones, every one of them on a mobile phone. They were not walking, they were frozen, talking to the mobile phone. This is what is engaging young people at the moment. Can you think up any way that we can use in our recommendations at the end of this inquiry to do something serious to stop this dreadful thing which is going to cross the big pond and hit us big time?

Dr Maryon Davies: May I just make a general point? Somehow we have to find a way of making physical activity and exercise and sport cool for young people, because there is a real problem with the image of that physical activity amongst young people. Dancing is cool; that is fine, that is acceptable. Some elite sports are cool as well. There is something about the whole business of active living which is just not cool and that is a root cause and we really have to tackle that.

 

Q494  Mr Burstow: I think there is something in what David has just been saying, but I want to pick up on this point about data, which may be slightly boring, but nevertheless is very important. Dr Davies' point was about it needing to be relatively easy to collect, relatively easy to collate and possibly relatively reliable as well. There is a tradeoff between all those things. The thing I have not actually heard from any of the witnesses yet, and it would be helpful to get some fix on this, is the method. We need to be a lot more concrete about what it is we should be measuring, how we should measure it, what are the specific mechanisms we should use. Pedometers were referred to. Is that the be-all and end-all of effective measurement? Are there other things we should be looking at as ways of ensuring we do get an accurate base line from which we can then measure progress?

Professor Riddoch: You are absolutely right that measurement is critical. What we have to remember is that physical activity is not the same as fitness. Fitness is easy to measure, it is a physiological trace, you can put somebody on a treadmill and you can apply very intricate science to get a very accurate score. Physical activity is a very complex human behaviour and we do it in a variety of different ways. If we went round the Committee now and asked how you take your exercise, we would find squash players, people who walk the dog, people who cycle to work or we might find people who do nothing. I do not know.

 

Q495  Mr Burstow: Profesor Riddoch, we are asking the questions today, not answering them.

Professor Riddoch: We do have to apply what technology we have to capture the essence of that complex behaviour and to me it is instrumentation rather than pencil and paper and questionnaires. If we could go down that route - and we have to invest in it because these things do cost money - we would get a really valid base line now, that Alan was talking about, and we would be able to monitor trends accurately over time.

Dr Maryon Davies: That is fine, but any kind of a clinical measurement, face-to-face measurement, is time consuming and expensive and you do need the gear. What public health professionals need across the whole patch is some simple way of getting the history from people as to what their regular exercise is and we do have tools for that. We also just need something which can be done on a questionnaire basically. There are tools for that, but they are not as valid as the more physiological tools. We need to decide on a standard tool for measuring that on a population basis across thousands of people and then stick to it.

 

Q496  Mr Jones: Forgive me if this point has been raised before, since I am a new member and I have not read every word of the Committee's deliberations. Spurred on by the prejudices of my colleague, I do not think mine are prejudices, but they may be. It would seem to me that one of the most important factors which influence the way in which children walk is the perception, more than perception, the parents' realisation that children are at great danger in walking, not particularly from attack from other adults, but from cars. I have three young children and it is not possible and safe to allow my children to walk anywhere until they are ten or eleven, whereas where I was brought up I walked everywhere because the danger from traffic was so much less. Is that a prejudice on my part? Is it a prejudice which can be supported by any evidence?

Mr Franklin: Without doubt you are right. The conditions for people walking have got worse over the last half century or so, as there has been a rise in the motorcar, but also, the focus of people who are managing our streets has been about moving the traffic as fast and efficiently as possible and pedestrians have got in the way, so they have been shoved to one side. Very often the conditions for pedestrians have been getting worse and worse. That is why this has to engage with the traffic engineers, with people within the Department for Transport who have so much responsibility for the condition of our public spaces, if we are really going to make walking much easier, much safer. That is why we need a national walking strategy in this country, which is looking very seriously at what we can do to turn that tide, to make it safer. Safe Routes to Schools has been very, very successful in a very small way in turning that tide, in making it easier around schools for children to walk. You can promote walking. You can say to parents that it is safe, it is possible for the children to walk and then you can see a massive increase in the walking that is being done. I do not think children are naturally bone idle; they have learned that.

 

Q497  Mr Amess: You want to come to my house. I am going to have to get a Stannah lift to get them to go upstairs to turn their bedroom lights off. It is incredible.

Mr Franklin: For the first time ever less than half of our young children are walking to school. They have learned habits which they will take with them through the rest of their life which is that you drive round the corner rather than walk round the corner.

Dr Campbell: Just to tackle your complete prejudice here, I do agree that young people are not as active as they used to be and that is why I talked about those early years of valuing physical activity and engaging youngsters happily in physical activity. If you watch really young children, they do naturally move, that is how they explore, how they learn, they pick things up and put them down. They are always crawling around doing things. That is what the animal in them does. Somehow, by the way we have introduced technology, perhaps the way we have emphasised intellectual ability, very highly, very strongly, what we have done is devalue the physical. So even parents, although they were taught positively about physical education in school, when actually asked to compare that with whether the youngsters are achieving academically, will say academic work is actually much more important. We have to try to re-engage this notion of the physical and that being physical healthy and physically well is a valid parenting skill as much as anything else. What we are finding, with the work we are doing in physical education in schools is something we all instinctively know, but we now have the evidence to prove it and that is that where young people are engaged in better physical education, physical activity, programmes, they are achieving better academically. It is not a detractor, it actually helps. Somehow we have to re-engage everybody in understanding that. The old mind, body and spirit thing is actually real. Somehow the mind has become so important in our society in so many ways that the body part has slowly got pushed down the agenda.

 

Q498  Mr Amess: Would you agree that if the children are active, they are likely to remain active later in life?

Dr Campbell: It is; it is a massively complex issue and there are no simple answers unfortunately. I cannot sit here and give you one simple answer. Certainly we have found that where we can keep young people active and engaged and particularly within schools they feel a sense of involvement, engagement and accomplishment. We have a lot to do still to get it right in schools, because we still tend to emphasise the best and not the rest. We really have to work hard at PE and school sport being something for everyone, not just the ones in the school teams and making sure that the kinds of menus we are offering within schools and in school playgrounds and around schools are really attractive to every youngster. I think that is very critical. Yes, all the research I have seen - and I am not as learned as these two gentlemen - would say to me and all the research we are gathering says that those young people who are engaged in physical activity and living what we would consider to be physically healthy lifestyles are achieving better academically, are often socially better integrated and certainly in terms of young women tend to have a better self body image, better self confidence and therefore tend to fall into problems less readily which we might associate with young teenagers for example. The evidence in my mind is indisputable and the strategy of how we actually bring this into everybody's life in the way we would all like to, is not simple.

 

Q499  Mr Bradley: want to go back to the point Jon raised about safety and you concentrated on walking but it is equally true of cycling. You say that Safe Routes to School is working but is it really working in the sense that parents feel they can happily send their children out on their bicycles to school with safe routes? Is there a better mechanism through planning and design to ensure that safety? I have young kids. They want to cycle to school but, picking up the point about being cool, one of the deterrents is that they do not actually wearing their helmets to be safe when they are cycling to school because it is not cool. My daughter says she is called Mushroom Head. It is an important point that you need not only the routes, you need the design and you need it to be seen as something which is appropriate for children. When I was a kid everyone cycled to school. Now it is a great minority sport. If you get kids cycling, then they are more likely to carry on cycling into later life. How do we actually ensure that safety element is built in, particularly in urban areas?

Mr Grimshaw: You are raising a whole series of issues. Charles Clarke has recently launched an extremely interesting programme for Safe Routes to Schools nationally and he is working with his counterparts in Transport. We know from Europe, Denmark for example, that very large numbers of children still cycle. They cycle because the whole culture has encouraged them to do it. One of the key parts of that culture, as far as we can see, is that there is a champion in every school. That champion may be the head teacher, it might be somebody on the board, it might be a senior teacher, but there has to be somebody who takes the lead. Without that you have this image issue. We have to tackle issues like helmets. There are two sections in the Department for Transport warring over whether or not to have helmets. You either encourage people to cycle, in which case you have to put helmets a little to one side and make it optional. If you make them compulsory, all the evidence from Australia and America is that you get very low levels of cycling. Certainly the medical people here will know that the level of risk of not cycling is greater than the level of risk you have from an accident while cycling. In other words, you are far more likely to suffer from lack of exercise. Picking up David's point about his indolent children, we have surveyed tens of thousands of children and the actual survey work is that something like 90 per cent of all primary school children in the UK have bikes. Of the primary school children, something like 75 per cent of them want to cycle to school, but only two per cent are allowed to. If there were anything, dare I say, that members of the Committee wanted to do and 75 per cent of you wanted to do it, that would immediately be allowed. What you are talking about actually is the child suffering in an adult's world, where an adult has created a world in which the needs of the child are not considered important. For example, most of us would consider that the child's journey to school is the equivalent of the adult's journey to work. We should consider it as important as that, but transport policy is made by men in suits and they consider their journey more important. For example, one quarter of all journeys in the UK are under one mile. One half are under two miles. I am sure if you asked a road engineer, he would say he drives ten miles to work, but that is not the average journey. For a child journeys are very short, yet of these journeys of under a mile, six per cent are driven, six per cent of journeys under a mile are driven and 25 per cent of journeys under two miles are driven. These are journeys which could be done by bike. These are journeys which we really need to tackle. If I dare go on, the issue is that the streets are designed for motorists. I do not think a single one of you will have a walking street where you as a pedestrian get a priority at a junction. The Highway Code say that motorists should give way to pedestrians at junctions, but no pedestrian who is alive has ever obeyed that rule. We know that motorists will not. There are design standards which simply say that we could give the pedestrian pavement run-across at every residential junction. That would be a symbol to the child in particular that they are considered important. The same with traffic speeds. If you go to a German city, speeds are down to 20 miles an hour (30 kilometres) and accident rates are way down. Hull has pioneered it in Britain and it has accident rates which are only half of the UK accident rates. There are plenty of techniques around, we just have not adopted them. The very wide programme announced by the Secretary of State for Education a few weeks ago, £50 million, is really going to tackle this on a wide scale. If I might just pick up on the last point about habit, we know from European countries that if you want high levels of cycling as adults you have to have higher levels as children. In Britain we only have cycling levels of one per cent as children to school. So the Government has no hope of meeting its target of getting to eight per cent of all journeys by bike which is its target by 2012. To achieve that it would have to get cycling up to 15 per cent by analogy with European schools, which probably means 30 per cent in half the schools in the country, because some schools give up. Picking up David's point, I hope that your children were in the 75 per cent of children who actually wanted to cycle when they were children, but maybe you did not permit them.

 

Q500  Mr Amess: My other half would not.

Professor Riddoch: This is such an important point. What you will gather is where we are all coming from is that we have created a culture, an environment where not being active is the easy thing to do and it is the quickest thing to do. To take David's point about children, children actually cope with it slightly better than adults, in fact they take twice as much exercise as adults. It is not enough, because we know they are getting fatter. All the issues which have been raised about parental perceptions of danger, about traffic, about paedophiles behind every bush are very, very important things to address. We have to get the environment in which we live fixed in some way and it will be a long-term strategy involving many agencies to enable us to live an active lifestyle in an active environment. Any individual strategy is doomed to not high levels of success while that individual strategy is operating in an environment which is more pervasive towards sedentary living. For all the GP referral schemes, all that PE teachers do, all that sports clubs can do, these children will still be living in an inactive environment.

 

Q501  Dr Taylor: While we are on cycle paths, can I ask Mr Grimshaw's opinion of the yard-wide tracks at the side of major roads with pictures of cycles inside them? Is that really to cut down the speed of the traffic or is it actually to enable cyclists to cycle there?

Mr Grimshaw: I hoped you were going to congratulate me on the beautiful path I built from Kidderminster to Stourbridge for you along the canal banks.

Q502  Dr Taylor: Give me a chance and I will.

Mr Grimshaw: The issue about cycling lengths, which is what you are talking about, is quite critically that they do not work at all unless they are continuous. If they are continuous through junctions and if they give cyclists space at crucial junctions then they are of value because they are firstly sending a message to motorists that cyclists are legitimate travellers and if you analyse photographs and so on, the traffic does move over that little bit. Unfortunately in Britain there is no culture which says cyclists are important travellers as with walkers. So mostly any cycle lane stops exactly where you want it, at the junction. You are quite right. If you do not see the red line going through every junction in Kidderminster, then you should take some direct action.

 

Q503  Dr Taylor: Our Chairman is keen on canals for the use of the water but the towpaths are ideal for cycle tracks. Turning back to the measurement of exercise, should one of our very simple recommendations be that pedometers are much more widely available, cheap to provide and simple to use?

Mr Franklin: I would very much agree with that. In the studies we have done, they are a very, very effective tool. People do not actually have to wear them for that long. People only have to wear them for a week or so before they start to get a pattern of their exercise and they start to consider, if they did that slightly differently, what the effect would be. In a sense they are a guide, but they are a very, very effective guide. The thing about walking is that it is susceptible to marketing campaigns, to individualised marketing campaigns. In Perth in Western Australia, there was a very large shift from car journeys to walking, for those journeys which can be walked, as a result of going into somebody's home, sitting down with them and talking through the changes to their lifestyle they could have. The problem is that the Government is almost embarrassed about promoting walking. I have to say that I think this comes from the John Cleese sketch 25 years ago of the Ministry of Silly Walks. Since 1996 every Transport Minister has promised a national walking strategy and every one has failed to deliver, going right the way back to the previous Conservative Government which began the moves to get a national walking strategy. They have not delivered because each time ministers get cold feet because they think they are going to be perceived as the Minister for Silly Walks. We have to get the message over that it is not silly to promote walking, it is actually a very sensible thing to do, for health benefits as much as anything else.

 

Q504  Chairman: How widely available is the pedometer which I have been supplied with which actually indicates the calorific value of the miles you have done in terms of how many you have burned off?

Mr Franklin: We find them very difficult to get hold of. I do not know whether anybody else can.

 

Q505  Chairman: I am very fortunate in the one I have then.

Professor Riddoch: You can get them anywhere. The cheap ones are very good for motivational purposes and we have to differentiate between the ones we use for motivational purposes, which are cheap and simple, and those you would want to use for research purposes. Pedometers only measure walking; they do not measure cycling or swimming and they do not differentiate between strolling, walking, running and sprinting. They just measure landings.

 

Q506  Chairman: It is very helpful if you know in relation to your exercise just how many calories you have got rid of by that exercise.

Professor Riddoch: Absolutely, yes; that is the motivational side of these instruments, which is quite strong.

 

Q507  Dr Taylor: In the States we were actually given a conversion for cycling. It was something like 150 steps is one minute cycling.

Professor Riddoch: Maybe.

 

Q508  John Austin: Just on cycling, I do not wish this to be seen as a criticism of Sustrans because I am a great supporter of what they have done. I take Richard's point. I live on the banks of the Thames and the cycle path now - I cycled it last week - is an excellent innovation. When you come to the urban environment are we really going to be able to succeed in an urban environment like London when the key thing about Holland and the other countries such as Denmark, is the complete separation in many places of the cyclists from the other traffic? If you go down the Plumstead Road now you have a bit of green tarmac which suddenly swerves out between the bus lane and the motor traffic and cuts back across again. I take your point about continuity being important and a different culture. Most motorists do not even stop at traffic-light controlled pedestrian crossings unless there is somebody physically in the middle of the road. Are we really wasting our time trying to get people onto bikes in environments like London?

Mr Grimshaw: Coming from Bristol, I am afraid I cannot comment about London. There is a whole range of matters which are physical arrangements which are common in Europe which we just do not adopt here. The most obvious one is the pedestrianised city centre which has completely destroyed cycling in Britain and we may disagree on this but if you go into an Italian town or a Danish town all the city centres are completely permeable to cyclists, in other words they are walking and cycling areas. The average cycle journey is very short: it is one or two kilometres. The average walking journey is half that distance. If you sit in any Italian town, whether it is Florence as a tourist town or a smaller town, Pesaro or somewhere, you will find that people of every age are making these short journeys. If you like, we have sealed off most town centres to the most important journey. There are some exceptions to this, like the City of York which permits cycling before ten and after four. That enables the journey to school and the journey to work to go across the city. That is just one example of a stranglehold that we have created in our culture.

Q509  John Austin: So we need a complete change in our urban planning and urban design.

Mr Grimshaw: That is not a big change, with respect. After all, you let service vehicles into these places. Another very common example is the notion that cyclists go two ways down a one way road. That is normal in Denmark or Holland because the object of walking or cycling is to give the public the shortest possible journey to make that mode of transport the most convenient. In Britain, if you talk to the Department of Transport, they have an absolute horror of allowing walkers or cyclists to have a benefit, an advantage over motorists. In other words, if motorists go the long way round the cities then cyclists have to because it would be unfair on the motorists if the cyclists had a shortcut. Last summer I was in Wintertuhr in Switzerland, the main industrial city of Switzerland and cyclists were going two ways on all roads. It was a very simple bit of paintwork, a few hundred pounds at either end. You could say that is a cultural thing, but physically it would be possible for us to do. The real cultural issue in Britain is that pedestrians and cyclists are not treated as real travellers. You probably know that cyclists are often faced with a sign which says "Cyclists dismount". I do not think any motorist has ever faced a sign saying "Get out of your car and push the button" or something. That is just an indication of the way they are treated as a sub-species. It is possible, but it is a huge battle, because there is no city in the western world which has managed to get cycling up from the very low levels we have allowed things to fall to in Britain. We have lost a habit and there is a whole generation of people who have not cycled in Britain.

Dr Maryon Davies: On the question of London, I am a cyclist and I cycle into it every day and I am certainly grateful for the little green channels by the kerbside; they make a huge difference. One thing I have noticed, particularly in London, is the effect of the congestion charge, which has suddenly made life for cyclists so much safer and more pleasant. That has been a great boon and if the notion of congestion charges in city centres is rolled out across the country that in itself will have a terrific effect on enhancing and encouraging cyclists.

 

Q510  John Austin: May I come back to the question of physical education and physical activity in schools? There is no doubt that there has been a reduction in the formal physical education which goes on in schools. There are also alarming figures which show that the number of children taking part in no sport at all has increased and is increasing. What proportion does physical education in schools play as part of the physical activity needed by children? If we could get all children doing two hours a week of physical activity formally in school, what would the impact of that be?

Professor Riddoch: The actual time a child is in physical education is a small proportion of its waking hours. We are looking at it in slightly the wrong way, with all due respect. It should not be a dose of activity to contribute towards the total because it will be a very small contribution to the total of what a child does. If it is used for educational purposes to encourage children into different types of activity, promoting fun and enjoyment, making the child feel competent at physical movement, then all those things are wrapped up with the psychology of the child as well and will make that child much more comfortable with the notion of exercise. It is down to the quality of that experience and not how much exercise is done during those two hours. That impacts back on training of PE teachers and whether they are appropriately trained for this sort of educational experience.

Dr Campbell: I am sure you are fully aware that the Government is putting a large amount of money into physical education and school sport, a massive investment in facilities and £750 million which will impact on around 2,300 schools in terms of providing improved school sports facilities and £459 million on top of that which will provide and is providing people in every school; every primary, every secondary and every special school will have a person whose job it is to lead a more effective physical education programme and to ensure that after-school activity is wide ranging and reaches as many children as it can. This is very different from what we used to have where it was very much the ones who wanted to play in teams who stayed after school. Whilst that is still very valuable, we are trying to expand that. But physical education and school sport is one contributor to physical activity. It cannot be the contributor. I am obviously very passionate about it and if we can teach it effectively and well, we can excite, engage and energise kids who want to be physically active. The greatest challenge we have is getting that right in our primary schools where we have primary teachers who are generalists by training. That is what is true in all primary schools. What has happened with the increased emphasis on numeracy and literacy, which we all understand the need for, is that the physical education part has been squeezed more and more. Indeed the generalists who are trained now in primary teaching are getting less time, particularly for physical education, in their training. At a time when we have little people who might be willing to engage with us and be active and get physically engaged, we probably have the people with perhaps the least personal desire to be delivering it. That is not a criticism of primary teachers; they are wonderful and you can watch them all over the country. Many of them are fantastic as teachers, but their own personal experience of PE was not often very positive, they have had a limited amount of training, yet here we are asking them to excite, enthuse, energise children to be engaged in physical education and to think physical activity is fun. We have a lot of work to do. We are making a great start. The investment is tremendous but we still have a long way to go and particularly in our primary schools, a long way to go to get this right. The early research evidence from the work which is going on now in playgrounds in primary schools is absolutely fantastic: £10 million from DfES invested in the 27 highest crime areas, which will transform around 450 playgrounds in some of our most challenging primary schools in inner city areas, not just in terms of physical activity, but in terms of learning, in terms of behaviour management, in terms of social development. Sometimes the smallest investment in some of these schools can actually generate a massive return. Physical education, physical activity on the school playgrounds, after-school activity and after-school sport are all contributors, but they are as much contributors to attitude as they are to activity. It is about whether we have really captured kids minds and understanding, whether they know why they are doing this stuff, why they need to be active, why they need to be healthy, why it is relevant to them and how they can do it in a way they want and which is enjoyable.

 

Q511  John Austin: On the playground initiative, could Dr Campbell tell us when that is likely to be evaluated?

Dr Campbell: It is being evaluated independently by Loughborough University. The early research on it is outstanding in terms of the impact it is having.

 

Q512  John Austin: Is anything available at the moment which we could see?

Dr Campbell: We could certainly let you have the interim report; I should be happy to do that. I will make sure you receive that.

Dr Maryon Davies: One of the key factors about PE and sport in schools initiative was that it was focused initially on the most deprived parts of the country, which is really important. Another key criterion in terms of where the grants were made was that the equipment and gear which was put into schools and the building which went on should be something which could be used by the whole community. You are using the school as a resource and facility for the whole surrounding community and families could get involved. It is one thing to get it happening in the school with the school children themselves: it is quite another thing to get the parents and the families involved and the community. It is very important.

 

Q513  John Austin: You talked about exercise which was cool or not cool. One of the things a lot of young people do is go clubbing and some of that takes a lot of physical activity. Do we underestimate the value of dance in schools?

Dr Campbell: Dance is part of the physical education curriculum which is to be delivered in all schools. I do think we underestimate the power of dance, particularly to reach young women. I do not want to be sexist but certainly the work we have done with eleven to thirteen-year-old girls - we did a survey of 3,000 young women in secondary schools - showed that whilst they often liked the PE teacher in that she seemed quite cool because she was always dressed differently from all the other teachers, they had actually gone off PE already. They were doing it because they quite liked the teacher, but they were not engaged in it; they went along but were no longer really engaged in the activity. About 80 per cent of them had really decided this was not so cool, the way they were dressed, the activities they were being asked to do, the nature of the showers. I could spell it out and I am sure you could tell me. All those things actually made physical education a deterrent to physical activity rather than an enabler. What we have done now is worked with 1,500 secondary schools and over the next 18 months we will be tackling just over 1,500. We have looked at redesigning the physical education curriculum for young women for that 11 to 14 age group and dance comes zooming to the top there, all sorts of dance. Activities which are more esthetic in nature do appeal to young women as opposed perhaps to the traditional menu of hockey and netball, which is still valid for some young people and certainly I would have still wanted to do my hockey and netball, but for the vast majority you have to provide a much more engaging menu and dance is a big part of that.

 

Q514  John Austin: Is there a danger of underestimating the attraction dance may have for some young men as well?

Dr Campbell: Absolutely. That is why we should not stereotype things; we must not do that. Some young women - and I would have been one of them - love playing games and there are still women who want to do that. When you actually do attitudinal survey work, which again was done by Loughborough University for us, the majority of those young women did not find games playing particularly attractive. Some did, but they were in the minority; the majority did not want to play games. Equally, I am sure if you surveyed boys the majority would have been happy with games, but there would have been a minority for whom that was not comfortable either. We have to make sure, as we design our physical education programmes, that they are wide and they touch the interests of every youngster so that we can engage them and we can capture them at the one time we have them all in our hands in a sense. That is the power of schools. We have them in our hands to do things and that is why it is so exciting.

 

Q515  Chairman: Can I press you further on the research you have done with girls? Was it your opinion that the actual activity was a turnoff, or perhaps the competitive nature, it was dirty or whatever? Or was it more to do with the wider picture, changing facilities? As part of this inquiry we went to the Leeds area and I went into a school which has Sports College status. One of the things they have been able to do is address the changing facilities for both girls and boys. They have individual cubicles, separate shower arrangements. Is that a big issue or is it your view that it is the nature of the activity which is the problem rather than the wider aspects of preparing and showering afterwards etcetera.

Dr Campbell: You are not going to like this answer, but it is both really. It is complex stuff. Aspects like the kinds of clothes we ask people to wear to do physical activity, whether that is in school or out of school. We have certain images of the way people should dress when they do physical activities. Sometimes those images are not terribly young people friendly. So redesigning the gear in which they can do PE. Changing rooms are a massive issue, particularly for young women as they are going through that change in their lives where their body shape is changing. They are very much more self-conscious and you are asking them to strip off and run through what are often horrible smelly showers with a lot of others. There are things there that really make the whole environment uncomfortable in which you are asking them to perform. Many of the specialist sports colleges are doing some outstanding work with young women and indeed, building on the point made earlier, working in the community with women in the community, re-engaging back into activity and part of that has been the re-design of the changing rooms. It is a big issue; you cannot underestimate how big an issue it is, as is clothing. It is also this menu. You probably thought so already, but I started off life as a PE teacher. We worked on a very traditional menu. We did hockey and netball in winter and athletics and tennis in summer and a bit of gym and dance. That is what many schools turn out. We really have to challenge that. If we are really going to reach every child, that menu does not do it. It really does not. It does it for those who are keen, good, enthusiastic and athletic. It really does not do it. As you get up that age range, so the whole thing starts to drop away. We really have to tackle that.

 

Q516  Chairman: May I put it to you that you have been around for some time in key positions in relation to government policy on sport? You will have had this question put to you on many previous occasions. One of the worries I have, as someone who has had a love of sport and active involvement in sport all my life, is the way in which government policy appears increasingly to address the development of excellence, possibly at the expense of participation. I was particularly struck, as somebody who is a rugby league fanatic, that when we were in Leeds and we went to a particular group of kids who were at an obesity clinic or something, these kids were pretty overweight and one lad said that he had applied to join an amateur rugby league club and he had been turned down on the basis that he would never make it. I find that surprising, because I think my sport is pretty inclusive usually. I thought that kid could have been turned into a fairly useful prop possibly and something could have been done. It was the way in which the perception was "He ain't going to make it, so don't bother". That saddened me. I get the impression that is not just an isolated example. There are lots of kids who feel they are not going to get anywhere and they are not really encouraged to participate. Is that an issue you have looked at and if so what are your views on how we address it?

Dr Campbell: The PE and sport post in schools which we are beginning to transform lends itself neatly to the next piece of the jigsaw which is sports clubs. Not that that is where every youngster will go by any means, but for those who do want to venture there, we need to make sure it is a child friendly, child safe environment which embraces all young people. The reality of most sports clubs is that they are run by volunteers. For me, one of the biggest challenges we have, and it is one we are now engaged in talking to Sport England about and the Department for Culture, Media and Sport, is how to bring about the same kind of transformation in club sport that we are beginning to make happen in school sport? Then we will have some sort of connectivity. We have a long way to go in club sport and you are right, we get the annual questions about Wimbledon or other things and one of the biggest challenges in tennis is that tennis club members tend to be people who want to play tennis. They are not very keen on having these hundreds of marauding youngsters appear on their door wanting to take their court time. Tennis clubs are very aware of that and starting to do some good work, but it is about a change of culture and a change of attitude. If we are looking at sports clubs, yes, I believe that is the next big piece of transformation work we have to do in sport development if we are going to connect this re-engaged enthusiasm we are hoping to get in schools into clubs.

 

Q517  Chairman: I am genuinely encouraged by some of the things we have seen in schools in respect of PE and I know that the Sports Minister is very well aware of the issues which have to be addressed and he is watching this inquiry with interest because he understands the links we are all well aware of. One of the issues which worries me very much in terms of our objectives on increasing school sport is the way I am being told by teachers in my area, head teachers, to whom I have talked about trying to increase the levels of physical activity, is that the real pressure on them is in academic achievement in relation to league tables. You are well aware of this. We are not telling you anything you are not fully conversant with. How do we balance out the pressure in terms of measurement and achievement in schools and league tables to reflect the health gain of activities as well as the academic gain of the work they are doing.

Dr Campbell: That is such a massive question and it is such a good one too. First of all, would it not be great to publish a league table on physical activity levels in our schools? I wonder whether that would change parental choice. We do not: we produce league tables on academic achievement and that does create a pressure within the school. It comes back to the first question, that what we then end up with is disenfranchising the physical part of it. The way I have often described it, is that the physical education department is often parked in a small gym on its own past the toilets at the extremity of the school. In a way we are less important to the head teacher than whether the toilets are working, because we have taken ourselves to the extremity. What we are trying to do with this new initiative is bring PE and sport back into the heart of schools and demonstrate with good evidence, properly recorded, well researched evidence, that when that happens it enhances academic achievement, it improves citizenship, it improves social responsibility, it really can help transform the ethos of the school. That is what the specialist sports colleges are trying to do. Not all of them are 100 per cent successful, but that is their endeavour. It is not just to be better at sport, but rather to use it to create a better school environment within which young people learn. We have to find a way of making sure for parents that we record and make sure on a very regular annual reporting basis that they know what we are doing and what this means in terms of health and physical activity. That is a big step. I have found one of the difficulties is getting clarity about the minimum levels of physical activity. We talk about five lots of 30 minutes, but at what intensity? Is ambling to school with your mate, having a chat, intense enough? Does that make a real health difference? That is one of the things I, as a professional in the field, think I need greater clarity on. What is it we are asking here? Having defined it very clearly, all these strategies have all to come together. It is not one strategy, it is all of us collaboratively creating the environment in which we can do that. In schools we have to record and value physical education in the same way we record and value academic achievement.

 

Q518  Chairman: What are your views on the issue of screening youngsters for weight? You are talking about reporting to parents and that stimulating their interest in the activities. What about the issue of regular measurement of weight. This has been kicked around as an issue during this inquiry. Most of us remember having regular medical checks when we were in school and it does not happen in the way it used to happen when most of us were at school for a variety of reasons.

Dr Campbell: I remember conducting those. PE staff used to have to do those and they were not very nice; all those feet you had to look at. Not very comfortable.

 

Q519  Chairman: Would that be an issue? Would that tie in with what you are aiming to do with a wider awareness of issues?

Dr Campbell: That is where we need to work with the health experts and the health professionals to try to use what we are now doing in PE and school sport, which is to create a network for the first time, of people with dedicated time and energy to drive these agendas. I am not a health specialist, I am a physical education and sport expert. If that is something which through the Department of Health and the health experts we felt was a really good way of helping to incentivise and develop a better attitude to physical activity, then we would do that. We always have to be a bit careful of being overly prescriptive with kids and certainly in schools. Our job in schools is to help young people make informed choices: it is not to tell them what their choices are. Many people think that education is about telling kids what their choices are. I do not sign up to that. I really believe it is about helping kids make informed choices and providing the information to them so that they can make those choices, but giving them the understanding that goes with it. Some degree of screening might be very useful, but I would look to our health experts to tell me what kind of screening.

Dr Maryon Davies: On the business of screening, that used to be a key function of the school nurse. There are several issues there. One is that school nurses are getting thinner on the ground and we have to increase that workforce, it is an important workforce. Secondly, they have tended to move away from this regular monitoring of height and weight and have moved into more interesting areas of sexual health and drugs and relationships and that sort of stuff. I think we may well need a return to some sort of regular monitoring, just in terms of early diagnosis, to see which children are beginning to show signs of overweight and then perhaps targeting. What we have to do is target some of the work we do at the more at risk people. The danger, the down side, is that you start victim blaming and you start stigmatising and that can be a problem. To get back to the issue of half an hour a day and five days, I sometimes think that these notions of targets or levels of what is acceptable activity can get in the way. Here we are talking about obesity, here we are talking about expending energy. Frankly, anything you do to get up out of bed and start moving about is expending more energy. The more you walk up and down stairs and around, the more energy you are spending. You do not have to do half an hour a day five days a week in order to expend more energy. Sometimes that can get in the way and be very offputting for people if they think they are not going to achieve that sort of thing. One other comment about encouragement and empowerment. I think of it in terms of the five "Es". I think of the five things we need to get right for children and also for adults - we have not talked much about adults today because we have focused mainly on children. Education is clearly important, understanding why it is useful to take up exercise and to keep active. Empowerment is important. A lot of people, young people in particular, feel embarrassed, self-conscious, they lack self esteem, they do not think they are up to it. That whole empowerment thing is important. We talked about encouragement, which is all the motivational stuff, "You can do it and it is worth doing", encouraging people to get stuck in. Enablement. This brings us onto the whole area of access to facilities and I am sure we have touched on that before, being able to get to facilities conveniently, cheaply, nearby, all that sort of stuff. Environment - and we have talked a lot about that this morning in terms of safe environments for exercise, comfortable environments, convenience and convivial. Let us not forget convivial, because the social aspects of all this, the conviviality of keeping active, can make a huge difference. I should like to push the five "Es" of exercise.

Professor Riddoch: A general comment on that area. The recommendation for children is 60 minutes a day on most days of the week and double for adults. That is going to be called into question in the near future as well, as we feel that might not be enough even so. The Chief Medical Officer's report on physical activity and health comes out in January and will comment on appropriate levels of activity for different diseases and for adults and for children. The other thing to remember is that physical activity is not just important in terms of obesity. I know that is your focus, but there are 20 chronic conditions which are impacted beneficially by regular physical activity. We must not lose sight of that. I would be much more comfortable if we monitored physical activity levels in school rather than just waited.

Mr Grimshaw: One quick point about your notion of the curriculum being crowded. There is one part of the curriculum which every child has to do which is not crowded and that is the home to school journey and back again. We feel very strongly that the school day should start when you leave home and the school journey really must be kept in sight. It is the real opportunity for every child to have exercise every day, whether boy or girl, and to take that habit into adult life on the journey to and from work. Sport has such a high profile, but however successful you are with sport, it will not tackle everyone and how you take it through into adulthood. Really the two together need to be held onto.

 

Q520  John Austin: Dr Maryon Davies mentioned the issue of availability of facilities and cost. One of the areas where the UK is sadly deficient compared with many of its European neighbours is in swimming facilities. It seems to me that swimming has virtually disappeared off the school curriculum at this stage. Is there any evidence to back that up?

Dr Campbell: I am sure there is evidence that there is less swimming. The Department for Education and Skills is just about to produce a charter to try to re-engage schools more in swimming. One of the problems is that if there is no pool on the school site, you are talking about cost of transport, which starts to become a barrier, you are talking about time.

Q521  John Austin: They could walk.

Dr Campbell: It is true that they could walk, but that is even more time.

 

Q522  John Austin: Or cycle.

Dr Campbell: It is not safe. You then have the whole business of one person going and changing 30 little people into swimming costumes and trying to dry them all off and change them and get them all back again. It is pretty time consuming. What we have been looking at, particularly for primary schools, is that actually the best way to learn to swim is in a more compacted space than once a week for a series of weeks. What we tried was what we called a top-up course this year where we actually took all the youngsters who could not swim in a whole geographic area of primary schools and gave them a three-day course in swimming to ensure that at least they could swim. We also did it and introduced all the other different kinds of fun you can have. Actually you can deliver the whole national curriculum in the water if you want to. You can do games, play polo, you can do esthetic activity, synchronised swimming, you can do endurance work and athletic work because you can swim up and down. You can do an awful lot in the pool to deliver physical education. What we have found from that is that we are now tracking those youngsters to see whether they are returning and going swimming on a regular basis. It drops off quite quickly, as I think you will find if you look at the Welsh study. Wales opened all their swimming pools to young people this summer all free of charge and got a tremendous response. As soon as you charge again the thing starts to dive again. Cost is an issue, transport is an issue, time is an issue. I agree with you that swimming is a tremendous activity whether you are young or old. It is something I try to do.

 

Q523  Mr Burstow: In our trip to the States we learned that in New York the pools are free during the summer as well and that was quite interesting. I just want to pick up Professor Riddoch's point about what to measure and the assertion he made about much preferring to measure physical activity than weight. One of the things we picked up during our visit to the States was how obesity is rapidly becoming the number one behavioural cause of death in the United States and how it is the gateway disease through which a whole range of other diseases are triggered and risk factors are increased. Are you really saying that we should not have any focus at all on the issue of weight gain? Do you really think that just focusing on activity, which is understandable today in terms of the evidence you are here to give us, is going to address the obesity question?

Professor Riddoch: It is more a question of where the measurements are made and the chances of stigmatising children and humiliating them in front of their peers and all that sort of thing. The physical education department or the school is the place to measure physical activity. The place to measure weight is maybe with the general practitioner or the school nurse or something like that. It is a different issue, a sensitive issue. It is not a screen for physical activity. It obviously involves diet as well.

 

Q524  Mr Burstow: Do you really think that it is a sensible thing to do, to separate out the issues around activity and getting good PE teachers who can really motivate and encourage people, all that, when they do not necessarily have the knowledge around the diet issues? Surely those two have to be part of one package. Are they already clearly addressed in that way in the curriculum? Could more be done on that?

Professor Riddoch: There is certainly a move in public health generally towards more multi-skilled health professionals who are skilled in diet and exercise and maybe smoking cessation as well. If that could be reflected in the education of teachers, that would be a great move forward.

Dr Campbell: Secondary physical education teachers do study health related exercise, particularly if they are doing GCSE PE or A-level PE. There is a real underpinning of helping youngsters understand and have a much broader understanding of health based issues. We could do better and we need to do better in the future. The area where we perhaps do less well on that is the primary level because of the limited training time we have. They tend quite naturally to be more concerned with delivering safe activity than educating through that activity, because that is as much as their training has allowed. Your question is a very useful one and it is something on which, both at primary and secondary level, we could put greater emphasis and have greater benefit. Many young people, when they are asked whether they like PE answer no. The next question I always ask is: did you understand the relevance of doing it? Answer: no. We have not helped them understand the very basic issue of why it is important to be physically active. You are right, that needs to get built in and we need to do a better job at bringing that much more to the front of our teaching rather than letting it get hidden at the back of our teaching sometimes.

Dr Maryon Davies: I just want to get away from schools at the moment. You were talking about obesity emerging as the number one contributor to early mortality in the States and we probably following here in about ten years' time. In primary care, which is another important setting for this sort of work, smoking cessation is well funded, it is beginning to be reasonably well co-ordinated: we have a three-tier system of basic advice given by the practitioners, an intermediate level which is done on a group basis locally and then a specialist level where you are referred to a specialist unit. What the Faculty would like to see is a similar sort of setup for dietetic advice, in terms of getting brief advice from the practitioner nurse, referral to a community dietician for further advice and then referral to a specialist service. The same around exercise too: some brief motivational advice from the practice nurse or GP, referral to more specialist advice and then, for those who really need it, something much more tailored to them. We do not have that. We do not have that infrastructure. We do not have the resources for that. It is not something which is well organised at local level. We believe that those should be firmly established services. As well as a smoking cessation service, we have a dietetic service which focuses on obesity amongst other things, diabetes and other thing and an exercise service as well, well organised and well resourced.

 

Q525  Mr Burstow: One of the things we have seen in evidence is this whole issue of GPs making exercise referrals. We understand also that the health education authority have done some evaluation of that in the past back in 1998, but they have said that there is an even much more rigorous evaluation of these sorts of things, because there are not actually very many of them around the country. Are you aware of any pieces of work which have been done which would give sound reliable information to judge whether or not these packages work and which ones work most effectively?

Professor Riddoch: I actually wrote the report you referred to. It is very difficult to measure. That is a common scientific answer, but it is. You are trying to measure complex behaviour out there in the field, not in a laboratory. There is a large trial in north London which is reporting very soon, the first well-funded study involving multiple GP practices and that will give us the first real handle on how effective these schemes were. The point I should like to make on all of this is that we have had a very succinct summary of what is going on with children here. Alan has mentioned primary care, it is very easy to look for a magic bullet about how to get population levels of activity up and there is not one. We have to do what Sue says, we have to do what Alan says, we have to change the built environment. Unless we get everything working in concert, then the population levels of activity are not going to shift very much.

 

Q526  Mr Burstow: What sort of timescales is that evaluation work you have mentioned working to? When is it likely to be published?

Professor Riddoch: I know there is going to be a presentation of the results, which I believe will be the first presentation at a conference, and I think it is in April next year.

Mr Franklin: We have to be slightly careful about this push towards referring people to exercise, to gyms and so on. While that works for some people, it does not work for the vast majority of people. It is like the Bridget Jones syndrome of joining a gym and then working out it has cost you £150 every time you have gone because you have been twice in the year. Joining is one thing: actually going is another thing. I have certainly joined somewhere and then there have been three or four months when I have not been and then you eventually get round to cancelling the subscription and everything else. For the people who probably need it most, they are the ones who are probably least likely to make the big changes to their lifestyle that they need in order to get the benefit from the gym. It is much more about building in through GPs, through primary care, how we can motivate people to make these very small changes. It is not big changes, but it is very small and it then has to be consistent, making those changes over every day of their life. It might be simply walking to the bus stop rather than taking the car. This sort of thing. We have to look inclusively and I am just a bit worried that we focus too much on physical activity.

 

Q527  Mr Jones: In the last few contributions I am recognising what I often see when in meetings like this, that people look at things according to ensuring their own professional organisations, their own gatekeeper roles. Naturally people who are involved in sport will wish to enhance their professions, but at the same time, ensure their professions have a clear role. We do not want it muddied with ideas of healthcare. Those health professionals very much want to ensure that they safeguard their role as gatekeepers. Sometimes, in fact quite often, those desires from professional organisations to ensure that they protect their organisation and the meaning of their organisation gets in the way of delivery. I think it might be getting in the way of delivery here.

Dr Campbell: If any of us here are giving the impression of gatekeeping, it is not the one we intend.

 

Q528  Mr Jones: May I just make it clear? The practicalities of referring everybody for quite simple health messages to primary care, to GPs, when you look at how overwhelmed GPs are, in my view is not the best way of sending simple messages to a large number of people.

Dr Campbell: It is part of it.

Dr Maryon Davies: You have to see it as part of the whole palate. Rather than thinking of it in terms of professions, I would think of it in terms of setting. We are looking at the setting of the home or the family, the individual setting of the school, the setting of the workplace. We have not talked much about the workplace which is an important setting. We are looking at community groups and what we can do through community groups. Primary care is a setting. I raised it because it is important for some people for whom basically it is a particular risk. I am thinking of people who have a family history of heart disease, of diabetes, of high blood pressure, osteoporosis, a whole range of things. Those are the people for whom we do have to use what you might call the high risk approach, focusing on those people who have particular risks and making sure we have a service for them.

 

Q529  Mr Jones: In your earlier evidence you told us that the generality of people are getting fatter. We know that is happening, and we know that we have schools which are wonderful institutions and we have everyone together. We have them and we can do things. If you are going to say this is the only way you can do it - - -

Dr Maryon Davies: No, I did not say that. It is not either/or.

 

Q530  Mr Jones: But Sue Campbell said she did not want to be looking at feet because it was not a pleasant job. She wanted to be enhancing sport, because that was what she trained for.

Dr Campbell: I do not remember saying that. Did I say that?

 

Q531  Mr Jones: Yes, you did.

Dr Campbell: I did say I do not like looking at feet. I do not remember the second phrase.

Dr Maryon Davies: Many years ago Professor Geoffrey Rose formulated a model that you need two complementary and mixed approaches. You need a whole population approach, which is the very wide, "let's get everybody up to speed" approach. However, you need to complement that with a focused high risk approach for those individuals at particular risk. The two are together. They are not mutually exclusive. Whatever formulation we come up with, recommendations we come up with, we should bear in mind that there is that spectrum.

 

Q532  Chairman: Jon wants to shift us in a slightly different direction, but before he does and he leaves schools, may I ask one question of Sue Campbell? You were talking about how you could do many parts of the curriculum in a swimming pool. That reminded me of when we were in the States. I think it was in Colorado where they have a lot of good ideas on exercise. They made the point that the use of the pedometer in a classroom setting was quite helpful. What they were doing was collectively measuring how far the youngsters had walked, say in a week. Then they looked at this total amount for a class on a map to see how far they had walked from Denver or wherever. Then they focused their class session, whatever subject matter it was, on that area. It might have been some mathematical problem, geography, or whatever the subject was and they located it in respect of the exercise they had taken. We did a quick Round Robin this morning before the Committee had started and I worked out that collectively in the past week as a Committee we have walked to Yorkshire in total. I am not sure where that takes me, but I just thought I would make that point. Have you come across any imaginative sorts of connections between the exercise issue and the way that can be used within the school setting?

Dr Campbell: Yes, we have quite a lot. If it would be helpful, I can send you a summary of some of the cases.

 

Q533  Chairman: It would be very helpful.

Dr Campbell: It is the kind of thing the specialist sports colleges have been very much focused on. Some of them have taken health as very much their kind of theme. We have some excellent examples.

 

Q534  Chairman: If you would do that.

Dr Campbell: Yes, I shall do that.

 

Q535  Dr Naysmith: I want to move on to a different area to do with the commercial involvement in generating obesity and so on. It ties in quite nicely with something Dr Campbell was saying about enabling children to make informed choices. What are your views on commercial tie-ins between companies like Cadbury/Schweppes and Walkers Crisps in providing recreation facilities or computers for schools in return for tokens or labels off the products they make, which tend to be harmful, certainly if taken in excess? How do you think we can approach that area?

Dr Campbell: I am probably going to be the one out of sync here with everybody else on the top table. First of all I would say that Professor Clive Williams, who is an eminent sports nutritionist based at Loughborough University, has an expression which says there are no bad foods, just bad diet. What we have to be careful about in our desire to safeguard our young people is not to remove them from the real world in which they live. The power of some of these brands, which we may choose to keep away from young people, to communicate and to present a message in a way which people in the public sector, or even well-meaning people in the charitable sector that I represent, cannot communicate effectively with those young people, is a really tough one. I personally believe that if we vilify them and exclude them from the opportunity to work with us, we are in danger of assuming that children do not make informed choice, or are not encouraged to make informed choice. Secondly, we are losing the opportunity to reach in a very distinctive and different way, which some people may not agree with, but a distinctive way, reaching those youngsters who perhaps our public service type message does not reach. Certainly, why can we not work with a company like Cadbury, which in a given period of two months will put 120 million messages into the marketplace, to engage in a positive dialogue which helps them become part of the solution rather than part of the problem? I feel quite strongly.

Q536  Dr Naysmith: That is not really the question. I will come to that in a minute and the ways companies can work. Is it a good thing for us to encourage companies to come into schools in that kind of backdoor fashion when they seem to be helping, but what they are actually doing is promoting their products.

Dr Campbell: The Youth Sport Trust has done a lot of work with a whole range of companies and the answer to that question is that there are some companies which do not do this with any degree of integrity at all and I would agree, we should not be anywhere near them. There are some companies which genuinely enter into a debate. Yes, of course, we are not stupid, they are commercial companies, but they genuinely enter into the debate and want to be engaged and be part of the solution. They accept their responsibility for the part they play and want to be part of the solution. If they are entering with integrity, entering with the right motivation, then my answer, which is probably not the popular answer, is yes, I would work with them.

 

Q537  Dr Naysmith: This is straying into what I was going to follow up with in asking how companies can help. Some of these fast food companies, confectionary businesses are anxious to assure us that they want to be part of the solution, as you have just laid out. Certainly, when we met Coca-Cola in the States, they said that to us. They said that they wanted to work with health providers and governments and local authorities to try to reduce obesity, but their answer to it, unfortunately, when we were talking at the time about slot machines in schools delivering soft drinks, was that they had to give people a choice. They had to make sure there was something else in there besides Coca-Cola. I did not really think that was an answer.

Dr Campbell: No. Vending machines in schools is a separate issue and if that is the motivation for their involvement, which is to get more vending machines in schools, I would say that lacks enormous integrity.

 

Q538  Dr Naysmith: It happens in this country too now.

Dr Campbell: Vending machines?

 

Q539  Dr Naysmith: Yes.

Dr Campbell: It does indeed; absolutely it does. Those are choices that head teachers make and I think that is an interesting choice they make. A lot of pressure is being brought to bear on them and they are beginning to make different choices about what kind of vending machines, what kind of diet we are putting in front of youngsters. It is a fine line between whether or not you can work effectively with these companies in a managed way or whether you just take a blanket approach and say this is something we are not going to do. If I take one which is less emotive, because it is not about food, if I take Nike as an example, the work Nike has done on zone parks in primary schools has come directly from their course related project budget. They have no particular desire - I do not think, although you would probably tell me they do - to sell kit to primary age youngsters, although I presume they get brand affiliation.

 

Q540  Dr Naysmith: They are just registering their brand.

Dr Campbell: They are; I understand that.

 

Q541  Dr Naysmith: That is not the same at all because you are in the position of putting before children - and it does happen elsewhere in huge advertising campaigns - by putting things into schools that you really want to educate the children about from a balanced choice.

Dr Campbell: Correct.

 

Q542  Dr Naysmith: One or two lessons on diet are not going to compensate for the fact that you have a big advertising industry doing plus things in schools which say this is a good company, helping us a lot, we should buy their products.

Dr Campbell: The Cadbury project is being very, very well monitored independently of both that company and ourselves. When that evidence is available I think you may be proved to be right and I may be proved to be wrong. What we do know is that some of those brands are trusted in the home and the way a message you or I might want to send would not be viewed in the same light at all. Some of these are trusted products and that is part of working through whether you do these things with integrity, or whether you are merely doing them for commercial ends.

 

Q543  Dr Naysmith: They are obviously just doing it from commercial angles. There cannot be any other reason for it; they would not do it otherwise.

Dr Campbell: Of course there is a commercial gain for them, because that is their business. I believe you can marry that with a real intention to make a difference. I have accepted and refused, as Chief Executive of the Youth Sport Trust, a whole range of different commercial opportunities to work with companies based on a very careful assessment as to whether or not what you are doing is actually helping to deliver the right messages to the right people. Maybe I have got some of those wrong, but I have yet to not have demonstrated to me through independent research that sometimes those brands speak to kids in ways we cannot.

 

Q544  Dr Naysmith: Perhaps that is the problem.

Professor Riddoch: I was also going to mention Nike because they funded research at Loughborough University to try to get more girls to enter sport. There is no evidence of this but to me, if you are in the commercial world of exercise or physical activity that is a healthy behaviour. Diet is potentially not a healthy behaviour. It is the food companies which you have to look at very critically as to what their true motives are. I cannot see too much wrong with a physical activity or a sportswear company coming into a school.

 

Q545  Dr Naysmith: No, I am not talking about that. I am talking about creating an obese population. There is all sorts of evidence that obese children become obese adults, as we know.

Dr Campbell: Except we know that calorific intake is not going up. We know that, the evidence is clear. The calorific intake is not going up; if anything it is slightly declining and obesity is escalating.

 

Q546  Dr Naysmith: Are you talking about the average calorific intake not going up? For sections of the population it is going up hugely.

Dr Campbell: You obviously know more than I do. I will not comment on that.

 

Q547  John Austin: On the commercial side, there is a world of difference between Nike and Pepsi-Cola and Walkers Crisps, for example. Surely if the desire is to lower calorific consumption, it surely cannot be a good thing for kids to drink three or four cans of high sugar content fizzy drinks a day. The habit of snacking on high fat, high salt content foods like Walkers crisps cannot be a good thing. It may not be a bad food in itself, but several packets a day and several cans of full fat Coke a day is bad for health. Therefore having the availability of those vending machines in the schools is too an important an issue to be left to the discretion of individual heads or governors. Just as we ban cigarette advertising within the curtilage of schools, should we not be saying there should not be vending machines selling these products in the schools?

Dr Campbell: There is a difference between advertising and vending machines and programmes which are sponsored or course related sponsorship. The answer to your question would be yes, I do not think there should be vending machines in school. That is a separate commercial issue for me and I would agree with you. I also do not think there is a person sitting here who would say three packets of crisps or three cans a day is a good thing. Of course we do not. What we have to do is try to help young people understand that and make those choices.

Q548  John Austin: We do not help them if the vending machine is sitting there in the school.

Dr Campbell: I could not agree more; I do not agree with that at all.

 

Q549  Dr Naysmith: The original question was about a company suggesting that the school could get facilities for the school, say computers or recreational facilities, by saving up things like wrappers from sweets or crisp packets and bringing them into school or taking them to the supermarket and getting a computer for the school in return. Is that a good thing or a bad thing? That was the original question. We got onto vending machines because I did not phrase the question particularly carefully.

Dr Campbell: The research around those programmes and our early indications around the Cadbury thing is that actually people do not eat more chocolate, they change brands. That would be the same.

 

Q550  Dr Naysmith: It is what they say about smoking.

Dr Campbell: You cannot compare chocolate with smoking. You are vilifying something here which I have to say is part of my daily diet. What we have to come back to is that at the end of the day what is creating obesity is that the amount of energy going into the body is not getting expended in the way it used to. We are less physically active, so we do have to say that to tackle this we have to have a major drive to get young people physically active and we have to help them make good choices about what is a balanced diet. I think that is something we have to stay committed to.

 

Q551  Chairman: You referred earlier on to the issue of the employer, companies, the workplace, which I was very interested in picking up. In the States - I was trying to remember where - we were told of a particular local company where at around mid-afternoon each day the chief executive leads the staff in a walk. They go round a few blocks and back in. I was thinking we could try it here. It would be a chance to have a word with the Prime Minister now and again. No, not now. Do you have any examples of that nature within the UK or any thoughts on what companies are doing or could do of relevance to this issue?

Dr Maryon Davies: Yes, there are many things. Starting with simple things like whether bike racks are provided and whether there are regulations about how many bike racks there should be per employee. I am not sure about that, though others will probably know. Clearly you need to have some regulation about that so that it becomes something which is not a voluntary thing, but something which has to be provided. I have cycled here today. I tried to park my bike outside the front door of Portcullis House and was told by the commissionaire person to go away, it was untidy.

 

Q552  Chairman: We will do something about that.

Dr Maryon Davies: That is one thing: provision of bike racks. Another one is shower facilities so that people who come in in a hot sweaty condition can make themselves feel decent again. That is crucial. Something about the notion of siting the stairs where they can be easily seen; when people stand there waiting for the lift, they can see that actually there is a staircase there and they could use the staircase. You can expend an awful lot of energy each day just rushing up and down stairs in the office and people do not do that; a few notices around to remind people to use the stairs. The idea of having organised sessions is okay. There is a danger of it being health fascism and that is a slight worry. There are examples around where companies have taken that view. The Japanese were notorious, were they not, for having exercise sessions every day or probably several times a day? There are many things which could be done in the workplace and we should be trying to push that.

 

Q553  Dr Taylor: I hope that Dr Maryon Davies did not tie his bike to a lamp post because the local council actually has a team of people to go around removing bicycles which are parked like that. It strikes me as absolutely awful. I want to move on to the role of the Department of Health and coming back to primary care. Talking to my own primary care trust the local strategic health authority has only two priorities: to reach financial balance and to meet targets. What incentives are needed for primary care trusts to promote physical activity to get them looking at the whole question of obesity? You mentioned that smoking cessation is funded. Is there anything in the NSFs to make GPs record weights of patients and get interested in those?

Dr Maryon Davies: There is a massive amount of work which can be done to try to embed this much more into the NHS and into delivery of health. Firstly, yes, it is certainly there in policy, in the coronary heart disease national service framework, in the diabetes national service framework, mental health and older people in particular. There is an element in there about promoting physical activity and there is stuff about healthy eating. It is there in policy. You are right, health improvement in general tends to get marginalised and this area does in particular because of course the pressure on health authorities is to balance the budget but also the waiting times and waiting lists, those are the things in the premier league of must-dos for health authorities. Smoking is in there in that premier league, interestingly, but the obesity thing, diet and exercise, are way down the bottom of the list, almost falling off the bottom. It does probably get marginalised. One thing we should like to see to help to address that, to provide the incentive, is to make sure that indicators around promoting exercise, indicators around promoting healthy eating, reducing obesity, are much more embedded in the performance assessment framework for these organisations. At the moment chief executives jump up and down if you talk about smoking cessation; they get very anxious. Would it not be good if we could get them to jump up and down just as much around what they are doing about exercise, what they are doing about healthy eating?

 

Q554  Dr Taylor: I think it was Professor Riddoch who said that it should be GPs who are weighing children and adults as well. Is there any legal compulsion on GPs to record these things? They get brownie points for recording blood pressures. Is there any way this could be made more attractive?

Dr Maryon Davies: There is a great opportunity in the pipeline right now. As you may know, a new contract is being worked through with general practice and as part of that there is the quality and outcomes framework. There are going to be much more formal ways of recording certain aspects of lifestyle concerned with chronic diseases like heart disease and diabetes, blood pressure, chronic bronchitis, etcetera. What we can do, through our quality framework, is to make sure that firstly the measurements are made, secondly that it is properly recorded into a proper framework and it is fed back up through and analysed so that we can see what is happening. There is a great opportunity for improving all that.

 

Q555  Dr Taylor: Are there any strategies for sport co-ordinators linking with public health doctors?

Dr Maryon Davies: One of the issues I mentioned earlier on about the lack of infrastructure is that it is very patchy. For instance, I was talking only the other day to somebody who is in South London, whose title is healthy lifestyles co-ordinator. That is a good post. It is a joint post with the local authority and the health organisation. There are not many of those people around the country. There are a few, but it is all very patchy. What we need are people like that who will help to co-ordinate the work which is going on around physical activity and healthy eating, but also have people who can actually do the frontline stuff. So they need many more community dieticians; there are not enough of those around and we need them for obesity, but we also need them for diabetes and high blood pressure, etcetera; we need many more exercise experts and trained physical activity instructors based largely in the leisure service; we need more of them too. What we need to set up is a properly organised system, rather like the smoking cessation one I was mentioning earlier on, so that it is embedded in there, it is not just a one-off, it is not subject to "projectitis", here one day, gone the next; it is a sustained service, a mainstream service for physical activity and for healthy eating.

 

Q556  Dr Taylor: Local strategic partnerships are supposed to exist for this very purpose. Are they doing that? They exist, but again, very patchy. Are they engaging in this sort of work? Some are, some are not. It is all highly irregular around the country and it is not very well performance assessed around the country. You get it working in some places better than others. Ditto with all the regeneration work and the neighbourhood renewal work which is going on, which is sometimes taken on board by the local strategic partnership and sometimes is not. There are great opportunities for regeneration, town planning and all that sort of thing - we talked about them today - to really get some of the environment side of this thing happening properly. It is not really very well co-ordinated. A lack of co-ordination, a lack of infrastructure and a lack of performance assessment.

Mr Franklin: I have been a local authority councillor as well for about nine years. During that period there has been a dramatic change in the way that health has come into the local authority agenda. That is really positive. There are some good examples coming through. When the local strategic partnership started off, sometimes you got people in the same room who had never met before, local authority and health authority and so on. It is really positive. A good example is Stockport where staff from PCT have actually been seconded to the local authority to work within their transportation team. That is brilliant and it is getting the traffic engineers to be thinking about health for the first time. For every new transport policy in Stockport, they are thinking about the health implications of that policy. They are creating a green corridor through the centre of Stockport and people can use that for leisure walking but also for utility trips as well. They are creating a green A-Z and thinking about how they can use signage to encourage people to be more active. That is a really good example to go to look at; others are at a very early stage and we need to spread that best practice more.

Q557  Dr Taylor: So our report can emphasise that.

Mr Franklin: Yes.

 

Q558  Dr Naysmith: The National Audit Office reported in 2000 on obesity and said that there were lots of good examples of cross-departmental working to combat obesity. Is that your experience?

Dr Campbell: What I was going to say was that I think there are some very good examples of local good practice beginning to happen. I absolutely support the fact that it is very piecemeal and very patchy. I do think it is critical that the Department of Health comes to the table with some way of incentivising this. It is not a prescriptive programme, because that will not work. It needs to be locally developed, but it needs to be incentivised to try to create and take this good practice and make it common practice, but in a way which does not disappear. We did that in schools for years. We came up with one initiative, followed by another initiative, followed by another initiative. It was like a revolving door: one came in and another one went out. I do not know what the solution is, but we have to find some funding mechanism and some infrastructure to make sure that what we want to do has a pivotal point, whether it is the co-ordinator that you described or somebody who takes responsibility for that in every local area and then works through the strategic partnerships and finds very different solutions locally. There is no one solution. You need somebody with the energy, the time, the expertise to do that and in fact no, we do not have that now. Although there is a lot of good talk going on across departments, I still feel that there is a way to go for health to play its full part in delivering this agenda.

 

Q559  Dr Naysmith: One of the problems is that if you get different departments all collaborating a little bit on obesity or increasing activity, nobody is really in charge, nobody ever takes it as their prime concern. How could we combat that? Is it a question of appointing some kind of co-ordinator? Either we are talking about across government or we are talking about local initiatives, but there needs to be somebody, does there not?

Dr Campbell: Yes. There is a cross-government group called ACT, the Activity Co-ordination Team, which is jointly chaired by DCMS and Department of Health. You are right, what is happening under its umbrella is that people are looking at how we join up all the initiatives which are there and that is a very worthy and important thing to do. We have to go further than that if we want to create the step change we are talking about. If I may say so, it is about the Department of Health seeing this as equally as big an issue as some of the issues that it addresses and applying the same resource to it that it has applied to tackling smoking and other key areas of health. I believe this is now going to be the biggest issue in public health that we have and we cannot sit by and think that by joining up all we are doing, however good it all is, it is going to be enough, because it is not.

 

Q560  Mr Bradley: Just to go back again, we have touched on various aspects of the environment and the safety aspect of the environment and it is quite interesting talking about cycle points. We have had huge arguments in planning applications about how many car spaces there should be in a new flat development, but we do not consider any other aspect of transport related to residential living. We talked earlier about making it safer in cities, but in my area the problem is the urban residential areas with high flow of traffic through areas. I have no city centre, but I have a huge number of safety issues around urban highways. Are there any other ways in which planning or urban design can actually really kick in and take the fear we addressed earlier out of other forms of travel instead of cars?

Mr Franklin: Very often we are talking about the detail, because if you are going in a car at 60 miles an hour you do not need the detail. If you are walking at three miles an hour, you do need that detail to feel safe and secure. It is things like lighting which is very, very important if you want to encourage people to use the public realm when it is getting dark. So what sort of lighting? We are still getting lighting in this country which is the old sodium, the yellow light, really bad for recognition. People feel safer if they can see at a distance somebody's facial expression for instance. We have invested a lot in things like CCTV, but not very much in improving the lighting stock in this country. On planning, some of the principles behind secure by design are about making sure the building is secure inside rather than the public realm outside being secure. You still find new buildings going up with little alcoves in which people can hide, which make people feel less safe when they are walking home. Shops. If you have full shutters coming down on the shops at night, firstly, they are likely to have graffiti on them by the next morning; secondly, it makes it a much more threatening environment when you do not get the natural light coming from the shops out onto the pavements. Having planning regulations so you have grilles rather than full shutters can make a difference. It is these small details. The other thing I want to say as well is that we have to be very careful about this issue of safety. It has been used in the past to stop people doing things. In a sense, it is almost like saying the safest thing to do is not to get out of bed in the morning. There are some people who would prefer there to be nobody walking on the streets, because that is better and there will be no pedestrian casualties at all, so that is what they are aiming for. What you find is that people walking are sent underground, they are sent over bridges, they find railings at the side of the pavement so they cannot cross where they want to cross. The overall effect is that the experience of doing the activity is much less pleasant, so they are less likely to do it and they will take to their car instead. It is that fine detail that we need to address if we are going to encourage people to be more active in the street.

Mr Grimshaw: I would say on the Fallowfield loop that we are finding the planners are not saying to new developers that they have to make links. Another area of interest is the Bridgewater canal which is a 40-mile long green corridor, largely through the urban area and the Port of Manchester is very keen to turn that into a resource for the whole city. The real challenge on that will be to make the hundreds and hundreds of links from that back into the community. That does require planning powers, it requires a commitment by a very large number of people from individual companies. For example, if every company adopts a bit, as often happens in America, that would be tremendous. So there are communities. The real key issue with which I think Tom would agree, is adopting better practice such as lower speeds, home zones, where the street is rearranged so the car is a visitor, a residential street and the people who live there are the primary people and kids can play and so on. It is just changing the priority so that the residents, the citizens, have their space and cars are not dominating it. There are city engineers in this country who until recently would report to the council the number of trees they had cut down each year; in other words it was a good thing to cut down urban trees. I think all of us on this side would say that the tree in the street is a significant determinant about using that street as a pedestrian or as a cyclist. There is a whole range of other players who can each in their own way make the environment more attractive for people to exercise in.

 

Q561  Chairman: It has always struck me in my constituency that there are certain roads where it is frankly virtually impossible for pedestrians to cross. I have often worried over the way in which increasingly the car use has dominated our entire thinking. If ever we have a problem - and we had this dispute a few years ago when there was a blockade on petrol supplies and a huge national crisis - there is a huge lobby behind the motorist and motorised road user. Where is the pressure from the pedestrian? Mr Franklin, is an increasing voice being developed among pedestrians which is saying this is jut not on when I cannot cross a main road in an area I travel through on a daily basis?

Mr Franklin: The problem is that people have developed such low expectations of their public realm that they do not expect any better any more. They expect to have trouble crossing the road, they expect to have a car zooming round the corner and to have to nip across really quickly. This is the sort of thing they have now got used to. Part of the problem also is that most people do not see themselves as pedestrians. Everyone walks around, everyone uses that public realm, but they do not actually see themselves as pedestrians. I have to say that as a country we are not at the stage where people are beginning to realise that we have been moving in the wrong direction for decades, but the practice on the ground is still moving in the wrong direction and it is going to take a Herculean effort to turn that round. I have to say that a lot of what we are talking about here with exercise in the street really comes down to the attitudes within the Department for Transport because they control so much of that environment and they are the leaders for people in local authorities who are making the decisions about the urban environment, the public realm.

 

Q562  Chairman: There is a walking strategy coming up at some point, but we have been waiting for quite a long time; it is taking a while to arrive.

Mr Franklin: Part of the problem with the health agenda, and it is great that it is based on this, is that the Department for Transport might see this as being let off the hook. They might say it is fine and they can concentrate on roads and railways and fast travel and that is fine because walking is now the responsibility of the Department of Health and is a health issue. You have to make sure you are really engaging the Department for Transport in this and they do not just pass the buck to you, which I suspect they may do. I have to say I am not holding my breath for a national walking strategy.

 

Q563  John Austin: I thought the Office of the Deputy Prime Minister was responsible for the national walking strategy.

Mr Franklin: No, it is Department for Transport and it has to stay there. The Office of the Deputy Prime Minister and the Select Committee have also been pressing the Department for Transport for action on this because they are interested in livability and the public realm. I think we have to make sure that the focus stays there and they do actually deliver what they have been promising.

Mr Grimshaw: May I pick up the point about the inter-relationship between departments? The Department for Transport has this target of increasing cycling fourfold to eight per cent of all journeys, which would more or less be in common with what was achieved in Sweden. I am sure that the Department of Health have not put their weight behind that; they probably do not even know it exists. Yet a fourfold increase in cycling would probably be more valuable for their aspirations than for the Department for Transport which is actually only interested in reducing congestion. The only reason they want more cycling is because they see it might help reduce congestion in the cities. If your Committee could persuade the Department for Transport that this is a key health issue and persuade the Department of Health that they should back this to the hilt, then you would get the situation, going back to Richard's point in hospitals, where green transport plans and how staff get to hospitals would not be just seen as something which is by the by, it would be seen as equally as important as targets or waiting lists because it would be central to the health service delivering what it has to do. Very recently Worcestershire health authority have suggested to their staff that they might give them an extra five minutes a day holiday if they walk or cycle each day. Five minutes a day is almost a week's holiday a year. If it is true - and I am sure colleagues here will say a fitter population is better for the employer - surely we should be able to work out how much better it is. If a fit person gives an employer two more weeks' work, why do we not split it between the employer and the employee so we start at last to get positive feedback to encourage people to walk and cycle.

 

Q564  Chairman: How is that monitored?

Mr Grimshaw: I am not sure how it is monitored, but in our firm, where we employ 120 people, we are debating whether to do exactly that. Our problem is that everybody cycles. We are badly lacking positive incentives to encourage people not to drive or to drive less or to walk. On the issue of incentives, which perhaps picks up Doug's point about getting commercial companies involved, it is not a benefit to a motor manufacturer to have less driving, for example.

Q565  John Austin: May I get away from the general increase in physical activity for all to concentrate on those people with a very severe weight problem or who are obese? Dr Maryon Davies mentioned the issue of stigma earlier and we all know how stigma is reinforced when the overweight child is forced into physical education they are not particularly good at doing. Many people with obesity problems of course have real physical difficulties in exercising at all. What can be done practically to encourage exercise for those who are severely overweight or obese?

Professor Riddoch: My understanding is that from a physiological point of view you are right. Very overweight people have difficulties exercising, they have trouble regulating their body temperature for instance and then there are all the psychological barriers, being seen in public, being seen getting changed in changing rooms, that kind of thing. My own understanding is that in the early stages diet is probably the most important strategy and physical activity is built in later as weight reduces. In any long-term weight reduction programme, if exercise is part of it, it is doomed to long-term failure. Exercise has a very important effect in keeping the weight loss going; maintenance is much better in a diet and exercise programme.

Dr Maryon Davies: Another aspect is to try to get away from the Lycra brigade, the fact that people have to dress up in all the shiny gear, which is very off-putting for the people you are describing. What is happening round the country is that there are special sessions for people who are overweight and the norm is just to dress in any old flopsy-mopsy stuff you want to dress in and you do not have to have the gear. Most of these sessions are separate sessions, screened away in separate rooms from areas where the general public are. There are ways and means of trying to remove the stigma around that and make it more accessible for people who feel embarrassed about that sort of thing.

 

Q566  Dr Taylor: I must just pick up something Mr Grimshaw said. There is no doubt that the best way of getting people out of cars is not to provide enough parking spaces and this is why at home the Worcestershire people are not trying to help their employees, they are purely trying to make room in car parks for patients to get to the hospitals. However, that is an aside. Moving on to the role of the government, in the States we talked a little bit about fiscal measures. Do any of the panel have any ideas about fiscal measures that the government could take, subsidies, tax benefits, tax penalties, to help in this general picture?

Dr Campbell: There has been some discussion around tax relief for people who join physical activity or leisure clubs and so on. Those kinds of things could work. Local authorities had plenty of schemes in the past where they had leisure passports where they used the subsidy from one group which could afford to subsidise free use to other groups.

 

Q567  Dr Taylor: What about taxation on bad foods? Sorry, I should not have said "bad", because you are quite right, one should not label foods as good and bad.

Dr Campbell: I am not sure about that.

Dr Maryon Davies: Tax is one area but subsidy is another. There has been a lot of work, mainly through the European Union, around the Common Agricultural Policy and the shifting of agricultural policy away from things like the butter mountains and the milk lakes and the fatty carcases and towards leaner carcases of meat and more careful use of dairy products so they do not go back into the market as high fat food and moving towards encouraging more fruit and vegetable growing. There are more agricultural policy shifts which can be made. Taxation is a much more difficult one. I have no views on that one.

 

Q568  John Austin: May I raise a slightly different issue? When we were in the States we were informed that there were particular groups who are at risk, largely Hispanic and African American populations and there is evidence here that among certain ethnic groups there is a very worrying rise in Type II diabetes and cardio-vascular disease. Some of those communities may be less culturally used to engaging in the kind of physical activity that we have been talking about addressing here. Are there any programmes which are targeted at those particular communities where there is perceived to be a high risk?

Dr Campbell: I can only speak about the schools experience. I am conscious that we have talked a lot about young people, but certainly a few of the specialist sports colleges which are in health inequalities areas and indeed where there are large ethnic populations have begun to develop some different and what would appear to be relatively successful strategies at reaching both the young people with different cultural backgrounds and different understanding of physical activity and different types and expectations of activity and indeed their parents. If it would be helpful, I can certainly let you have a couple of those case studies. It is about us understanding as a multicultural society. We do often start from a rather white middle class view of what we are talking about and as much as we try to do the right thing, we have to be very clear we need to engage with populations and with people from a whole range of backgrounds to help understand how to present these messages perhaps in a very different way to certain young people. We are not often good at that. We are getting better at it within schools, but in terms of the population yes, having worked in some of the toughest inner city areas in England for a while as a development officer, I made the classic mistake of assuming certain things about certain population groups. I always remember turning up in a particular area of Leicestershire which was predominantly West Indian with cricket bags. How had I ever got to that assumption? I automatically assumed they would all want to play cricket and they all looked at the stuff and said "What's that for?". I said "Don't you want to play cricket?", they said "Absolutely not". We can make those assumptions and we can make very general assumptions. We really have to communicate very effectively and make sure that the messages are shaped to have the impact we want to by the people we are trying to work with and not assume we know what the messages are for them.

Dr Maryon Davies: To echo that, it is very important to use the people themselves as part of developing the programme. There are lots of examples around the country of programmes which are aimed at specific risk groups. For instance, quite a few are aimed at South Asians who are particularly at risk of diabetes and heart disease; quite a few aimed at Black Caribbeans because of their particular risk around high blood pressure. My own day job is in South London and we have culturally sensitive programmes and working through community groups aimed particularly at Black Africans to try to get them moving. Incidentally, it is useful to share these examples around the country and what the Faculty of Public Health has done is produce a toolkit, and I am happy to provide you with copies of this, which includes a lot of good examples from around the country, many of which are aimed at specific groups. For instance, one of the most effective ways of appealing to South Asian women is through the medium of dance. That is very popular and seems to work very well. The sort of thing which is listed in the publication.

Professor Riddoch: That question highlights something Alan mentioned a while back, that in any strategy to get people active you have to have this overarching population level strategy, so we can generate medical officers' reports, we can change the environment, we can put out educational messages, we can improve training and they are all very good for the physical activity environment. Then the delivery at the individual level is done within PCTs or even smaller units than that, within general practice and to get those individual focused initiatives going within this overarching environmental strategy is probably the way forward. It is very much a local population specific problem. Every location has its particular barriers to activity.

 

Q569  Dr Naysmith: This will probably be the last question so if anyone has something they urgently and briefly want to get in, now will be the time to say it. The Government has this 70 per cent participation rate in physical activity by the year 2020 which we heard a little bit about earlier on. Do you think you are going to meet that target and if not, what are the major barriers which exist to the Government meeting its target?

Dr Maryon Davies: Just an initial observation. There is some discussion about redefining that target in terms of what we mean by activity, not to make it much easier for us to reach it, but simply to be clearer about what it means because of the different benefits for different levels of activity.

Dr Campbell: My response would be that once we have redefined it we will only achieve it if we really recognise that this is probably one of the biggest cross-cutting agendas we have and that every department plays its part in delivering the response. It cannot be left to one department. It is about all departments in government really coming to the fore and really recognising that together we can make a difference. If we do not get that joined up working across the government departments and that joined up investment, then no, we will not achieve this. It cannot be left on the shoulders of one department. It is too big an issue, as I think we have demonstrated.

Professor Riddoch: I should just like to make the point that physical activity as a health promoting behaviour is relatively new on the agenda. In 1999, when I first went to Bristol University, we set up a course in exercise and health and we wondered whether it was needed. It had been raised in America that this was a problem, but in Britain it was fairly radical at that time. It has since rocketed up the agenda. There is still a traditional resistance against things which are new in this country and to juxtapose it now with diet, although we have known for much longer than that that diet is bad for you, means we are always playing catchup with other areas. The other thing I should just like to say is that surely the way to attack low activity levels is to remove the causes of inactivity rather than try to give people coping strategies to move actively through a physical inactivity environment. If we can really address the causes of inactivity, which we are trying to get over to you today, that would be a much more effective way of setting forward.

Chairman: Any further questions? If not, may I thank you for an excellent session. We have learned a great deal and one or two of you have mentioned that you are going to follow up with further information and we appreciate that. Thank you very much for coming along today.