Examination of Witnesses (Questions 485-499)
6 NOVEMBER 2003
DR ALAN
MARYON DAVIS,
MR JOHN
GRIMSHAW, PROFESSOR
CHRIS RIDDOCH,
DR SUE
CAMPBELL CBE AND
MR TOM
FRANKLIN
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 Davis: I am Dr Alan
Maryon Davis. 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 Davis 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 Davis: 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 10 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% 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% 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 Davis: 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 Davis: 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 Davis' 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 Davis: 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% of all primary school
children in the UK have bikes. Of the primary school children,
something like 75% of them want to cycle to school, but only 2%
are allowed to. If there were anything, dare I say, that members
of the Committee wanted to do and 75% 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 and 43% 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,
17% are by car and 36% of journeys under two miles are by car.
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 1% as children to school. So the
Government has no hope of meeting its target of getting to 8%
of all journeys by bike which is its target by 2012. To achieve
that it would have to get cycling up to 15% by analogy with European
schools, which probably means 30% 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% of children who actually wanted
to cycle when they were children, but maybe you did not permit
them.
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