HC 1048-III Health CommitteeWritten evidence from the Sport and Recreation Alliance (PH 10)

The Sport and Recreation Alliance is the national independent voice for sport and recreation, representing over 320 member organisations including the national governing bodies. Our members account for 151,000 sports clubs catering for some 13 million participants, and the Alliance exists to protect and promote the role of sport and recreation in society. The Alliance welcomes the opportunity presented by this inquiry to highlight the importance of physical activity for public health and consider the likely impact of the proposals contained within the Health and Social Care Bill.

Summary

Physical activity brings significant benefits in tackling a wide range of preventable diseases, for people of all ages.

Sport and physical recreation have a broad appeal, are inexpensive to deliver and are an essential part of an effective strategy for public health.

The Government’s proposal to radically shift power to local communities should not come at the expense of much needed coordination at the national level.

The Department of Health, the Department for Culture, Media and Sport and the Department for Education all have a common goal in promoting and delivering sport and physical recreation. This shared interest should be reflected in close cooperation between departments and between Cabinet colleagues.

Health and Wellbeing Boards must include representatives from sport and recreation. Such boards could potentially serve as a valuable coordination mechanism for local sport provision and physical inactivity initiatives, but to do so effectively they require strong leadership.

It is vital that the creation of a separate public health body does not lead to a fragmented health system; physical activity has a role to play both in terms of preventing and treating disease.

“Medic-to-sport” initiatives such as the Amateur Swimming Association’s “Swim4Life” GP Referring Programme which form a connection between patient advice and local sport and recreation opportunities should be a key feature of public health framework.

The Value of Sport and Recreation

1. The myriad benefits of physical activity for health are well documented. There is a comprehensive evidence base to support the promotion of sport and physical recreation as a cost effective, inclusive and sustainable route to tackling a range of public health challenges. Physical activity brings significant benefits in tackling a wide range of common diseases, for people of all ages, and inactivity is as important as smoking and an unhealthy diet as a major factor of chronic disease; achieving the recommended levels of moderate intensity physical activity can reduce premature mortality by between 20–30%.1

2. Research has shown physical activity to be protective against obesity, type II diabetes, osteoporosis, haemorrhagic strokes,2 arthritic problems,3 cardiovascular disease and certain cancers. An active lifestyle can also improve psychological wellbeing, proving effective in tackling clinical depression, stress, anxiety and low self-esteem.4 Increased sporting activity is linked to the development of the type of personality resistant to drug and alcohol addiction,5 while girls participating in sport are less likely to be sexually active at a young age and have teenage pregnancies.6

3. Despite the benefits on offer, levels of physical activity in England remain low. The Department of Health’s most recent survey revealed that only a quarter of adults reported that they regularly took part in sport, and less than half of respondents said they made walks of 20 minutes or more at least three times a week.7 The UK is the most obese nation in Europe, and the Government’s proposals for public health must therefore address a significant challenge. The promotion of active lifestyles – of which sport and physical recreation are a key part – would both improve health outcomes and represent a significant saving for the NHS. The direct costs associated with physical inactivity have been estimated to be between £1 billion and £1.8 billion,8 excluding the far greater indirect financial costs to society as a whole which are estimated to exceed a further £5 billion. Without decisive action the costs of tackling obesity could reach £50 billion by the year 2050.9

4. It is vitally important to reverse the current situation whereby a majority of adults are either overweight or obese while a minority meet guidelines for regular physical activity.10 Sport and physical recreation have a broad appeal and are inexpensive to deliver, and can bring about lasting improvement for individuals of every age and background. It is clear that there can be no effective strategy for public health which does not promote and facilitate sport and physical recreation.

The Role of National and Local Government

5. Given the long-term public health benefits of regular physical activity, the Department of Health, the Department for Culture, Media and Sport and the Department for Education all have a common goal in promoting and delivering sport and physical recreation. This shared interest should be reflected in close cooperation between departments and between Cabinet colleagues, and it would therefore be extremely disappointing if the Secretary of State for Health did not take an active role in this regard. At the very least, Public Health England must engage fully with national governing bodies, Sport England and DCMS. The Government’s proposal to radically shift power to local communities should not come at the expense of much needed coordination at the national level.

6. The success of the shift of power to local communities will depend on the effectiveness of Health and Wellbeing Boards as mechanisms for fostering collaboration between local networks. While they are potentially very valuable as a mechanism for coordination between local authorities and commissioning consortia, they will fail without strong leadership and solid support from all sides. If physical activity is to form a part of the public health agenda it is clear that sport and recreation must be represented, given that local authorities already carry out a range of relevant functions, including provision of leisure services. The Sport and Recreation Alliance has therefore recommended that County Sport Partnerships be included on the boards, as each has full view of local initiatives and is able coordinate and facilitate the sharing of information locally (and nationally through the County Sport Partnership Network).

Physical Activity as Prevention and Cure

7. While the intention to ring-fence funds for the purpose of delivering public health outcomes is welcomed, it is extremely important that this separation does not lead to a fragmented health system; physical activity has a role to play both in terms of preventing and tackling disease. While exercise in early life is protective against a wide range of conditions, physical activity in later life can help the management of painful conditions, and should not be confined to a “public health” function. There is a risk that, under the proposed arrangement, sport and physical recreation could in fact become more alienated from areas of the health service in which they have much to offer.

8. The Sport and Recreation Alliance believes that GPs should be fully equipped to promote and facilitate sport and physical recreation, and as such proposals to strengthen the focus on public health issues in education and training are welcome. GPs can be stronger advocates for participation in sport and physical recreation and should not only understand and communicate the full range of benefits of regular physical activity (both as a preventative measure and as a form of treatment) but also be aware of local opportunities and have access to resources which can be easily disseminated to patients. Sport and recreation organisations are well placed to work alongside GPs to develop pathways to physical activity, as demonstrated by the example of the Amateur Swimming Association’s “Swim4Life” GP Referring Programme. The programme is an initiative to establish swimming as a tool for GPs across the UK, seeking to transform the way swimming is delivered to individuals.

9. The trial run of “Swim4Life” was successfully delivered in the East Midlands through the effective coordination of ASA regional staff, a GP Practice and the manager and staff of a local swimming pool. Patients were contacted by the GP – utilising the ASA’s template correspondence – and were encouraged to visit their local pool, where participating staff greeted patients and guided them through the visit. The results of the trial programme were encouraging; of the 1,500 patients who were contacted by their GP, 60 participated in the programme and a quarter of those who completed the programme went on to become members of the facility. The ASA’s initiative therefore goes beyond a GP recommendation to undertake more exercise by providing a comprehensive system of referral, starting with active engagement by the GP. By linking the advice individuals receive in the doctor’s surgery with the service provided at local facilities, swimming becomes more accessible and more attractive to those who would otherwise remain insufficiently active.

10. The “Swim4Life” example demonstrates the potential benefits of utilising sport and recreation networks at the local level. A second example is the Get Walking Keep Walking (GWKW) programme, which is a four year project developed by the Ramblers. GWKW aims to increase regular independent walking amongst previously inactive and insufficiently active people. The scheme comprises of six projects designed to exploit the ease and accessibility of walking in an imaginative way, drawing together a unique combination of outreach, led walks, resources and online tools. The basic principle of GWKW is for people to gradually increase their level of walking using structured plans, and there are a number of ways in which participants can engage with the programme; at the end of February 2011 GWKW had engaged 71,635 people from across the UK. An independent evaluation of GWKW11 revealed that participation in the programme led to an increase in the number of days on which people are active for more than thirty minutes. There were clear benefits for individuals, who were more likely to be happy, motivated, energised and engaged, with nearly 40% saying they had taken up another form of exercise following their involvement in the programme.

The Public Health Outcomes Framework

11. Sport and recreation clearly have a significant role to play across the five domains identified in the Government’s White Paper, and the list of proposed indicators of health improvement rightly includes the percentage of adults meeting recommended guidelines on physical activity. However, the Sport and Recreation Alliance believes that the Framework should take into account the wide range of activities that may be included here, ranging from shorter duration, more intensive activities (such as squash or running) to less intensive, longer duration activities such as cricket or golf. The indicator must reflect that each of these activities leads to a positive outcome for health, but that patterns of participation differ greatly.

12. It is important that the Government recognises that there is to some extent a hierarchy in terms of importance within the set of recommended indicators, and the Sport and Recreation Alliance has sought to bring attention to the importance of the physical activity indicator. Physical activity is in effect a “super-indicator”, given the evidence linking it to positive outcomes across a range of other indicators including: reduction in crime (domain 2); truancy rate (domain 2); prevalence of healthy weight (domain 3); self-reported wellbeing (domain 3); prevalence of recorded diabetes (domain 4) and mortality rate from all cardiovascular disease (domain 5). The relationships between these various measures of health highlight the fact that indicators should not be taken in isolation.

13. The framework should do more than track what is happening (eg measuring mortality rates) but should indicate progress in prevention. In this context, physical activity indicators are more revealing as a measure of an effective public health strategy, and should be prioritised when it comes to the payment of a health premium. The Outcomes Framework must also take into account the pattern of participation in physical activity across different age ranges. It is vital that public health strategies address the problem of declining physical activity levels over the life-course; last year a quarter (26.2%) of 16 to 34 year olds met activity guidelines in 2009–10, as opposed to 7.7% of those aged over 55.12

14. The Sport and Recreation Alliance believes that the formula driving the health premium should be able to accurately reflect achievements relating to physical activity, taking account of the varied nature and time span of the associated health outcomes. Many of the benefits derived from physical activity are not seen for many years; for example, exercise in early life will lead to healthy outcomes in later life (for example, by preventing cardiovascular disease). Given that physical activity is important for health outcomes across the life-course, the health premium should be designed so as to reward long-term thinking as well as short-term results.

June 2011

References

1 Department of Health (2004) At least five a week: evidence on the impact of physical activity and its relationship to health.

2 Coalter, F (2005) The Social Benefits of Sport: An Overview to Inform the Community Planning Process, SportScotland, Report 98.

3 Macera, C, Hootman, J and Sniezek, J (2003) Major Public Health Benefits of Physical Activity, Arthiritis & Rheumatism 49(1):122–128.

4 Scully, D, Kremer, J Meade, MM, Graham, R and Dudgeon, K (1998) Physical exercise and psychological wellbeing: a critical review, British Journal of Sports Medicine, 32:111–120.

5 Kircaldy, B, Shephard, R and Siefen, R (2004) The relationship between physical activity and self-image problem behaviour among adolescents, Social Psychiatric Epidemiology 37(11):544–550.

6 Sabo, DF, Miller, KE, Farrell, MP, Melnick, MJ and Barnes, GM (1999) High school athletic participation, sexual behaviour and adolescent pregnancy: a regional study, Journal of Adolescent Health, 25(3):173.

7 NHS Information Centre (2011) Statistics on obesity, physical activity and diet, England 2011.

8 Department of Health (2009), Be active be healthy: a plan for getting the nation moving.

9 Foresight (2007) Tackling Obesities: Future Choices:http://www.bis.gov.uk/foresight/our-work/projects/published-projects/tackling-obesities

10 NHS Information Centre (2011) Statistics on obesity, physical activity and diet, England 2011.

11 Centre for Local Economic Strategies (November 2010) Evaluation of Get Walking Keep Walking.

12 Sports England (2010), Active People Survey 4.

Prepared 28th November 2011