National Assembly for Wales
Children and Young People Committee
CO 05
Inquiry into Childhood Obesity
Evidence from : Sustrans
Sustrans and public health
Sustrans has over thirty years’ experience in the development of policies and strategies, and the design and implementation of practical work programmes, to foster behaviour change towards healthier ways of travelling. Delivery of these programmes involves wide, multi-sector partnerships at all levels, from individuals and local communities to national government and the European Union.
Introduction
Obesity in Wales is costing the NHS well over a million pounds a week, and experts are predicting that cost to rise significantly over the coming years. Today’s obese children are the obese adults of tomorrow.
As the introduction to your inquiry states, almost one-in-five children in Wales are obese, giving Wales one of the highest rates of childhood obesity in Europe. The “Creating an Active Wales” plan highlights that “Only 44% of children aged 7 to 11 and 35% of those aged 11 to 16 achieve the recommended guidelines of 60 minutes of moderate intensity physical activity on 5 days a week.”
Sustrans response to this inquiry highlights the effectiveness of physical activity in preventing and combating obesity. In particular, we stress the importance of building physical activity into our everyday life, as recommended by health organisations such as the National Institute for Health and Care Excellence (NICE), World Health Organisation and the British Medical Association. Despite clear guidance from these organisations we have not yet seen an approach in Wales which moves towards supporting increases in everyday physical activity such as active travel.
Whilst many of the Welsh Government strategies, notably the ‘Creating an Active Wales’ recognise the issues they have failed to deliver change in Wales because inadequate funding is associated with the intended aims. Projects are too small scale to have an impact, or cut after only a short period.
The Welsh Government has also failed to work cross-department to effect the changes needed to create the conditions for a more active Wales.
We remain concerned that many of the existing strategies in Wales designed to combat the increase in childhood obesity are focussed solely on sport, which is an exclusive activity. In the education environment, active travel falls outside the responsibilities of schools, and is not promoted by the physical activity workforce, meaning it is usually sidelined.
Sustrans believes that a clearer budget should be designed for preventative health measures, and that the focus should be on levels one and two of the childhood obesity pathway.
The importance of active travel
Active Travel (walking and cycling) is an accessible and life-enhancing form of health benefitting physical activity and cutting obesity.
Guidance from NICE is unequivocal on the case for active travel; most recently in November 2012 the school environment was named as one of three settings with the greatest potential for increasing physical activity. A set of recommendations quoted evidence of effectiveness where physical activity has increased as a result of targeted active travel approaches. Recent academic research confirms that travelling actively to school is associated with an increase in the total amount of time children spend in moderate to vigorous physical activity.
Active travel to school needs to be recognised and promoted as an effective and equitable way of young people increasing their physical activity levels and reducing levels of childhood obesity across Wales.
Change4Life & MEND programmes
The Committee asks specifically for respondents’ views on the effectiveness of the Change4Life and MEND programmes.
Sustrans supports promotional and marketing programmes designed to help ‘normalise’ changes in behaviour, in particular in relation to active travel. However, these programmes are most effective when combined with other initiatives – for example changes to the built environment, travel planning or cycle training.
Sustrans believes that the Change4Life programme has so far fallen short of its potential to change behaviour by existing in isolation. Although authorities were encouraged to badge some of their services as Change4Life only superficial funding was made available to do this. The Welsh Government needed to support the campaign with other projects across the spectrum.
It is widely accepted across the health sector that the easiest way to get the physical activity we need is to build it into our everyday routine. We therefore feel that the MEND programme is limited in its ability to change behaviour, because it provides additional barriers, such as time and specific locations. This is also true of the National Exercise Referral Scheme, which relies on a leisure centre based approach to increase physical activity.
Programmes that are designed to build physical activity into the daily routine are likely to be more effective at combating childhood obesity.
Strategies
The “All Wales Obesity Pathway (2010)” was produced to inform Welsh Government strategy on dealing with obesity in Wales. The strategy references NICE guidance highlighting the need for a long-term strategy, a cross-government approach and the importance of the environment to people’s ability to be active.
Notably, this final point was supported by the Chief Medical Officer for Wales, Dr Ruth Hussey, in her comments at the launch of the Welsh Government’s Active Travel (Wales) Bill:
“We know our environment and transport can have an impact on our health, and I believe the Active Travel Bill will make it easier in everyone in Wales to make healthier choices. Small changes to our daily routines, like walking and cycling short distances, can improve the way we feel as well as our physical health. By making changes to the environment and transport, the Active Travel Bill will make the healthy choice, the easier choice. This is a great step forward for Wales.”
The “Creating an Active Wales” document – which underpins other Welsh Government strategies including the Walking and Cycling Action Plan – also stresses the importance of our environment in encouraging people to travel actively, including:
· Ensuring that the natural and built environment encourages people to be physically active, ensuring any redevelopments or new builds are accessible, safe and designed to make physical activity an attractive option.
· Developing an infrastructure to support travel by healthier and more sustainable modes, such as walking, cycling and public transport.
However, evidence of low levels of cross-departmental working can be found in the lack of focus on the built environment on the face of the Active Travel (Wales) Bill and no mention of active travel, exercise, physical activity or cycling in the Sustainable Development Bill.
The Welsh Government has set up a number of pilot programmes with the aim of tackling childhood obesity, but they have never been linked together or rolled out across wider areas – or indeed Wales as a whole – to have a meaningful impact. Investment is kept small scale, and departments within Welsh Government regularly fail to take note of projects from other departments, meaning lessons are not learnt.
This focus on limited pilot programmes is especially concerning given the nature of behaviour change programmes, which are more successful if run widely and over a long period. Behaviour change programmes are longer-term and rarely succeed when significantly limited in scope.
Two recent examples of success in Wales are the smoking ban and the introduction of a levy on plastic bags. Both of these initiatives have successfully changed behaviour and had positive outcomes, respectively in health and the environment. Crucially, these programmes were not piloted in a limited capacity, but were introduced across Wales with accompanying publicity campaigns.
Both these initiatives are rightly highlighted as success stories, yet the learnings from how both were applied do not seem to be taken into consideration when discussing childhood obesity in Wales.
There is a clear link between poverty/deprivation and obesity in Wales. In tackling childhood obesity levels, a focus on increasing physical activity in deprived areas will not only help to reduce obesity but can play a key role in improving access to education and subsequent employment.
Obesity pathway
In line with the above, Sustrans feels that in tackling childhood obesity, a greater focus and accompanying level of resource should be focussed on levels one and two of the Obesity Pathway, rather than focussing significant resources on the consequences of obesity in Wales.
Preventing obesity is a long term goal, a strategy designed to enable children in Wales to lead healthier lives will be more cost effective over the long term.
We would also support improved guidance on linking levels one and two of the pathway. For example, GPs at the moment are often unwilling to highlight obesity as an issue with patients visit their surgery. If GPs do prescribe greater physical activity, they also tend to recommend joining a gym or playing sport (which has cost and time implications) rather than advising more active travel.
Sustrans would recommend further guidance to GPs on the importance of active travel as a way of increasing physical activity. The average distance travelled to school by a Primary School aged child is 1.4 miles, so there is huge potential for the journey to school in particular to play a part in reducing childhood obesity levels.
Active travel in the school setting
Sustrans is concerned that the Physical Activity Ministerial Advisory Group taskforce reporting on physical activity in schools is focussed almost exclusively on sport, failing to recognise the potential for active travel to increase physical activity among all children. Sport is often an exclusive activity, with many children of lesser ability dropping out or failing to participate, meaning they have reduced levels of physical activity.
Active travel falls outside of PE and sport programmes and governing bodies’ structures. At the school or local authority level there is no ownership of the promotion of active travel; this is despite clear evidence that it is a very effective tool at increasing physical activity and physical literacy skills e.g. balance and coordination.
In countries where active travel is more prevalent, childhood obesity is lower. Active travel is a formative behaviour, unlike participation in sport where progression inevitably leads to drop off by less competitive children or where formal facilities restrain participation because of numbers, cost or access - walking and cycling are activities which are independently maintained for life.
In Wales, Sustrans can point to the considerable success of schools which are part of the Bike It project; regular cycling has increased threefold, with a corresponding reduction in sedentary travel modes. 76% of respondents said they thought that Bike It had a good or excellent impact on getting pupils at their school more physically active.
However, the BikeIt project in Wales is available in a limited number of schools across just five authorities, and without a long-term funding agreement. All of these factors limit the programmes ability to reduce levels of childhood obesity across Wales.
There is also a strong argument for adding cycling to the curriculum, so that every child has the opportunity to learn the skills needed to cycle safely. Programmes such as ‘Healthy Schools’ should include a stronger focus on active travel.
We remain concerned that physical activity in schools is dominated by sport and PE because this is easy for the Welsh Government to monitor. Programmes such as “5x60” focus on sport and is easily monitored with a tick-box exercise. However, theon getting pupils at their school more physically active.
However, the BikeIt project in Wales is available in a limited number of schools across just five authorities, and without a long-term funding agreement. All of these factors limit the programmes ability to reduce levels of childhood obesity across Wales.
There is also a strong argument for adding cycling to the curriculum, so that every child has the opportunity to learn the skills needed to cycle safely. Programmes such as ‘Healthy Schools’ should include a stronger focus on active travel.
We remain concerned that physical activity in schools is dominated by sport and PE because this is easy for the Welsh Government to monitor. Programmes such as “5x60” focus on sport and is easily monitored with a tick-box exercise. However, the sport focus (other forms of physical activity are excluded) means that those children who don’t enjoy sport are constantly missing out on opportunities to be active.
School travel plans are an effective way of helping pupils, parents and staff assess how the journey to school is made and can be used to increase levels of physical activity by identifying quieter routes more suited to walking and cycling. Ensuring all Welsh schools have a travel plan will also help to gather data on walking and cycling levels.
Active travel outside of school
However, it is important also to highlight that while journeys to and from school provide the ideal opportunity to enable active travel, our wider environment needs to change also to enable children to make more of their journeys actively. For example, an increase in 20mph zones will make our streets safer, allowing parents to feel more comfortable letting their children walk and cycle independently, or indeed play in the street.
Health impact assessments should be increased as part of the planning process and transport assessments to make sure that health benefits are factored in to new developments. Currently, WelTag – which is used to assess transport schemes – fails to assess the impact transport schemes will have on public health. Sustrans has long called for reform of WelTag, and for it to include the World Health Organisation’s Health and Economic Assessment Tool (HEAT).
Legislation
The Welsh Government is current pursuing both a Public Health Bill and the Active Travel (Wales) Bill, both of which have the potential to contribute to reducing childhood obesity levels in Wales.
However, both of these pieces of legislation will need to cross departments and have clear strategies if they are to be effective.
For example, in Sustrans submission to the Enterprise and Business Committee on the general principles of the Active Travel Bill, we highlight the lack of targets are part of the Bill. The Walking and Cycling Action Plan 2009-13 for Wales included targets – which have largely been missed – but failed to include a delivery plan for meeting them. The Active Travel Bill has the potential to combine both, for example an effective target for increasing active travel levels to school would lead to a focus on new routes linking communities to local schools. Targets are backed by both NICE and the BMA.
The forthcoming Planning Bill presents a clear opportunity to begin designing new developments across Wales so they provide the opportunity for safe physical activity as part of the daily routine.
Funding
Investment will be crucial in delivering the preventative measures needed to begin reducing levels of childhood obesity in Wales.
The Welsh Government has recently completed a review of Bariatric Surgery, with the aim of increasing the number of operations. The report calls for “an investment plan to increase the population rate of bariatric surgery”.
We believe that funding needs to clearly focus on preventative health, rather than increasing spend on the consequences of obesity.
The Health department budget for preventative health projects is not clear, and Sustrans would support moves to make this spend an indentified priority with a defined budget line.
Sustrans Cymru
123 Bute Street, Cardiff, CF10 5AE
029 2065 0602
References
Health in Wales: Obesity and alcohol costs to your NHS LINK
Sport and Active Recreation in Wales LINK
NICE: Walking and cycling: local measures to promote walking and cycling as forms of travel or recreation LINK
BMA: Healthy Transport = Healthy Lives LINK