National Assembly for Wales Health, Social Care and Sport Committee

Consultation: Inquiry into physical activity of children and young people.

Response from Hywel Dda Health Board

This document has been prepared in response to the request from The Health, Social Care and Sport Committee to provide supporting evidence in response to specific questions regarding the physical activity of children and young people within the three counties of Hywel Dda.

Hywel Dda University Health Board provides healthcare services to a total population of around 384,000 throughout Carmarthenshire (183,936), Ceredigion (79,488) and Pembrokeshire (120,576).  It provides Acute, Primary, Community, Mental Health and Learning Disabilities services via General and Community Hospitals, Health Centres, GP's, Dentists, Pharmacists and Optometrists and other sites.

Our overall vision is to support Hywel Dda residents to be resilient, to lead fulfilling lives and to be emotionally and physically healthy.

Question 1 What do we know about physical activity levels in children in Wales? How robust is the data on this issue?	Public Health Wales colleagues have provided current information in response to this question.  Data available for Wales (Welsh Health Survey 2015) indicates that the combined percentage of children aged 4-15 reported as being active for 60 minutes every day in 2015 was 36%. Girls are consistently reported as being less active than boys. The Health Behaviour of School Children study results from 2013/14 indicate only 15% of young people in this study are active for 60 minutes every day. The HBSC results indicate a similar gender gap to the Welsh Health Survey data, and the same trend over time i.e. no change in the past 10 years. The HBSC indicates no variation between the Hywel Dda population and Wales generally. The Welsh Health Survey ceased in 2015 and was replaced by questions in the National Survey for Wales. Initial data from the 2016 National Survey suggests 51% of children age 3 to 17 in Wales were reported as being active for 60 minutes per day – this figure is not comparable with previous years.
Question 2 Differences in gender-based attitudes towards, and opportunities for, participation in physical activity in Wales.	The School Sport Survey (Sport Wales) 2015 is the most recent survey of school age children’s attitudes towards sport and physical activity. In Pembrokeshire, over 6000 pupils took part in the survey, which considers children to be ‘hooked on sport’ if they take part in school-based extracurricular sport, and/or non school based club sports, three or more times a week. For example the percentage of pupils ‘hooked on sport’ in Pembrokeshire has increased since the 2013 survey, but the difference in percentage remains similar between boys and girls: 51% of boys and 42% of girls. The choice of sports also varies at primary and secondary level, with boys at secondary level choosing traditional team sports such as football and rugby, while girls prefer more individual fitness based activities such as swimming, jogging or fitness classes.. In terms of attitudes towards sports, enjoyment of school based PE in primary schools is similar between genders (80% boys vs 77% girls), but the picture changes at secondary level. Here, while 69% of boys enjoy PE, only 42% of girls report doing so. This is worrying as we know that enjoyment and good experiences of sport in school can lead to participation outside of school. The survey reflects this by showing that ‘playing sport’ is the most frequent top leisure time activity for boys through all the key stages, whereas it is far less popular amongst girls, increasing less popular as the girls get older.
Question 3 The extent to which Welsh Government policies are aimed at whole populations and/or particular groups, and what impact that approach has on addressing health inequalities.	Welsh Government polices including Creating an Active Wales and Climbing Higher although the recent Active Healthy Kids Wales Report Card 2016 (Stratton et al) has stated that ‘policy has not resulted in an increase in physical activity in Wales for the past 10 years’.
Question 4 Barriers to increasing the levels of physical activity among children in Wales, and examples of good practice in achieving increases in physical activity, and in engagement with hard to reach groups, within Wales, the UK and internationally.	Barriers may include: - in schools: staff commitment to physical activity, playground space and pressures of the curriculum -  out of school: need for volunteers leaders/organisers and parental time Examples of initiatives: Daily Mile: Schools across the three counties of Hywel Dda have instigated a daily mile routine.  This is supported by the Healthy Schools and Pre-schools Schemes in each county. Ceredigion Active Families is a project to increase families understanding of the importance of developing children’s physical literacy by providing them with plenty of opportunities to develop these skills. Family centre staff have been trained to deliver after-school sessions to parents. Ceredigion Active has purchased ten balance bikes for use within schools to encourage bike riding. A ‘Playful Walks’ programme has been developed in Carmarthenshire through a partnership with Carmarthenshire County Council Play Sufficiency Scheme. A booklet and training session created has been developed to promote the combination of walking and play as a form of activity for children and the vital role of parents. Pembrokeshire Street Games is an initiative delivered in areas of deprivation in Pembrokeshire, engaging young people who did not previously participate in sport. Pembrokeshire Get Out Get Active is a community based 'physical activity' programme for some of the most disadvantaged communities of young people in Pembrokeshire. The project will focus on encouraging more (disabled) young people to take part in activities which will lead to improved health and well-being.  This will challenge issues of social isolation and transport and support the development of transferable skills that could lead to enhanced levels of employability or community engagement.
Question 5 Physical activity guidelines and how we benchmark physical fitness in children.	Wales works to the UK Chief Medical Officers’ guidelines for Physical Activity which is 180 minutes per day of movement for the 0-5 year olds and 60 minutes per day of moderate activity for 5-18 year olds (Start Active, Stay Active, Dept. for Health, 2011)
Question 6 Measurement, evaluation and effectiveness of the Welsh Government’s programmes and schemes aimed at promoting physical activity of children.	Public Health Wales indicate that currently very limited evidence is available regarding the effectiveness of Welsh Government or other publicly or Lottery funded programmes on physical activity.
Question 7 Value for money of Welsh Government spending to promote exercise in children.	Whole schools programmes have been identified as one of the 7 best investments for increasing physical activity by the International Society for Physical Activity and Health (ISPAH 2011)
Question 8 The role of schools, parents and peers in encouraging physical activity, and the role of Sport Wales, NHS Wales and Public Health Wales in improving levels of physical activity.	Hywel Dda UHB has an overall vision to support residents to be resilient, to lead fulfilling lives and to be emotionally and physically healthy.  We work to the Welsh Government’s commitment in Our Healthy Future (2009) to improve the quality and length of life and to ensure that everyone in Wales has a fair chance to lead a healthy life which includes that: · children and young people are given a good start in life that supports their long-term health and wellbeing. · healthy sustainable communities – places where people want to live, work, play and flourish – are sought for all.   · health and social services place greater emphasis on prevention and early intervention. · our public health policies and interventions are based on good evidence and monitored. Hywel Dda University Health Board applies a public health lens to its planning and prioritisation within its draft Integrated Medium Term Plan.  10 Strategic Objectives have been identified, covering risk-taking behaviours and obesity, long-term chronic conditions, dementia and frailty and (through improved efficiency and productivity) how we could significantly improve waiting times and access to diagnostics and planned elective care. Securing and improving the health of our children and young people is central to this public health focused ambition.  The Healthy Child Wales Programme enables us to support a healthy start in life and our Healthy Schools and Healthy and Sustainable Pre-school Schemes support all schools and many pre-schools settings in promoting a healthy start in life. Physical activity promotion plays an important part in this development as a protective factor for mental and emotional health and supporting healthy weight.