Betsi Cadwaladr University Health Board Consultation Response to:
The Health, Social Care and Sport Committee Inquiry into physical activity of children and young people
What do we know about physical activity levels in children in Wales?
Physical activity levels in Children are well below the recommended daily guidelines.
A recent review of the Health Behaviour in School-aged Children (HBSC) survey data from 2002 to 2010 concluded that (Kalman et al., 2015):
· Over all survey years taken together, 23.1% of boys and 14.0% of girls reported at least 60 min of moderate to vigorous physical activity daily;
· A significantly higher frequency of daily activity was found among adolescents aged 11 years (23.2%) than those aged 15 years (14.0%);
· Adolescents from affluent families meet activity guidelines more often than adolescents from less well off families (19.8% vs. 16.3%).
In the BCUHB region, the latest data from the Health Behaviour in School-aged Children (HBSC) survey, 2013/14, showed that 17% of young people (boys & girls) aged 11 to 16 years, reported that they were active for 60 minutes every day. This is higher than the Welsh average of 15%. The data also shows that a higher percentage of boys are active for 60 minutes every day (22%) than compared to girls (11%) (Public Health Wales Observatory, 2016).
In the BCUHB region, an estimated 35% of young people (boys and girls), aged 11 to 16 years, either walk or cycle to school, this is higher than the Welsh average of 32%. There is little variation between the percentage of boys (36%) and girls (34%) who walk or cycle to school in North Wales (Public Health Wales Observatory, 2016).
In 2015, the Welsh Health Survey estimated that across Wales, 36% of children reported undertaking physical activity for at least an hour on every day of the previous week (Boys 42% / Girls 31%). However, 13% of children surveyed reported that they were not physically active for at least an hour on any day in the last week (boys14%, girls 13%).
The National Survey for Wales estimated that 59% of children use electronic devices for 2 hours or more on a weekday (Welsh Government, 2017), this would suggest that these children are predominately sedentary during such recreational time.
Data from the School Sports Survey, 2015, reported an increase in the percentage of pupils in Years 3-11 that are hooked on sport and take part in extracurricular or community club sport on three or more occasions per week, from 40% in 2013 to 48% in 2015.
How robust is the data on this issue?
The Health Behaviour in School-aged Children (HBSC) survey is a self-completed questionnaire, administered in the classroom. The questionnaire does allow the collection of common data across participating countries and therefore allows comparison between countries and identification of trends over time (HBSC, 2017).
The Welsh Health Survey (WHS) was a self-reported survey of households across Wales. The WHS has been replaced by the National Survey for Wales, which is a face-to-face survey of over 10,000 randomly-selected adults aged 16 and over, carried out across Wales. Data on children and young people’s lifestyles including physical activity levels are awaited (Welsh Government, 2017).
There is a risk of bias with survey data which is self completed and therefore the estimated results may not be an accurate reflection of levels of physical activity within the wider population.
There is a risk that different organisations use data from a range of different sources. This can lead to confusion about which data source should be used for planning processes. Therefore a universal source of data for planners and practitioners would be desirable.
Differences in gender-based attitudes towards, and opportunities for, participation in physical activity in Wales
Data from the School Sports Survey reports that a gender gap in the percentage of children who are ‘hooked’ on sport remains, despite an increase in participation by both boys and girls since 2011. In addition the survey also highlighted inequalities in participation levels depending on ethnicity, see table below:
Figure 1: Percentage of pupils who are hooked on sport by ethnic group and gender
Source: School Sports Survey, Sports Wales, 2015
The survey also reported that a higher percentage of children within the free School Meal (FSM) quartile one (least deprived) were ‘hooked’ on sport than compared to children within FSM 4 (most deprived) (54% vs. 43%).
There is no shortage of opportunities in Wales for children and young people to be more physically active. Most communities are within relatively easy reach of safe and accessible environments, and a natural landscape that lends itself to more active lifestyles. There is a comprehensive network of leisure centres across the country providing both indoor and outdoor activity areas and there is a rich and diverse range of sports clubs and organisations in the majority of communities. In addition, there are a number of government funded programmes working with children and young people in schools and communities to develop their interest in physical activity and facilitate their access to the opportunities.
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 has stated their aspiration to integrate actions that increase physical activity across all relevant policy areas, to reduce ‘silo thinking’, and to encourage more effective collaboration at government level to get the nation moving.
Creating an Active Wales emphasised how reducing inequalities should underpin ‘cross-cutting’ policy areas. Departmental strategic plans should subsequently be cascaded further to influence at regional and local authority levels and thus drive forward tangible changes. However, the absence of strategic leadership, and additional resources has meant the document was perceived by most as an informative guide, instead of a call to action.
Getting Wales Moving was recently published as a joint document between Sport Wales and the Welsh Government, and again highlights the need for a more ‘joined up’ approach across policy areas to achieve the common goal of increasing levels of participation across the population.
The Play Sufficiency Assessment (Wales) Regulations, 2012, requires all Local Authorities to assess the sufficiency of play opportunities for children within its area. The assessment contains play opportunities for children with differing needs, supervised and non supervised play, and the play workforce itself.
In addition, it is important that we work collaboratively to increase activity levels across the spectrum of physical activity, which includes everything from elite sport, to play and active travel.
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.
People are less likely to be active if they have a number of real or perceived barriers. Some of the key barriers include (WHO, 2006):
· Perception of lack of time;
· Perception that one is not “the sporty type” (particularly for women);
· Concerns about personal safety;
· Feeling too tired or preferring to rest and relax in spare time;
· Self-perceptions (for example, assuming that one is already active enough).
The perceived lack of time is a frequently identified as a barrier, however in general there are few real differences in the time available to active and inactive people. Therefore this is likely to be related to the priority assigned by active people to physical activity.
Parents often cite concerns regarding their children’s safety when playing out within their community. Concerns around ‘strangers’ and traffic can be barriers that stop parents allowing their children out to play.
Physical activity guidelines and how we benchmark physical fitness in children.
The Chief Medical Officer’s guidelines for physical activity for early years, children and young people are concise and easily understood (DH, 2011). The accompanying infographics and key messages are an extremely useful resource, when working with the public and partner organisations.
Benchmarking participation levels for children and young people is difficult because of the range of activities available to them in different settings, and at different age groups. Surveys like the HBSC can draw comparisons across specific types of activity throughout Europe.However, the survey does not have the scope to present a comprehensive picture for benchmarking. Similarly the School Sport Survey provides data that can be compared year on year, but doesn’t have the potential for benchmarking (Sports Wales, 2015).
Measurement, evaluation and effectiveness of the Welsh Government’s programmers and schemes aimed at promoting physical activity of children.
Measurement has often meant attendance, recording numbers completing programmes over time. Often the same children take part in all activities and may not necessarily be the ‘hard to reach’ individuals as intended.
Value for money of Welsh Government spending to promote exercise in children.
Evaluation often entails the assessment of numbers participating in the activity, some qualitative feedback from participants and/or a report of the activities provided over time. This approach doesn’t necessarily provide a robust analysis of the outcomes achieved or whether value for money has been provided.
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.
Schools, parents and peers have an important role to play in encouraging and enabling children to participate in physical activity. The Welsh Network of Healthy Schools Schemes supported by Welsh Government includes physical activity within their accreditation criteria. A good percentage of schools across North Wales are currently participating in the ‘Daily Mile’ campaign.
Local Authority ‘Sport for Life’ teams (formerly Active Young People teams) work closely with schools to offer children opportunities to try different sporting activities, and join local club structures to sustain their participation in the longer term.
Evidence indicates that households where the parents participate in physical activity encourage their children to do the same, whereas households where families are more sedentary generally have less active children.
The Outdoor Partnership in North Wales working closely with Sport Wales and Local Authority Sports Development team runs the Young Ambassadors scheme. This is a good example of how peer education and peer support from other young people that have been involved in specific sports can be successful in stimulating interest and engagement among their less active peers. Volunteering is an essential part of the club structures across the region, and young people get the opportunity to learn new skills, develop their own confidence and mentor their peers through volunteering with their local clubs and societies.
The Play Sufficiency Assessment prompts Local Authorities, and partners to ensure there are safe and accessible environments for children to play and be active. All partners have a role to promote ‘play for play’s sake’ and the importance of learning and participating in play and physical activity.
Sport Wales, NHS Wales and Public Health Wales have a key role to play in improving levels of physical activity, and across North Wales there is a well established tradition of collaboration to achieve that goal. Building on this tradition, the work of Getting North Wales Moving is bringing together a diverse range of organisations including (not exclusively): Sport Wales, Betsi Cadwaladr University Health Board, Natural Resources Wales, Snowdonia National Park, the third sector and Public Health Wales, to strengthen collaborative action to develop the culture and environments that enable people of all ages to move more and be less sedentary in all their daily activities.
Authors:
The response has been led by colleagues from the Betsi Cadwaladr Public Health Team, in conjunction with Betsi Cadwaladr UHB Area colleagues.
Dr E Rachel Andrew, Specialty Registrar, BCU HB Public Health Team
Aled Hughes, Senior Practitioner, BCU HB Public Health Tea
Rachel Lewis, Principal Practitioner, BCU HB Public Health Team
Appendix A: Health Behaviour in School-aged Children 2013/14
Appendix B: Welsh Health Survey data, 2015
Figure 5: Reported physical activity of children, by sex (a) (b)
References
Department of Health. Start Active, Stay Active. Department of Health: London. 2011Available at https://www.gov.uk/government/publications/uk-physical-activity-guidelines
HBSC. Health behaviour in school-aged children: World Health Organization collaborative cross-national survey. HBSC: St Andrews. 2017. Available at http://www.hbsc.org/methods/index.html
Public Health Wales Observatory. Health Behaviour in School-aged children, 2013/14. Public Health Wales: Cardiff. 2016. Available at http://nww.publichealthwalesobservatory.wales.nhs.uk/ad-hoc-requests
Kalman, M, Inchley J, Sigmundova D, Iannotti R.J, Tynjälä J.A, Hamrik Z, Haug E, Bucksch J. Secular trends in moderate-to-vigorous physical activity in 32 countries from 2002 to 2010: a cross-national perspective. European Journal of Public Health. Vol. 25: Issue 2. 2015.
Sports Wales. School Sport Survey 2015: State of the Nation. Sports Wales: Cardiff. 2015. Available at http://sport.wales/media/1667736/school_sport_survey_2015_-_state_of_the_nation_english.pdf
World Health Organisation. Physical activity and health in Europe: evidence for action. WHO: Copenhagen. 2006. Available at http://www.euro.who.int/__data/assets/pdf_file/0011/87545/E89490.pdf?ua=1
Welsh Government. Welsh Health Survey 2015: Health of children. Welsh Government Statistical Bulletin: Cardiff. 2015. Available at http://gov.wales/docs/statistics/2016/160929-welsh-health-survey-2015-health-children-en.pdf
Welsh Assembly Government. Creating an Active Wales. Welsh Assembly Government: Cardiff. 2009. Available at http://gov.wales/topics/health/improvement/physical/active/?lang=en
Welsh Government. National Survey for Wales. Welsh Government: Cardiff. 2017. Available at http://gov.wales/statistics-and-research/national-survey/?tab=el_home&topic=children_education&lang=en