Government Policies, Strategies and Investments
Physical Activity is high on the Welsh Government’s policy agenda and is mentioned across a variety of policy arenas (Sport, Health, Environment, Sustainable Development, Planning, Transport, Education etc.) However, at both national and local level it is one of the few portfolios that does not have either a statutory requirement or a stable ‘home’ and is moved as an add-on into a range of other portfolios whenever there is any kind of re-shuffle or re-organisation. Since the last Report Card there was a government decision to strategically merge physical activity within the emerging obesity strategy which risks marginalising the wider impacts of physical activity on health. The government also established a tripartite partnership of national organisations (Wales Physical Activity Partnership) to drive the physical activity agenda forward in Wales. This included Public Health Wales, Sport Wales, and Natural Resources Wales. Whilst ostensibly an improvement by recognizing the broader influences on physical activity, it also overlooks the critical role of other sectors including Education, Local Government, and the Voluntary Sector amongst others. Sharing responsibility amongst three national organisations continues to dilute the benefit of having a single responsible lead organisation or person providing leadership and accountability for this critical portfolio. There is still little systemic funding for Physical Activity promotion or delivery although one positive development since the last Report Card is the establishment of the Healthy and Active Fund. The fund now has a modest £5.9m available over four years and there are 16 projects, however the competitive and limited nature of the funding model means that many potential beneficiaries are overlooked.
It is evident that certain sectors continue to have a fragmented and ineffectual support for promoting physical activity, not least education where despite national reports on the low levels of physical activity amongst children in Wales; recommendations from a national group looking at Physical Literacy; key recommendations from a National Assembly cross-party report on children’s physical activity and a major revamp of the National Curriculum in Wales there is still very little overt evidence of increased support for the Education sector, other than the establishment of an ‘Educational Settings sub-group of the Wales Physical Activity Partnership Board (WPAP) including members from the Welsh Government Education Policy division. Indeed, the Welsh Government rejected the recommendations to “make 120 minutes of physical education in schools a minimum statutory requirement.”, pinning their hopes on the new curriculum. Meanwhile, guidance provided by Estyn on physical activity in schools, whilst offering good advice on the range of physical activity gives no indications on even a minimum amount that should be provided. And a recent Estyn report on School impact on pupils’ Health & Wellbeing only referenced ‘Physical Activity’ once and ‘Exercise’ once?
Guided by the HEPA PAT tool we considered the evidence relating to key policy domains that influence physical activity in children including: Health, Education, Sport, Transport, Environment, Design & Planning, Play, Sustainable Development, and Cross-cutting (i.e. cut across all policy portfolios). Within each of these domains a range of key ‘elements’ were identified from the HEPA PAT tool refined by the research working group (RWG), that could individually or collectively impact on the effectiveness of the policy instrument. These elements included:
- Number & breadth of policies
- Identified supporting actions
- Identified accountable organisation(s)
- Identifiable reporting structures
- Monitoring & Evaluation plans
- Identified funding/ resourcing
There are a number of national programmes designed to increase physical activity amongst children & young people in Wales, some operate at the UK level but have a Welsh component (This Girl Can; Change4Life; StreetGames) and a few are in the process of being evaluated before decisions on their future are made (Free Swim Programme; Dragon Multi-skill & Sport.) There is limited robust evidence on the effectiveness of these programmes at present.
Deciding on a grade
Unlike the other indicators there are no purely objective measures that can be used to inform the Report Card. However, after utilising the WHO Europe Health- enhancing physical activity (HEPA) policy audit tool (PAT)v2 to inform the 2018 Report Card, we developed a complementary weighted scoring tool that provided an objective measure aligned to the Report Card. The methodology was published in Health Promotion International in 2020. The same process was used to score this indicator for the latest Report Card. In interpreting this indicator, we included national policies, strategies, action plans, legislation and a few other advisory and technical documents that have a direct bearing on children’s physical activity, which were still ‘active.’
The final scoring matrix was as follows:
- No. and breadth of relevant policies - 10% (5% No. & 5% Breadth) = 8%
- Identified supporting actions - 20% = 15%
- Identified accountable organisation - 25% = 14%
- Identifiable reporting structures - 15% = 6%
- Identified funding and resources - 20% (5% no. of identified national programmes & 15% funding) = 5%
- Monitoring & Evaluation Plan – 10% = 2% Applying this led to an overall score of 50% that translates to a C grade.
It is evident from the difficulties in compiling meaningful robust data for the Report Card that there continue to be significant national data gaps in many of the indicators that inform physical activity for children and young people. This is a feature that appears to have deteriorated in recent years following the revision and streamlining of national surveys that took place in 2018.
How to improve
Whilst the wider environmental approach to physical activity promotion is to be welcomed, this has been compromised by the selective and limited range of engagement across policy sectors. Recent global events have compounded this problem as priorities changed and organisations tend to turn inward during times of crisis. There remain opportunities however, to re-engage with communities and organisations in a coordinated effort to tackle physical inactivity together.
Whilst there is of course a relationship between physical inactivity and obesity with many overlapping issues, there remain key issues that are mutually exclusive to physical activity which have far greater impacts both physiologically and mentally than those confined to obesity. It is simplistic and potentially dangerous to assume that strategies designed to address obesity will therefore also improve physical activity. Whilst some may, others will not, and opportunities will be missed. This policy ‘marriage of convenience’ also risks sending out the wrong messages. Increasing physical activity may help reduce obesity but will not eradicate it, whilst reducing obesity will not significantly reduce physical inactivity nor the many other health issues associated with it.