Health inequalities review of physical activity

Transcription

Adults, Wellbeing and Health Overview
and Scrutiny Committee
Health Inequalities
Review of Physical Activity
August 2011
2
Contents
Section
Subject
Page
1.
Foreword
4
2.
Executive Summary
5 – 28
3.
Remit of the Review
29 – 34
4.
Physical activity and Health Inequalities
35 – 40
5.
How policies, strategies and plans to
improve health and wellbeing and increase
physical activity are developed and
delivered at local, regional and national
level
41 – 50
6.
The Impact of the Built and Natural
Environment on Physical Activity Levels
51 – 60
7.
Delivery of physical activities in County
Durham
61 – 72
8.
Level of participation in physical activities
and the effectiveness, benefits and returns
on interventions/investment
73 – 84
9.
Best Practice, Guidance and Research
85 – 90
10.
Conclusions and Recommendations
91 – 94
11.
Appendices
95 – 127
3
Section One – Foreword
How we live our lives has changed dramatically over the past few decades and we are now
less physically active than at any time in human history. At the same time, more evidence
has been gathered that links physical inactivity with a growing range of acute, chronic and
life threatening diseases, as well as poor mental health.
Changing inactive lifestyles presents a tremendous challenge for the Government, NHS,
local authorities, sports and leisure bodies, schools and colleges, employers and
workplaces, parents and families. For most people the easiest and most acceptable forms
of physical activity are those that can be incorporated into everyday life. Examples include
walking or cycling instead of travelling by car and taking up active leisure pursuits and
hobbies such as gardening or sporting activities. Even shopping regularly, according to
recent research has the potential to increase physical and mental wellbeing.
There is also growing recognition that physical environments that support and encourage
physical activity can help improve the public’s health. Local authorities, through their
planning powers, management of traffic, parks and open spaces, leisure and cultural
services can contribute to the quality of the built and natural environment and thereby
improve health and wellbeing.
The Council’s Health Inequalities in County Durham Task and Finish Review Group has
undertaken a review of physical activity, focusing particularly on the impact of the built and
natural environment on physical activity levels and the effectiveness and value for money
considerations in the delivery of physical activity to improve health and reduce health
inequalities. The report concludes with a number of recommendations for consideration by
the Council’s Cabinet.
I would like to thank all those who gave evidence, my County Council Councillor colleagues,
together with co-opted representatives who worked with me on this scrutiny review and
finally the officers, who supported and advised the Review Group.
Vince Crosby
Chair of the Health Inequalities in
County Durham Task and Finish Review Group.
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Section Two – Executive Summary
2.1
2.1.1
Introduction
A scoping seminar took place in October 2010 where members of the Adults Wellbeing
and Health Overview and Scrutiny Committee received information on health
inequalities in County Durham. The scoping seminar was led by the Director of Public
Health and the Head of Social Inclusion. A key aspect of the event was to consider
where the most significant positive impacts could be made through interventions to
address health inequalities.
2.1.2
An important message coming through was that physical activity has a significant role
to play in contributing to the health and wellbeing of communities. The Chief Medical
Officer’s (CMO) report ‘At least five a week: Evidence on the impact of physical activity
and its relationship to health’ (DH, 2004) and ‘Start Active, Stay Active’, a report on
physical activity for health from the Chief Medical Officers of England, Scotland, Wales
and Northern Ireland (July 2011) provide strong evidence to confirm that there are
many health benefits of being active, with the latter, highlighting the risks of sedentary
behaviour for all age groups.
2.1.3
Members agreed the review look at physical activity to:
• assess the scale of inactivity in County Durham and its impact on health
inequalities;
• assess how local policies, strategies and plans are developed
and delivered;
• determine the impact of the built and natural environment on
physical activity levels;
• consider the role of strategic leadership ; services and commissioning;
strengthening communities; organisational level activity; measuring wellbeing
outcomes in order to make it happen;
• understand the effectiveness of interventions; their sustainability and return
on investment (human and financial); how they are measured;
• consider interventions that target place (work / school / community); people
(most vulnerable and hard to reach communities);
• understand the implications of the life course approach to the promotion of
physical activity;
• review best practice internationally, nationally, regionally and locally, with a
focus on return on investment.
2.1.4
Physical activity is defined as being any force exerted by a skeletal muscle that results
in energy expenditure above resting level. Sport consists of a normal physical activity
or skill carried out under a publicly agreed set of rules and with recreational purpose;
for competition, for self employment, to attain excellence, for the development of skill or
some combination of these. The Department of Health publication ‘Be active, be
healthy’ states that ‘ Physical activity includes all forms of activity, such as everyday
walking or cycling to get from A to B, active recreation not undertaken competitively,
such as working out in the gym, dancing, gardening or families playing together, as
well as organised and competitive sport. What unites all physical activity is its effect
upon our bodies, raising our heart rate, bringing about an immediate and often
beneficial physiological response and improving our overall wellbeing.
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2.1.5
County Durham’s participation rate is in line with the national average, however there is
a disparity across the former district areas. (Active People Survey undertaken by Sport
England) The former district of Easington has the lowest participation rates in the North
East whilst Durham City has the highest. This physical activity profile mirrors the
deprivation profile within the county. Male participation in County Durham has
increased however female participation has decreased. With regard to the 55 plus age
group there has been a decrease nationally.
2.1.6
The Health Profile for County Durham 2010 identifies that many of its health indicators
are significantly worse than the England average. These include: obese adults, early
deaths: heart disease and stroke, early deaths: cancer, deaths from smoking, adults
who smoke, hip fractures in over 65’s, binge drinking adults, hospital stays for alcohol
related harm, mental illness and healthy eating adults.
2.1.7
Life expectancy for men living in the most deprived areas of the County is over 6 years
lower than for men living in the least deprived areas. For women it is nearly 5 years
lower (Health Profile 2010). The distribution of premature death across County
Durham is unequal. It is greater in the more deprived wards.
2.1.8
Rates of obesity are higher in County Durham than the national average, with the
former districts of Easington, Sedgefield and Wear Valley having significantly higher
rates. Death from circulatory diseases, heart diseases, stroke and cancers occur
across the county at a younger age than the national average. (County Durham Joint
Strategic Need Assessment 2008-09). Participation in a physical activity can
significantly reduce the risks for both existing sufferers and those most vulnerable.
2.1.9
The direct costs of physical inactivity to NHS County Durham are estimated at £8.3m
per annum compared to an average PCT cost across the country of £5m per annum
(based on 2006/07 data).The costs of treating chronic disease can run into the millions
and figures for 2009/10 show for example - cancer cost approximately £65m,
diabetes £17m, CHD £23m and stroke £13m.
2.1.10 While interventions aimed at individuals may be important, they are not the only (nor
possibly the main) solution. Indeed, socio-economic and environmental factors have a
significant role in improving health and reducing health inequalities.
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2.2
Policies, strategies and plans to improve health and wellbeing and increase
levels of physical activity
2.2.1
Increasing physical activity, reducing health inequalities and improving quality of life
are key priorities at national, regional and local level and are recognised in key policy
and strategy documents and delivery plans.
Policy Development at Local Level
2.3
County Durham Health and Wellbeing Partnership
2.3.1
At a local level, the County Durham Health and Wellbeing Partnership brings together
different organisations in County Durham to improve people's health and wellbeing. It is
focused on ensuring that all services are delivered cohesively and in line with the
Partnership’s priorities which are: increasing life expectancy, reducing health
inequalities, focusing upon tobacco cessation, alcohol, diet and exercise and improving
mental health and wellbeing. The Altogether Healthier Delivery Plan sets out the
planned activities of the Partnership. It is underpinned by the County Durham
Sustainable Community Strategy 2010 – 2030 (SCS), the priorities of its Partners and
the Joint Strategic Needs Assessment (JSNA) 2009/10. (Further details Section 5,
paragraphs 5.2.1-5.2.6)
2.4
2.4.1
Council Plan 2011 - 14
The Council Plan sets out the corporate priorities for improvement and the key actions
that the Council will take in support of the delivery of the long term goals in the
Sustainable Community Strategy. It covers a three year time period and links closely
to the Medium Term Financial Plan. The actions within the plan are structured around
priority themes. With regard to the Altogether Healthier theme which is focused on
improving health and wellbeing, the Council has identified five objectives together with
actions to achieve the objectives. One of the objectives is to reduce health inequalities
and its related actions are to reduce obesity levels and increase physical activity and
participation in sport and leisure. (Further details Section 5, paragraphs 5.4.1-5.4.2)
2.5
Durham County Council’s Health Improvement Plan (2010-2013)
2.5.1
The Health Improvement Plan sets out Durham County Council’s (DCC) strategic
framework for improving health. It has been developed by DCC, in consultation with
partner agencies and members of the public. The plan demonstrates the Council’s
commitment and contribution to improving health and addressing health inequalities
within County Durham.
2.5.2
The plan also complements the recently published Marmot Review into health
inequalities, stressing the importance of a preventative approach, addressing the
wider, social determinants of health. (Further details Section 5, paragraphs 5.5.1-5.5.3)
2.6
A Physical Activity Strategy for County Durham
2.6.1
The above strategy, commissioned by County Durham Sport, aims to increase coordination between organisations, raise the profile of physical activity opportunities and
the benefits of increased participation, inform where future investment should be
channelled, and ensure effective delivery and the removal of duplication. County
Durham Sport has the lead responsibility for co-ordinating the implementation of the
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strategy and reports to the Health & Wellbeing Partnership to this end. (Further details
Section 5, paragraphs 5.6.1-5.6.3)
2.7
Durham County Council Sport and Leisure Service Strategy 2011- 2014
2.7.1
The above strategy, which was approved by the Council’s Cabinet on 2nd March 2011,
aims to transform the lives of individuals and communities through their participation in
a wide and inclusive range of indoor and outdoor activities that provide positive life
experiences and opportunities. Whilst there will always be a proportion of residents
who will remain uninterested in being physically active, the Service will work with its
partners to address the issues where possible to remove these barriers.
2.7.2
Its intends to deliver modern well-equipped sports centres, investment in and better
support for grassroots sports clubs and associations and better value for money. This
should led to increased participation by making better use of outside space and
community based programmes, supporting and expanding club activity, linking school
participation to community settings and working more closely with the voluntary sector.
2.7.3
The strategy recognises the important role that the Council’s Sport and Leisure Service
has in promoting a preventative approach to well-being and addressing health
inequalities. The Service works within communities, directly providing services as well
as co-ordinating and enabling others to deliver activities, which target and encourage
disadvantaged individuals and groups to participate, in particular:
• Those living in disadvantaged neighbourhoods
• Those affected by physical and mental health issues
• Those suffering from a disability
• Women and girls
• Adults and young carers
• Looked after children
• Ethnic minorities
(Further details Section 5, paragraphs 5.7.1-5.7.7)
Conclusion
The Council and its partners are clear about the direction of travel to improve
health and wellbeing. They have good plans and strategies in place to
improve physical activity and promote health. The partnerships that exist
demonstrate a strategic approach (that is joined up) in responding to the
challenges facing action to reduce health inequalities and action to promote
physical activity. The plans and strategies have been informed by local need
and policy priorities. The Council’s Sport and Leisure Service Strategy
recognises the Council’s important role as a community leader, often
co-ordinating and enabling others to deliver, directly working within
communities to increase participation and promoting a preventative approach
to well-being.
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Policy Development at Regional Level
2.8
2.8.1
Public Health North East
Public Health North East is accountable to the Department of Health. Its job is to
improve the health and wellbeing of people living in the region by working alongside
other government departments, public sector organisations and community and
voluntary groups. (Further details Section 5, paragraphs 5.8.1 - 5.8.2)
Policy Development at National Level
2.9
Fair Society, Healthy Lives – The Marmot Review
2.9.1
The Marmot Review proposes the most effective evidence-based strategies for
reducing health inequalities in England. The key messages from the review are that
action taken to reduce health inequalities will have economic benefits in reducing
losses from illness associated with health inequalities and that reducing health
inequalities will require action on six policy objectives. They are: give every child the
best start in life, enable all children young people and adults to maximise their
capabilities and have control over their lives, create fair employment and good work for
all, ensure healthy standard of living for all, create and develop healthy and sustainable
places and communities and strengthen the role and impact of ill health prevention.
(Further details Section 5, paragraphs 5.10.1 - 5.10.3)
2.10
Healthy lives, healthy people White Paper: Our strategy for public health in
England
2.10.1 The above White Paper sets out the Government’s long-term vision for the future of
public health in England. From 2012, it is proposed that Public Health England will
have responsibility for protecting the health of the population from infectious disease
and biological, chemical and radiological threats and helping people and families to be
able to take care of their own health and wellbeing.
2.10.2 From 2013, it is proposed that councils will be responsible for public health in local
areas. Health and Wellbeing Boards will be established in every local authority,
comprising of clinical commissioning consortia, Director of Public Health, Directors of
Adult and Children’s Services, local Health Watch and NHS Commissioning Board.
Directors of Public Health will be employed by the Local Authorities. They will lead
discussion about how the ring-fenced money is spent to improve health. This will
include influencing investment decisions right across the Local Authority, with the goal
of enhancing health and wellbeing. A new health premium will take into account health
inequalities and reward progress on public health outcomes.
2.10.3 The Secretary of State for Health in his foreword to the White Paper: stated that:
‘Health inequalities between rich and poor have been getting progressively worse.
We still live in a country where the wealthy can expect to live longer than the poor.
The dilemma for government is this: it is simply not possible to promote healthier
lifestyles through Whitehall diktat and nannying about the way people should live.
Recent years have proved that one size-fits-all solutions are no good when public
health challenges vary from one neighbourhood to the next. But we cannot sit back
while, in spite of all this, so many people are suffering such severe lifestyle-driven ill
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health and such acute health inequalities. We need a new approach that empowers
individuals to make healthy choices and gives communities the tools to address their
own, particular needs. The plans set out in the White Paper put local communities at
the heart of public health.’
(Further details Section 5, paragraphs 5.11.1-5.11.9)
2.11
Start Active, Stay Active – A report on physical activity for health from the four
countries’ Chief Medical Officers
2.11.1 The above report published in July 2011, emphasises for the first time, the importance
of physical activity for people of all ages. The report gives details of the risks of
sedentary behaviour for all age groups, updates the existing guidelines for children,
young people and adults on the amount and type of physical activity to be undertaken
and provides for the first time specific guidelines for those aged under 5 years and
older adults – 65years and over. The report has a dedicated chapter for Early Years
(under 5s), Children and Young People (5-18years), Adults (19 – 64 years) and Older
Adults (65+ years). Appendix 1 attached to the full report sets out the guidelines for
each group.
Conclusion
The Marmot Review identified the role of local government as pivotal in the
renewal of local democracy and giving citizens voice in developing the
prospects for their local area. Local councils hold the power to secure the
economic, environmental & health and wellbeing of their population.
This calls for the effective exercise of community leadership in drawing
together citizens, communities and key partners to build health, wellbeing
and resilience, through transformational leadership of Sustainable
Community Strategies and Health and Wellbeing Boards. These roles
become even more important as understanding of the social determinants of
health has developed. If inequalities in early child development and
education, housing, employment and working conditions, place and the built
environment, and sustainability are driven by the same causes, it requires a
concerted effort across the whole system. A number of policy strands are being
developed as part of the transition process for public health moving into local
government. It is hoped that this will strengthen what the Marmot Review concludes.
Recommendation 1
That Cabinet ensures that the Government’s Public Health Strategy (which
should include the Marmot Review six policy objectives) informs the
Council’s contribution to planning and delivery of a public health agenda
within the context of proposals contained in the Health and Social Care Bill
(and Act as appropriate).
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The Impact of the Built and Natural Environment on Physical Activity Levels
2.12
Built Environment
2.12.1 Local authorities have a significant role to play in improving health. Through their
services, they can contribute to the quality of the built and social environment.
2.12.2 The National Institute for Health and Clinical Excellence Guidance (NICE), Sport
England, Commission for Architecture and the Built Environment (CABE) and Play
England have issued guidance on the planning of new developments in relation to
encouraging physical activity and play.
2.12.3 One of the most important ways of encouraging more active travel such as walking and
cycling is to get the built environment right at the outset. The Chief Medical Officer
Professor Sir Liam Donaldson in his report, ‘At least five times a week. The evidence
on the impact of physical activity and its relationship to health’ makes the connection
between physical activity and the environment. The report states that
‘A mass shift in current activity levels is needed. This will only be achieved if
people see and want the benefits, but also if opportunities are created by
changing the physical and cultural landscape – and building an environment
that supports people in more active lifestyles’.
2.12.4 Planning Policy Guidance Note 13 - Transport, sets out the statutory provisions and
guidance on planning integrated, sustainable transport for new developments. When
preparing development plans and considering planning applications, the guidance
states that local authorities should:
•
Locate day to day facilities which need to be near their clients in local centres so
that they are accessible by walking and cycling
•
Accommodate housing principally within existing urban areas, planning for
increased intensity of development for both housing and other uses at locations
which are highly accessible by public transport, walking and
cycling.
2.12.5 Consequently engagement between the Council’s planners and developers at an early
stage will make it easier and more cost effective to integrate walking and cycling into
the design of new developments.
(Further details Section 6, paragraphs 6.1.1 - 6.5.2)
Natural environment
2.13
Green Infrastructure as a natural health service
2.13.1 The natural environment has a role to play in maintaining healthy lives. It provides for
physical activity which reduces obesity and heart disease, and improves air quality by
filtering pollutants, thus reducing respiratory problems such as asthma. Natural
England defines Green Infrastructure (GI) as a strategically planned and delivered
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network of high quality green spaces and other environmental features such as parks,
open spaces, playing fields, woodlands, allotments and private gardens.
2.13.2 If every household in England were provided with good access to quality green space,
it could save an estimated £2.1 billion in healthcare costs. (Our Natural Health Service
– The role of the natural environment in maintaining healthy lives, Natural England
2009). The Government’s commitment to protecting and improving the natural
environment is set out in the White Paper ‘The Natural Choice’. Key measures
included in the White Paper are designating green areas, enabling more children to
experience nature by learning outdoors, strengthening local public health activities and
a new environmental volunteering initiative ‘Muck in 4 Life’.
2.13.3 Durham County Council, in partnership with a range of organisations has employed a
Green Infrastructure Co-ordinator to create Green Infrastructure Implementation Plans
for County Durham and instigate such projects. This work will ensure GI is incorporated
into new development. The Green Infrastructure Strategy is being introduced within the
Council’s Local Development Framework or County Durham Plan.
2.13.4
County Durham has an almost unique pattern of large villages and small towns set in a
wide range of landscapes providing real choice for living in and enjoying the County.
According to research, used in preparation of the County Durham Plan – core strategy,
people in County Durham value natural environments and open space, and therefore,
one of the priorities identified in the work being undertaken on the Green Infrastructure
is supporting the work of landscape partnerships such as Limestone Landscapes, the
Heart of Teesdale, the Derwent Valley and the Heritage Coast Partnership. The latter
received the first UK Landscape Award in November 2010.
(Further details Section 6, paragraphs 6.6.1- 6.6.7)
2.14
Local Transport Plan 3 and its contribution to health improvement
2.14.1 Local Authorities can through their transport policies/plans actively promote walking,
cycling and the use of public transport. Walking and cycling both promote feelings of
good health and wellbeing and promote social inclusion. However in Britain the
average time spent traveling on foot or by bicycle has decreased from 12.9 minutes per
day in 1995/97 to 10 minutes per day in 2007. (Department of Transport 2010)
2.14.2 The Council is responsible for managing nearly 2,200 miles (3,500km) of footpaths,
bridleways and byways in the county, which provide opportunities for daily exercise in
natural green spaces, affordable green routes to work and increase a sense of
community, all of which can enhance quality of life and improve health. The Council’s
Rights of Way Improvement Plan 1, published in 2007, won an award from Natural
England in 2009 in the category ‘Best contribution to Local Prosperity and Quality of
Life’.
2.14.3 Durham County Council’s Local Transport Plan 3, effective from April 2011, has six
goals which are: support economic growth, maintain the transport asset, reduce carbon
emissions, promote equality of opportunity, contribute to better safety, security and
health and improve quality of life and healthy natural environment.
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2.14.4 The Plan was subject to various assessments to develop its content and policies
including Strategic Environmental Assessment, Equalities and Health Impact
Assessments. (Further details Section 6, paragraphs 6.7.1- 6.7.17)
2.15
Health Impact Assessments (HIA)
2.15.1 The purpose of Health Impact Assessments is to identify the potential health
consequences of a proposal on a given population and maximise the positive health
benefits and minimise potential adverse effects on health and inequalities. The
preferred starting point for HIA is a proposal (policy, programme, strategy, plan, project
or other development) that has not yet been implemented. Its primary output is a set of
evidence-based recommendations to inform the decision-making process associated
with the proposal. These recommendations aim to highlight practical ways to enhance
the positive aspects of a proposal, and to remove or minimise any negative impacts on
health and inequalities (known as a prospective HIA).
2.15.2 It should be pointed out that unlike a Strategic Environmental Assessment being a
requirement under national and EU legislation or Equality Impact Assessments as a
requirement of the Equality Act 2010, there is no similar statutory requirement to
undertake a Health Impact Assessment. (Further details Section 6, paragraphs 6.8.16.8.11)
Conclusion
The evidence base is overwhelming that planning, transport, housing, the built
and natural environmental, in short socio–economic and environmental factors
have a significant impact on action to reduce health inequalities, action to promote
physical activity and action to promote health.
The Health Impact Assessment (HIA) process is able to support action to improve
health and quality of life. It is a staged process involving screening of a policy or
strategy in the first instance. It should be pointed out that unlike a Strategic
Environmental Assessment being a requirement under national and EU legislation
or Equality Impact Assessments as a requirement of the Equality Act 2010, there
is no similar statutory requirement to undertake a Health Impact Assessment.
In the final analysis, the Council through its strategic and community leadership
role recognises the link between environmental, social and economic
sustainability to health and well being outcomes. An example of this can be seen
through the development of the Sustainable Community Strategy, where health
outcomes linked to socio –economic priorities have come to the fore. The
Council’s vision for a better place for people explicitly recognises the need for a
healthier community. Health outcomes and health improvement are seen as core
business and are progressed through existing organisational arrangements,
ensuring that health implications and action on health inequalities are challenged
at the corporate, cabinet and indeed scrutiny level. It is core business.
With the transfer of public health to local government, the Council’s approach to
embed health improvement as core business puts it in a very good place for the
transition, as its thematic priorities and organisational arrangements ensure the
system is applied effectively.
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Delivery of Physical Activity in County Durham
2.16
Sport and Leisure Provision in County Durham
2.16.1 The Sport and Leisure Strategy points to four ‘core’ sports and leisure areas of service
activity are:
•
Indoor Sports and Leisure Facilities - The Council provides a wide range of
indoor sport and leisure facilities from small local community focused centres to
facilities with regional appeal. The centres attract 3.75m visitors. Six are managed
by external organisations.
Cabinet (13 July 2011) considered a report of the Corporate Director,
Neighbourhood Services that provided feedback on the findings of the consultation
on the review of Indoor Facilities, approved by Cabinet 2 March, 2011, and made
recommendations as to how the Council should conclude the review. Indoor
facilities form only part of the sport and leisure offer alongside sport and leisure
development, outdoor sport and countryside services; all of which have a focus on
participation. The Sport and Leisure Strategy (approved March 2011) is explicit in
proposing a shift in emphasis from indoor facilities to alternative service
approaches, such as maximising the use of the outdoor environment and targeted
interventions, more able to engage hard-to-reach groups. Similarly, the Strategy
proposes a greater emphasis on raising participation via community settings and,
specifically, through voluntary sector sports clubs. Cabinet agreed that four of the
seven centres under consideration should be retained.
•
Outdoor Sport and Leisure Facilities – This area covers:
o
Play Areas - There are over 300 fixed play sites in County Durham which are
owned, managed and maintained by various organisations.
o
Outdoor pitches and facilities - Many sports/recreation grounds are owned
or leased by clubs or fall under the responsibility of Town and Parish Councils.
Standards vary significantly. Facilities include: multi-use games areas
(MUGAs) recreation grounds, bowling greens, skate parks, athletics track,
football and cricket pitches and tennis courts.
o
Parks and Open Spaces - The ownership and management of parks and
open spaces falls to a variety of organisations, which leads to various
standards and financing issues. The latest assessment of the Council’s parks
and green spaces has resulted in ten sites being awarded green flags in 2010.
o
Allotments - Allotment gardening provides a wide range of benefits to
communities and the environment. A county wide policy for the management
of allotments is being developed, which will encourage better use of available
plots and cut waiting lists.
Events - Events play a major role in the economic regeneration of the county
and can aspire people to become involved in sport – County Durham to host
Olympic torch.
o
•
Sport and Leisure Development - The Council’s Sports Development Team works
in partnership with a variety of different organisations at a county wide and local
level, to improve health and wellbeing through physical activity opportunities,
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lifestyle advice and education. It is responsible for the direct delivery of lifestyle
interventions such as the Wellness On Wheels Truck and others in partnership with
the NHS, including the delivery of both adult and childhood obesity programmes.
With regard to the 2012 Olympics, the ‘join in…programme’ for residents of all ages
has been launched by the Council to encourage participation in sport and physical
activity, inspire people to expand their horizons and aim as high as they can,
encourage excellence in the county and celebrate the olympic values.
•
Countryside Facilities - The Council’s countryside estate comprises of 30 picnic
areas, 3 country parks, 45 areas of nature conservation importance, including 8
sites of special scientific interest and a railway path network. The Countryside
Team promotes the countryside through events and guided walks, runs
environmental education sessions and works with volunteers and community
groups.
(Further details Section 7, paragraphs 7.1.1 – 7.10.1)
2.17
Physical activity projects funded by Area Action Partnerships
2.17.1 A number of the Area Action Partnerships have used their Area and Neighbourhood
budgets to fund physical activities for all age groups, but primarily for children and
young people. Details of the projects are listed in Appendix 2 attached to the full
report.
Conclusion
A range of facilities (indoor and outdoor), supported by good infrastructure exists
to support people participate in physical activity.
The next four years (2011-2014) will be extremely challenging as the Council
makes savings of £123.5 million required by its Medium Term Financial Plan. The
Council will need to achieve a reduction in budgets but still deliver effective and
efficient services for residents. Within this context of severe financial constraints
the Council will be faced with having to make very difficult decisions in relation to
the provision of leisure services.
Indoor facilities should not be seen as the only mechanism through which
participation in sport and leisure can be grown. More use of our parks and open
spaces for example, can provide great opportunities to be active and at very little
cost.
It is hoped that the Olympic and Paralympic Games 2012 will inspire and increase
participation in sport and physical activity. To this end the Council has launched a
brand new community campaign which aims to recruit and support at least 200
new volunteers to grassroots sport and leisure across the county, in eighteen
months. Be a sport…volunteer Durham’ is part of the Council’s ‘Join in…’ 2012
Olympic legacy programme. Under the authority’s Olympic offer, it has pledged to
provide community based support for the huge range of local sports clubs and
groups right across County Durham, encouraging more people of all ages and
abilities to try something new or simply pick up an old hobby.
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Joint DCC/NHS Commissioned Programmes / Projects
2.18
Health Improvement Service
2.18.1 The Health Improvement Service is part of the local NHS and works in partnership with
Durham County Council, Darlington Borough Council, other statutory partners and the
voluntary and community sector to plan, design and evaluate collaborative sustainable
solutions to improve health. It provides a range of commissioned programmes to nearly
600,000 people.
2.19
Changing the Physical Activity Landscape Programme (CPAL)
2.19.1 NHS County Durham has commissioned County Durham Sport to develop, coordinate
and manage the CPAL project - a physical activity intervention project in support of the
NHS Health Check Programme. The project’s long term outcome is to increase the
level of participation in physical activity for people (and their households) in County
Durham, aged 40-74, with an estimated and actual risk calculation of cardiovascular
disease (CVD) greater than 20%. Examples of projects are: Durham Swim Active
Scheme, which is a programme led by the Amateur Swimming Association in
partnership with Durham County Council to use swimming to tackle health challenges,
and Healthy Horizons - a collaborative partnership project, focused on increasing
levels of participation in physical activity for men and women aged 50+, particularly
those living in disadvantaged areas.
2.20
Health Trainers
2.20.1 NHS Health Trainers offer information and support to help people make changes to
improve their health and wellbeing. They work with individuals on a one to one basis
who would like help and advice to stop smoking, eat healthily and become more
physically active.
2.21
NHS Health Check Programme
2.21.1 Free NHS Health Checks are part of a national programme, aimed at identifying those
who have a high risk of developing heart disease, stroke, type 2 diabetes and kidney
disease. NHS County Durham and Darlington is working to provide Health Checks for
one fifth of the eligible population per year by 2012/13.
2.22
Life Style Change Programme
2.22.1 The County Council is piloting the Lifestyle Change programme where participants
receive phone calls, motivational texts and e-mails for 10 weeks as well as physical
activity information packs and monthly newsletters.
2.23
County Wide Exercise on Prescription
2.23.1 Exercise on prescription is provided by Leisureworks in Derwentside, County Durham
and Darlington NHS Foundation Trust in the East of Durham and Durham County
Council Leisure Services provide a service for the rest of the County. The long term
objective is to help people to attain sustainable healthy lifestyle changes.
2.24
Healthy Heart Programme
2.24.1 This is a joint initiative between Durham County Council and the NHS, which is aimed
at improving the heart health of the whole community in specific locations within
County Durham. The programme supports individuals to make informed choices about
16
their lifestyle and reduce the risk of cardiovascular disease through evidence based
medical interventions.
2.25
Family Initiative Supporting Children’s Health
2.25.1 The above initiative was delivered in 123 schools from September 2009 to December
2010 to tackle the problem of childhood obesity. It aimed to increase children’s
participation in physical activity inside and outside of school, engage with families of
target children, supporting them to develop and maintain a healthy lifestyle and
promote a whole school approach to a healthy lifestyle in support of the National
Healthy School Status. .
2.26
IMPACT Social Prescribing Website www.health-improvement.cdd.nhs.uk
2.26.1 There are now more than 800 activities on the IMPACT social prescribing website
(some are physical activities). Members of the public and professionals can access
information on activities that aim to improve the population's health in County Durham
and Darlington. (Further details Section 7, paragraphs 7.21.1 – 7.21.2 )
Conclusion
There are a number of lifestyle interventions aimed at targeting and engaging
people through creative and innovative ways. The range of interventions focus
on population groups e.g. older people, health conditions e.g. cardiovascular
disease, geographical area e.g. areas of deprivation and life course. Delivery
seems less planned and disjointed, even though we have a very clear
direction of travel.
The impact of many of these interventions is not fully understood and requires
more detailed evaluation that would assist in better understanding its impact,
cost effectiveness, health benefit and return on investment.
What is required is an evaluative model that can easily and simply support
organisations to determine the impact of the programmes that they deliver so
that investment is more targeted, delivers value for money (return on
investment) and demonstrates outcomes in the short and long term.
Secondly, in order to ensure that delivery is better planned and co-ordinated,
partners involved in ‘health improvement’ planning need to look to pool their
resources so that they may jointly commission physical activity programmes,
based on what works.
Recommendation 2
That Cabinet requests that the Director of Public Health, on behalf of the
Council and the NHS, to commission an evaluative framework to assess the
impact of physical activity programmes and other lifestyle interventions, as
appropriate and to explore, through existing partner arrangements, further
opportunities to pool budgets to jointly commission physical activity
programmes that work, based on evaluation results.
17
Level of participation in physical activities
2.27
Why do some people participate in sport and physical activity? And why do
some simply not want to join in?
2.27.1 Qualitative research may provide the answer as to why adults, teenagers and young
children do or do not participate in sport and physical activity. Weight management,
social interaction and enjoyment were common reasons for participation in sport and
physical activity. The main barriers to participation in sport and physical activity
identified by Sport England and local consultation during the development of ‘A
Physical Activity Strategy for County Durham’ are lack of awareness of what is
available, time, low aspirations, transport, cost, suitability of offer, club capacity, lack of
role models, need for more childcare and image (Further details Section 8, paragraphs
8.1.1 - 8.1.11)
2.28
Sport England’s Active People Survey
2.28.1 Information on the number of people undertaking physical activities can be accessed
through the Active People Survey, commissioned by Sport England to measure levels
of participation in sport and active recreation for those 16 plus and its contribution to
improving the health of the nation. The survey identifies how participation varies from
place to place and between different groups in the population.
Key Performance
Indicators
KPI 1 – At least 3
days X 30 minutes,
moderate intensity
participation (sport
and recreational
walking and Cycling
per week (all adults)
KPI 2 At least 1 hour
of volunteering to
support sport per
week (all adults)
KPI 3 Member of a
sports club
KPI 4 Received
sports tuition or
coaching (all adults)
KPI 5 Taken part in
organised
competitive sport (all
adults)
Active People
Survey 2
0ct 2007 – Oct
2008
A
Active People
Survey 3
Oct 2008 – Oct
2009
A
Active People
Survey 4
Oct 2009-Oct 2010
A
County
Durham
England
County
Durham
England
County
Durham
England
20.8%
21.3%
21.7%
21.6%
22.2%
21.8%
5.3%
4.9%
5.3%
4.7%
4.9%
4.5%
22.2%
24.7%
22.2%
24.1%
21.8%
23.9%
14.4%
18.1%
14.4%
17.5%
15.1%
17.5%
12.8%
14.6%
12.8%
14.4%
12.5%
14.4%
18
2.28.2 County Durham’s participation rate is in line with the national average. The table
overleaf shows how the County is performing for a number of key performance
indicators compared to the average for England for the period October 2007 to October
2010.
2.28.3 With regard to KPI 1 – Participation in sport and recreational walking and cycling,
Active People Survey 2 showed that the former district of Easington and the borough of
Sedgefield had the lowest participation rates (between 13.3% and 19.4%) whilst
Durham City and Chester-le-Street has the highest (between 23.9% - 30.9%). This
physical activity profile mirrors the deprivation profile within the county. (i.e. those
areas with lowest physical activity levels are also those with multiple deprivation
issues.) The map overleaf shows participation rates for the north east region including
former district areas. (Further details Section 8, paragraphs 8.2.1 - 8.2.8)
19
2.29
Sport England’s Market Segments Tool
2.29.1 Sport England has produced a practical guide, using nineteen sporting segments to
help understand the nations’ attitudes to sport and motivations for doing it (or not).
The market segmentation provides those working in community sport with an insight
into the sporting behaviours and the barriers and motivations to taking part amongst
existing participants and those that we wish to engage in a more active lifestyle. The
market segmentation data builds on the results of Sport England’s Active People
Survey and the Department of Culture, Media and Sport's Taking Part survey. (Further
details Section 8, paragraphs 8.3.1 - 8.3.7)
20
2.30
Social marketing
2.30.1 ‘Social marketing is the systematic application or marketing alongside other concepts
and techniques to achieve specific behavioural goals for a social or public good.’
(National Social Marketing Centre).
2.30.2 Social marketing is the use of marketing principles to influence human behaviour in
order to improve health or benefit society. Growing evidence and experience shows
that when social marketing is applied effectively, and in the appropriate context, it can
be a powerful tool for achieving tangible and measurable impact on behaviours.
Improving the level of understanding and application of social marketing is therefore
critical if we are to achieve real and measurable impacts on peoples behaviour(s)
across a range of different policy and practice agendas.
2.30.3 Interestingly, the House of Lords Science and Technology Select Committee has
appointed a sub-committee (19 May 2011) to investigate the use of behaviour change
interventions to achieve policy goals. The Sub-Committee will look at the evidence
base that supports current behaviour change interventions and at the effectiveness of
those interventions. The enquiry will seek to determine whether there is sufficient
expertise within public services to ensure that interventions are evidence-based, and
implemented and evaluated effectively.
Conclusion
County Durham’s participation rate is in line with the national average.
Barriers to participation need to be taken into account when planning for
physical activity. Importantly levels of participation correspond to areas of
deprivation which directly relate to health opportunities and heath inequalities.
The Sport England Survey (4) provides good information to assist planners
and provides relevant benchmarking information to monitor trends and
improvements. Analysis of children’s participation is lacking (up to16).
Tools exist for example, market segment information that can be used to
develop initiatives to meet customer needs, target investments efficiently and
effectively market sport to attract more customers. However these tools focus
more on sport than physical activity. Opportunities to use social marketing
techniques to influence human behaviour should be explored.
The House of Lords Science and Technology Select Committee’s report
(when completed) should provide an evidence base with associated case
study material that will be worth considering assisting the Council and its
partners with approaches/ interventions that support behaviour change.
Investment in people’s participation, for example in volunteering may well in
crease levels of participation. Anecdotal evidence suggests that volunteering
and or buddy schemes motivate and help people to be more active. Impact of
such interventions is unclear.
21
Recommendations 3a and 3b
a) That Cabinet requests the Director of Public Health, in conjunction with the
Council and the NHS, to bring forward proposals on interventions that support
behaviour change reflecting on the evidence base that exists, including the
outcome from the House of Lords Science and Technology Select Committee.
Analysis of such interventions should include for example, social marketing
techniques and best practice regarding volunteering.
b) Secondly, that Cabinet ensures that details of such approaches are
cascaded to all partners and partnerships, namely all physical activity
providers and commissioners; the Council’s Area Action Partnerships
(irrespective of whether they have or do not have health priorities), the NHS
Health Networks and the Health and Wellbeing Partnership/Board.
22
2.31
Benefits and returns on investment/interventions to improve levels of physical
activity
2.31.1 One of the challenges for preventative interventions to promote physical activity is to
evaluate their impact. There have been a number of attempts recently to identify the
potential and actual return on investment for initiatives aimed at preventing or reducing
the risk of ill health. Where this is related directly to costs, the concept of return on
investment is used. Return on investment (ROI) is the ratio of money gained or lost
(whether realised or unrealised) on a project investment – relative to the amount of
money invested in that project.
2.31.2 The return on investment may be considered in relation to the improvement of quality
of life. Current terminology describes this in terms of quality adjusted life years or
‘QALY’. A year of life adjusted for its quality or its value. A year in perfect health is
considered equal to 1.0 QALY. The value of a year in ill health would be discounted.
For example, a year bedridden might have a value equal to 0.5 QALY
2.31.3 Calculating the costs of interventions is usually relatively simple. The difficulty is to
identify the potential health effects and health benefits of the intervention. It is also
important to recognise that there will be a delay between increase in physical activity
and measurable benefits.
2.31.4 The Social Return on Investment (SROI) is another useful approach for those who plan
and deliver public services to make judgments about the best ways of achieving
savings and improvements based on value not cost. SROI can help increase
understanding about the impacts of policies, projects and services. It identifies and
values those impacts from the perspective of people affected. Using a SROI approach
helps to include those things that do not result in changes to income or costs, but are
nonetheless important. The aim is to give the people who are most affected a voice
about allocating resources. (Further details Section 8, paragraphs 8.4.1 - 8.5.11)
Conclusion
A common by-line being used to promote physical activity is ‘the cure of ills is
not to sit still’ and ‘eat less, do more’.
This apparent common sense approach to physical activity needs to be
supported by organisations and professionals to help individuals and
communities recognise the health benefits of regular and sustained physical
activity. By emphasising and promoting flexible approaches to physical
activity that can be incorporated into existing lifestyles, there are
opportunities for improving physical activity levels. To achieve this, there is a
need to promote the health benefits to all ages and groups; and all
orgnaisations and agencies.
A number of tools have been developed that demonstrate Social Return on
Investment (SROI) .These need to be incorporated into any future work to
develop an effective evaluative framework.
23
2.32
Best Practice /Guidance /Research
2.32.1 A number of international and national guidance documents have been produced
aimed at promoting physical activity. All emphasise the need for evaluation and
monitoring.
2.33
National Institute for Health and Clinical Excellence Guidance
2.33.1 In March 2006 the National Institute for Health and Clinical Excellence (NICE) issued
guidance on the four commonly used methods to increase physical activity. The aim of
the guidance is to help practitioners deliver effective interventions that will increase
people’s physical activity levels and therefore benefit their health.
2.33.2 In addition to the above, NICE also produced in 2008 complementary guidance on how
to encourage employees to be physically active - ‘Workplace health promotion: how to
encourage employees to be physically active’. (Further details Section 9, paragraphs
9.2.1 - 9.2.10)
2.34
Toronto Charter for Physical Activity
2.34.1 The Toronto Charter for Physical Activity outlines the direct health benefits of investing
in policies and programmes to increase levels of physical activity. It makes a case for
increased action and greater investment on physical activity as part of a
comprehensive approach to non communicable disease prevention. It refers to seven
“best investments” for physical activity. (Further details Section 9, paragraphs 9.3.19.3.2)
2.35
Toolkits/Frameworks
2.35.1 The following toolkits are available to promote physical activity:
• Let’s Get Moving (LGM) Commissioning Framework- provides a physical activity
care pathway which can be used by service providers systematically to recruit
patients and screen for inactivity using a validated questionnaire. Patients identified
as not meeting the Chief Medical Officer’s recommendations for physical activity will
be offered a brief intervention. (Further details Section 9, paragraphs 9.4.1-9.4.3)
• Promoting Activity Toolkit - has been developed by Make Sport Fun on behalf of
the NHS, Department of Health, Transport for London and other partners. It is a
community project, with many partners contributing and with all resources available
to all users.
British Heart Foundation (BHF) Exercise Referral Toolkit was developed by the
BHF National Centre for Physical Activity and Health, to support professionals in
designing, delivering, commissioning and evaluating exercise referral schemes.
•
2.36
Research ‘Movement as Medicine’
2.36.1 Newcastle University has developed the UK’s first clinically accredited professional
development programme for physical activity. It is designed to advise doctors and
nurses on methods that worked in getting people with Type 2 diabetes to become more
active. (Further details Section 9, paragraphs 9.7.1 - 9.7.9)
24
Conclusion
A number of toolkits and frameworks exist internationally, nationally and
locally. Whilst each may suggest slightly different interventions, there are a
number of core themes that are repeated across the world:
•
The need for good communication and support between individuals and
health professionals;
•
The need for choice in the type of physical activity undertaken;
•
The need to think about physical activity within lifestyles leading to gentle
lifestyle change
A number of national guidance documents have been produced in Britain
aimed at promoting physical activity. All emphasise the need for evaluation
and monitoring to ensure that participants benefit from interventions.
25
2.37
Conclusion
2.37.1 Improving physical fitness helps prevent and manage over 20 conditions and diseases
including cancer, coronary heart disease, diabetes and obesity and can also help to
promote mental wellbeing. It should be seen as an effective means of providing value
for money and return on investment. It should deliver significant savings on the cost of
treating chronic diseases when you consider that the cost of treating cardio vascular
heart disease (CHD) was approximately £23 million in County Durham in 2009/10.
2.37.2 Liam Donaldson, former Chief Medical Officer said that ‘inactivity pervades the country.
It affects more people in England than the combined total of those who smoke, misuse
alcohol or are obese. Being physically active is crucial to good health. If a medication
existed that had a similar effect on preventing disease, it would be hailed as a miracle
cure’.
2.37.3 Evidence of the health benefit for physical activity is seen throughout the life course. In
children, effects are predominantly seen in amelioration of risk factors for disease,
avoidance of weight gain, achieving a high peak bone mass and mental wellbeing. In
adults, protection is conferred against the diseases themselves, including
cardiovascular disease, cancer, type 2 diabetes and obesity. ‘Start Active, Stay Active’
2011 - a report on physical activity for health by the four home countries Chief Medical
Officers, stresses the importance of investing in a lifecourse approach to the
promotion of physical activity and reducing sedentary behaviour at different key life
stages of childhood and adolescence, adulthood and older age.
2.37.4 Reducing health inequalities will require action on six policy objectives identified in the
Marmot Review:
• Give every child the best start in life.
• Enable all children young people and adults to maximise their capabilities and have
control over their lives.
• Create fair employment and good work for all.
• Ensure healthy standard of living for all.
• Create and develop healthy and sustainable places and communities.
• Strengthen the role and impact of ill health prevention.
2.37.5 For most people the easiest and most acceptable forms of physical activity are those
that can be incorporated into everyday life. Examples include walking or cycling
instead of travelling by car and taking up active leisure pursuits and hobbies such as
gardening or social sporting activities. Even shopping regularly, according to recent
research reported in the Journal of Epidemiology and Community Health, has the
potential to increase physical and mental wellbeing.
2.37.6 Physical activity makes a significant contribution to reducing health inequalities.
Consequently, increasing physical activity and participation in sport and leisure and
reducing obesity levels are identified in the Altogether Healthier Section of Council Plan
2011 – 14 as the two main actions to reduce health inequalities.
2.37.7 The over-riding aim of the Council’s Sport and Leisure Strategy 2011 – 2014 is to
increase participation in physical activity by 0.5% per year in accordance with the
Sustainable Community Strategy and Council Plan, whilst anticipating a significant
26
reduction in funding over the plan period. The strategy generally seeks to reduce
dependence on built facilities, by refocusing on the natural environment and
development of targeted activities as a resource for people to take part in physical and
recreational activity, as part of either sport or day to day routines. The Council’s Sport
and Leisure Service Strategy recognises the Council’s important role as a community
leader, co-ordinating and enabling others to deliver, directly working within
communities to increase participation and promoting a preventative approach to wellbeing.
2.37.8 Changing inactive lifestyles presents a tremendous challenge for key partners i.e. the
NHS, local authorities, sports and leisure bodies, schools and colleges, employers and
workplaces, parents and families. Current levels of physical activity reflect personal
attitudes about time use and how conducive our homes, neighbourhoods and
environments have become for more inactive living.
2.37.9 Growing evidence and experience shows that when social marketing is applied
effectively, and in the appropriate context, it can be a powerful tool for achieving
tangible and measurable impact on behaviours. Sport England’s Market Segments
Tool will help those working in community sport to understand the nation’s attitudes to
sport, motivations for doing it (or not) and will assist with the development of initiatives
to meet customer needs, target investment efficiently and attract more customers.
2.37.10 Local authorities, through their planning powers, management of traffic, parks and
open spaces, leisure and cultural services can contribute to the quality of the natural,
built and social environment. They have specific duties and powers to promote equality
and social inclusion and social, economic and environmental well-being. They work in
partnership with the NHS and other agencies such as the police, to support public
health. The National Institute for Health and Clinical Excellence in its public health
guidance 8 – ‘Promoting and creating built or natural environments that encourage and
support physical activity’ provides evidence based recommendations covering,
strategies / policies / plans, transport, public open spaces, buildings and schools.
2.37.11 The natural environment has an important role to play in maintaining healthy lives. It
provides for physical activity which reduces obesity and heart disease, and improves
air quality by filtering pollutants, thus reducing respiratory problems such as asthma.
2.37.12 In the White Paper ‘Healthy Lives, Healthy People: Our strategy for public health in
England’ the Government recognises that the quality of the environment, including the
availability of green space and the influence of poor air quality and noise affects
people’s health and wellbeing. It states that the social costs of the impacts of air
pollution are estimated at £16 billion per year in the UK. The White Paper details plans
for a shift of power to local communities, including new duties and powers to local
authorities to improve the health of local people. The Government is of the view that it
is simply not possible to promote healthier lifestyles through Whitehall diktat and
nannying about the way people should live. It therefore proposes a new approach
which empowers individuals to make healthy choices and gives communities the tools
to address their own, particular health needs. This is a significant shift of policy
direction from the previous government as this government pursues a policy of less
nannying by the state rather promoting individual responsibility and potentially a culture
27
of victim blaming if people are unable to actively engage for whatever reason.
According to the Marmot review action to reduce health inequalities requires both
individual and collective responsibility.
2.37.13 The Government’s commitment to protecting and improving the natural environment is
also set out in the White Paper ‘The Natural Choice’. Key measures included in the
White Paper are designating green areas, enabling more children to experience nature
by learning outdoors, strengthening local public health activities and a new
environmental volunteering initiative ‘Muck in 4 Life’.
2.37.14 The proposed public health system, as outlined in the White Paper ‘Healthy Lives,
Healthy People - Our strategy for public health in England’, includes Health and
Wellbeing Boards, which will be charged with assessing and agreeing local health
priorities. The Boards will comprise of clinical commissioning consortia, Director of
Public Health, Directors of Adult and Children’s Services, local Health Watch and NHS
Commissioning Board. The Director of Public Health will be employed by the Local
Authority and will be the ambassador of health issues for the local population.
Historically, money for public health has disappeared into other services. Under new
arrangements, the flow of money will change so that: money will be allocated from the
NHS budget and ring-fenced for public health. Local Authorities will receive an
incentive payment or health premium, which will depend on the progress made in
improving the health of the local population and reducing health inequalities, based on
elements of the Public Health Outcomes Framework.
2.37.15 Promoting physical activity in the workplace is vitally important as physically active
employees are less likely to suffer from major health problems, less likely to take
sickness leave and less likely to have an accident at work. In England, the costs of lost
productivity have been estimated at £5.5 billion per year from sickness absence and £1
billion per year from premature death of people of working age. (The Economic Burden
of Inactivity 2002). Employers therefore need to develop employee initiatives with a
range of organisations to increase participation in physical activity and wherever
possible provide and promote opportunities to travel to and from the workplace by
walking and cycling.
2.37.16 It is important that all preventative interventions to promote physical activity are
evaluated to assess whether they are reaching those most in need and are cost
effective. The use of cost-utility analysis – where the outcomes are expressed in one
measure that combines information on life expectancy and health related quality of life
(quality adjusted life years or ‘QALYs) can be used to make comparisons across
different programmes, for example prevention and treatment.
2.37.17 The Health Impact Assessment (HIA) process is able to support action to improve
health and quality of life. It is a staged process involving screening of a policy or
strategy in the first instance, however unlike Strategic Environmental and Equality
Impact Assessments, there is no statutory requirement to undertake Health Impact
Assessments.
2.37.18 In the final analysis, the Council through its strategic and community leadership role
recognises the link between environmental, social and economic sustainability to
health and well being outcomes. An example of this can be seen through the
development of County Durham Sustainable Community Strategy, where health
28
outcomes linked to socio-economic priorities have come to the fore. The Council’s
vision for a better place for people explicitly recognises the need for a healthier
community. Health outcomes and health improvement are seen as core business and
are progressed through existing organisational arrangements, which ensure that health
implications and action on health inequalities are challenged at the corporate, cabinet
and indeed scrutiny level. This approach puts the Council in a good position for the
transfer of public health to local government.
Recommendations
1.
should include the Marmot Review six policy objectives) informs the
Council’s contribution to planning and delivery of a public health agenda
within the context of proposals contained in the Health and Social Care Bill
(and Act as appropriate).
2.
appropriate, and to explore, through existing partner arrangements, further
3a. That Cabinet requests the Director of Public Health, in conjunction with the
Council and the NHS, to bring forward proposals on interventions that
support behaviour change reflecting on the evidence base that exists,
including the outcome from the House of Lords Science and Technology
Select Committee. Analysis of such interventions should include for
example, social marketing techniques and best practice regarding
volunteering.
3b. That Cabinet ensures that details of such approaches are cascaded to all
partners and partnerships, namely all physical activity providers and
commissioners; the Council’s Area Action Partnerships (irrespective of
whether they have or don’t have health priorities), the NHS Health Networks
and the Health and Wellbeing Partnership/Board.
4.
That a systematic review of this report and progress against its
recommendations should be undertaken 6 months after it has been
considered by Cabinet.
29
Section Three – Remit of the Review
3.1
Rationale
3.1.1
It is a particularly opportune moment to explore the role of local government in
addressing health inequalities within the policy context of emphasising the power of
general competence, public health moving to local government and the importance of
co-ordinating the commissioning of health and social care services via Health and
Wellbeing Boards.
3.1.2
This policy context will also need to reflect the challenge the County Council is facing in
respect of unprecedented cuts in expenditure and services and more than ever, the
need to demonstrate cost effectiveness and the economic and social value of its
services.
3.1.3
Physical activity has a significant role to play in contributing to the health and wellbeing
of communities. Physical activity cuts across a range of different policy areas and
drivers so consequently, no single agency or organisation has taken a primary role or
responsibility for co-ordinating the planning and delivery of physical activity.
3.1.4
The role of physical activity in health promotion and disease prevention has been well
documented. The Chief Medical Officer’s (CMO) report (DH, 2004) demonstrated that
there is strong evidence to confirm that there are many health benefits of being active
and that an inactive lifestyle has a substantial negative effect on the individual and
public health.
3.2
Focus
3.2.1
Physical activity is a key public health priority. Increasing levels of physical activity can
improve health by decreasing the risk factors for a number of chronic conditions, in
addition to improving weight management.
3.2.2
It has been hypothesised that physical inactivity alongside an unhealthy dietary intake,
has contributed to the rapid elevation of both child and adult obesity.
3.2.3
Physical activity is also linked to improving mental health. Low level mental health
problems are one of the most common reasons why patients attend their medical
practitioners.
3.2.4
The economic burden of inactivity in England has been estimated at £8.3 billion,
however, this figure excludes the contribution of inactivity to obesity, which alone has
been estimated to cost £2.5 billion annually.
3.2.5
However, while interventions aimed at individuals may be important, they are not the
only (nor possibly the main) solution. Environmental factors also need to be tackled.
Indeed, there is growing recognition that physical environments that support and
encourage physical activity can help improve the public’s health.
30
3.2.6
The focus of the review was to look at these areas taking into account effectiveness
and value for money considerations in the delivery of physical activity in order to
improve health and reduce health inequalities.
3.3
Terms of Reference
3.3.1
The terms of reference of the Review were:
1. To assess the scale of inactivity and its impact on health inequalities.
2. To assess how local policies, strategies and plans are developed and delivered.
3. To determine the impact of the built and natural environment on physical activity
levels.
4. To consider the role of strategic leadership – links to the 2012 (Olympics);
services and commissioning; strengthening communities; organisational level
activity; measuring wellbeing outcomes in order to make it happen.
5. To understand the effectiveness of interventions; their sustainability, return on
investment (human and financial); how they are measured;
6. To consider interventions that target place (work/school/community); people(most
vulnerable and hard to reach communities); and other
7. To understand the implications to the life course namely:
7.
•
Starting well: Early on, the health of mothers before and during pregnancy
and good parenting are crucial to getting the best start in life.
•
Developing well: As children develop, it is important to encourage healthy
habits and avoid the adoption of harmful patterns of behaviour.
•
Growing up well: Childhood is also a critical time for identifying, treating and
preventing physical and mental health problems.
•
Living and working well: Lifestyle choices in adulthood can have profound
impacts on an individual’s longer term health and wellbeing.
•
Ageing well: As people age and become increasingly at risk of frailty. There
are challenges in supporting them to remain resilient to ill health
by maintaining their social networks and by being physically active.
Protecting vulnerable people, including the elderly, from preventable
harms is also an important challenge for public health and includes
falls prevention, protecting people from seasonal weather extremes, and
providing vaccinations such as the seasonal flu jab.
To review best practice internationally, nationally, regionally and locally with a
focus on return on investment.
31
3.4
Approach / Methodology
3.4.1
The Review Group gathered information and evidence as follows:
a)
A total of 8 meetings were held between January and May 2011
b)
Presentations were received in relation to:
•
Overview of Physical Activity in County Durham – M. Campbell, Strategic
Manager, Adults, Health and Wellbeing, Durham County Council, J. Russell,
Strategic Manager, Sport and Leisure, Durham County Council, G. Greig,
Public Health Specialist, NHS County Durham and Darlington
•
Impact of the built and natural environment on physical activity –
T. Wright, NHS County Durham and Darlington
•
Green Infrastructure, Our Natural Health Service – S. Dobson, Green
Infrastructure Programme Co-ordinator, Groundwork Northeast
•
Local Transport Plan 3 and its contribution to health improvement –
H. Harvey, Strategic Transport Planning Manger, Durham County Council
•
Local Adult Participation in Sport and Active Recreation Statistics/Sport
England Active Market Segmentation Tools – S. Mitchell, Strategic
Partnership Manger and L. Gallagher, Marketing and Research Officer,
County Durham Sport.
•
Best Practice on Return on Investment – B. Cook, Consultant
Coach Facilitator, The Centre for Public Scrutiny
•
Health Checks/Physical Activity – Dr. M. Lavender, Consultant in Public
Mental Health Medicine, NHS County Durham
•
‘Movement in Medicine’ – Dr. M. Trenell, Newcastle University
c)
Site visits by Members of the Review Group to Wellness on Wheels (WOW)
Trailer at Great Lumley, Legacy Gym at Coundon, Helford Road Pavilion,
Peterlee and Robin Todd Centre, South Hetton to view the facilities.
.
d)
•
•
•
•
The following key documents were examined:
Department of Health Publication ‘Be Active, be health’
Mapping Physical Activity in the North East Region
County Durham Joint Commissioning Strategy for Adults with Mental Health
Needs 2009-2013, Durham County Council Adults, Wellbeing and Health
and NHS County Durham
County Durham Partnership, County Durham Sustainable Community
Strategy (SCS) 2010-2030
32
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Durham County Council Health Improvement Plan 2010-2013
County Durham Health and Wellbeing Partnership: Altogether Healthier
Delivery Plan
Regional Director of Public Health; North East Public Health Strategy ‘Better
Health Fairer Health’ (2008)
County Durham Health Profile 2010
Durham County Council – Sport and Leisure Service Strategy 2011 - 2014
Couch kids: the nation’s future – British Heart Foundation
Durham County Council Local Transport Plan 3
Cycling and Health – What’s the evidence? Nick Cavill and Dr Adrian Davis
Chief Medical Officer’s Annual Report 2009
Advancing Health – Examples of the work of the Chief Medical Officer for
England 1998 – 2010
Fair Society Healthy Lives The Marmot Review 2010
NICE public health guidance 8: Promoting and creating built or natural
environments that encourage and support physical activity
NICE public health guidance 13: Workplace health promotion: how to
encourage employees to be physically active
NICE public health guidance 17. Promoting physical activity, active play and
sport for pre-school and school age children and young people in family,
preschool, school and community settings
NICE public health guidance 25: Prevention of cardiovascular disease
NICE – Walking and cycling - draft scope for consultation document April
20011
Securing Good Health for the Whole Population – Derek Wanless
Understanding participation in sport and physical activity among children and
adults: a review of qualitative studies
All’s Well That Ends Well? Local Government Leading on Health
Improvement LGiU
White Paper – The Natural Choice
Review of Indoor Sport and Leisure Facilities – Report to Durham County
Council Cabinet 13th July 2011
Start active, Stay Active - a report on physical activity for health from the four
home countries’ Chief Medical Officers
3.5
Reporting
3.5.1
The report will be considered by:
•
•
•
•
•
•
•
Group and Adults, Wellbeing and Health Overview and Scrutiny Committee,
Assistant Chief Executives Management Team,
Adult Wellbeing and Health Management Team,
Neighbourhood Services Management Team
County Durham Health and Wellbeing Partnership,
Corporate Management Team,
Cabinet.
33
3.6
Timescale
3.6.1
The Review commenced in November 2010 and concluded in July 2011.
3.7
Membership of the Review Group
3.7.1
Members of the Review Group were:
Councillors J. Armstrong, A. Barker, B. Brunskill, J. Chaplow, O. Temple, R. Todd,
A. Shield and P. Stradling
3.7.2
The following co-opted members were members of the Group:
V. Crosby, (Chair of Review Group) Mrs. K.J.M. Currie, Mrs. R. Hassoon and
Mr. D.J. Taylor Gooby
3.8
Project Support Officers
3.8.1
The following officers supported the Scrutiny Review Group during the course of the
investigation:
Feisal Jassat – Overview and Scrutiny Manager
Gillian Garrigan – Overview and Scrutiny Officer
Joanne Thompson – Senior Democratic Services Officer
34
Section Four - Physical activity and health inequalities
4.1
What is health?
4.1.1
Health has been defined in many different ways. One basic definition is ‘freedom from
disease and abnormalities’. In 1948 the World Health Organisation’s (WHO) Charter
set out a much broader definition that equated health with ‘A state of complete
physical, mental and social wellbeing’.
4.1.2
The WHO Ottawa Charter for Health Promotion (1986) emphasised the notion of health
as a resource for living, the components of which might include:
•
Physical fitness – the capacity for physical functioning
•
Psychological fitness – the ability to cope with stressful situations; personal
strength and autonomy
•
Social fitness – integration with the community enabling an individual to draw on
and contribute to social support.
4.1.3
People with good health are therefore able to have control of their lives, live life to the
full, participate in their communities, and function effectively in society.
4.2
What is meant by inequalities in health?
4.2.1
However you define health, there tends to be systematic inequalities in health
experience between different geographical areas, genders, ethnic communities, and
different social and economic groups.
4.2.2
The term ‘underlying determinants of health’ is commonly used to describe social and
economic factors that can have an adverse effect on an individual’s health.
4.3
What is physical activity and sport?
4.3.1
Physical activity is defined as being any force exerted by a skeletal muscle that results
in energy expenditure above resting level. Sport consists of a normal physical activity
or skill carried out under a publicly agreed set of rules and with recreational purpose;
for competition, for self employment, to attain excellence, for the development of skill or
some combination of these.
4.3.2
The Department of Health publication ‘Be active, be healthy’ states that ‘ Physical
activity includes all forms of activity, such as everyday walking or cycling to get from A
to B, active recreation not undertaken competitively, such as working out in the gym,
dancing, gardening or families playing together, as well as organised and competitive
sport.
4.3.3
What unites all physical activity is its effect upon the human body, raising heart rate,
bringing about an immediate and often beneficial physiological response and improving
overall wellbeing.
35
4.4
Why is physical activity important?
4.4.1
Evidence of a health benefit for physical activity is seen throughout the lifecourse. In
cardiovascular disease, cancer, type 2 diabetes and obesity.
4.4.2
Physical activity substantially reduces the risk of common diseases.
Disease
Effect of physical activity
Coronary heart
disease
Moving to moderate activity could reduce risk by 10%.
Stroke
Moderately active individuals have a 20% lower risk of stroke
incidence or mortality.
Type 2 diabetes
Active individuals have a 33 – 50% lower risk.
Colon Cancer
The most active individuals have a 40 – 50% lower risk.
Breast Cancer
More active women have a 30% lower risk.
Osteoporosis
Being physically active reduces the risk of later hip fracture by
up to 50%
Source Chief Medical Officer’s Report 2009
4.4.3
The relationship between inactivity and obesity is well recognised. Almost a quarter of
adults are obese and 30% of children are either overweight or obese. These increases
are partly due to declining levels of physical activity. More heart disease deaths are
due to inactivity than smoking or high blood pressure and up to 3,000 cases of cancer
per year could be prevented by becoming more active. (CMO Report 2009)
4.4.5
Physical activity can also help to promote mental wellbeing, which is important given
that mental health problems including stress, depression and anxiety resulted in an
estimated 10.5 million days lost (Health and Safety Executive 2007).
4.4.6
Physical activity is associated with reduced risk of depression and dementia in later
life. It is effective in the treatment of clinical depression and can be as successful as
psychotherapy or medication, particularly in the long term.
36
4.4.7
Exercise seems to have an effect on certain chemicals in the brain, like dopamine and
serotonin. Brain cells use these chemicals to communicate with each other, so they
affect people’s mood and thinking. Physical activity can stimulate other chemicals in
the brain called “brain derived neurotrophic factors”. These help new brain cells to grow
and develop. Moderate exercise seems to work better than vigorous exercise. Exercise
also seems to reduce harmful changes in the brain caused by stress.
4.4.8
Experts believe that the benefits of the release of these chemicals are less tension,
stress and mental fatigue, a natural energy boost, improved sleep, a sense of
achievement, focus in life and motivation, less anger or frustration, a healthy appetite,
better social life and having fun.
4.4.9
On average, an inactive person spent 38% more days in hospital than an active
person, had 5.5% more contact with doctors and 13% more specialist services, as well
as 12% more nurse visits than an active individual.
4.4.10 Physical activity such as cycling and walking are also environmentally friendly and can
lead to a reduction in traffic congestion and pollution. The social benefits of joining a
sports club or team are also important in developing strong and cohesive communities.
4.4.11 The Chief Medical Officer’s (CMO) report ‘At least five a week: Evidence on the impact
of physical activity and its relationship to health’ (DH, 2004) and ‘Start Active, Stay
Active’, a report on physical activity for health from the Chief Medical Officers of
England, Scotland, Wales and Northern Ireland (July 2011) provide strong evidence to
confirm that there are many health benefits of being active, with the latter highlighting
the risks of sedentary behaviour for all age groups
4.5
Physical activity levels in England
4.5.1
Physical activity levels are low in the UK. Factors contributing to lower activity levels
are greater use of cars for short journeys, sedentary occupations, parental reluctance
to allow children to play outdoors, increased pressures on time available for school
sport and physical education and greater access to television and computers and other
sedentary activities.
4.5.2
In 2008, 61% of men and 71% of women aged 16 failed to meet the minimum adult
recommendations for physical activity, according to self reported surveys. These
figures are likely to underestimate the true burden of inactivity, as when a sample of
respondents in the Health Survey for England had their physical activity levels
measured only 8-10% who claimed to exercise for 30 minutes five times a week,
actually did so.
4.5.3
Physical activity levels decline rapidly with increasing age. In England only 17% of men
and 13% of women aged 65-74 are physically active.
4.5.4
Levels of inactivity amongst children are high. Amongst 2 -15 year olds, 68% of boys
and 76% of girls do not meet the minimum recommendation of an hour of moderate
physical activity per day. As a result, children are being exposed to health risks,
including obesity, weak bones and future heart disease.
37
4.5.5
Several factors were found to influence children’s physical activity levels, including
household income and parental physical activity levels. The 2007 Health Survey for
England found that participation in sport and exercise tended to increase as
comparable household income increased, while the reverse was true for walking, with
higher levels of participation among those in the lowest socio-economic group.
4.5.6
Among boys aged 2-10 years, more met the physical activity recommendations for
children if their parents did so for adults. Among boys aged 11-15 the same pattern
was apparent for fathers’ activity levels, not for mothers.
4.5.7
Among girls, the activity level of parents made relatively little difference to the
proportion meeting recommendations. However, those who had parents with low
activity levels were considerably more likely to be in the low activity category
themselves.
4.5.8
Children and young people with a disability take part in physical activity and sport less
frequently and their experiences are less positive than their non-disabled peers.
4.5.9
Ethnicity also has an influence on participation in physical activity. With the exception
of Pakistani boys and Irish boys and girls, children in minority ethnic groups are less
likely than the general population to achieve their 60 minutes a day. (Sproston and
Mindell Health Survey for England, the health of minority ethnic groups - 2006 )
Additionally, in most groups, girls are less likely to have a high level of physical activity
than boys.
4.5.10 Young people are increasingly spending a significant amount of time being sedentary,
which some researchers suggest can have a negative impact on their health and
wellbeing. This has prompted physical activity guidelines in a number of countries to
include a recommendation to reduce sedentary behaviour.
4.5.11 Two thirds of adults are sedentary for 6 or more hours on weekdays and the average
adult watches 2.8 hours of television per weekday, increasing on weekends, which is
16 times greater than the average time spent in physical activity. Sport is largely a
spectator activity providing entertainment by watching, rather than participating.
4.6
Physical activity and ill health levels in County Durham
4.6.1
The total population of County Durham is estimated to be circa 508,500 (mid 2008
population estimates, Office of National Statistics). County Durham is amongst the
most deprived unitary authorities in the country, particularly in relation to both health
and employment, with the east of the County experiencing by far the highest levels of
deprivation.
4.6.2
The most detailed and locally applicable data available on physical activity participation
levels derive from the national Active People Survey undertaken by Sport England.
(Further details of the survey can be found in Section 8 of the report)
4.6.3
County Durham’s sport and physical activity participation rate is in line with the national
average, however there is a disparity across the former district areas. The former
38
district of Easington has the lowest participation rates in the North East whilst Durham
City has the highest. This physical activity profile mirrors the deprivation profile within
the county.
4.6.4
As is the national trend, male participation in County Durham has increased but
participation among females has decreased. Although overall participation in adults’
groups 16-34 and 35-54 has increased; there has been a decrease nationally in the 55
plus age group.
4.6.5
In addition to participation rates, the ‘Active People Survey’ data also highlights below
national average achievement in areas which support and link to increased
participation. The data indicates that County Durham is below national average in the
percentage of adults who have enjoyed tuition, which is often a critical component to
confident participation. Fewer adults in County Durham engage with regular
competitive opportunities or are members of sports clubs, which often provide positive
opportunities for social interaction and group belonging, which can increase an
individual’s motivation or commitment to participate regularly.
4.6.6
Life expectancy for men living in County Durham is 1.7 years less than the
England average. Life expectancy for women living in County Durham is 1.5 years
less than the England average (County Durham Health Profile 2010).
4.6.7
Premature all cause mortality rates per 100,000 are significantly higher in County
Durham, than England. The all cause mortality rate (under 75) in County Durham
(2006-2008 pooled) was 331/100,000 compared to 296/100,000 in England.
4.6.8
There are inequalities in health within County Durham. For example life expectancy for
men living in the most deprived areas is over 6 years lower than for men living in the
least deprived areas. For women it is nearly 5 years lower. (Health Profile 2010) The
distribution of premature death across County Durham is unequal. It is greater in the
more deprived wards. Across the wards, premature all cause mortality rates vary from
120/100,000 in Neville’s Cross to 686/100,000 in Neville and Simpasture. This relative
inequality gap in mortality or the size of the gap in mortality across all wards,
expressed as a percentage, is 58%.
4.6.9
The Health Profile for County Durham 2010 identifies that many of its health indicators
are significantly worse than the England average. These include:
•
•
•
•
•
•
•
•
•
•
Obese adults
Early deaths: heart disease and stroke
Early deaths: cancer
Deaths from smoking
Adults who smoke
Hip fractures in over 65s
Binge drinking adults
Hospital stays for alcohol related harm
Mental illness
Healthy eating adults
39
4.6.10 Rates of obesity are higher in County Durham than the national average, with areas
such as the former districts of Easington, Sedgefield and Wear Valley being
significantly higher. Death from circulatory diseases, heart diseases, stroke and
cancers occur across the county at a younger age than the national average (County
Durham Joint Strategic Need Assessment 2008 -09).
4.6.11 The direct costs of physical inactivity to NHS County Durham are estimated at £8.3m
per annum, compared to an average PCT cost across the country of £5m per annum,
(Department of Health publication ‘Be Active, Be Healthy’). The costs of treating
chronic disease can run into the millions and figures for 2009/10 show for example:
Cancer cost approximately £65m, Diabetes £17m, Coronary Heart Disease £23m and
Stroke £13m.
4.7
Life Course Perspective
4.7.1
Recently, there has been a growing awareness in public health research of the longterm impact on health of various events and exposures earlier in life.
4.7.2
The first proponents of the ‘life course perspective’ concentrated on events and
exposures in fetal life, but later studies showed that circumstances throughout
childhood and adult age influence health in old age. A number of chronic diseases such
as coronary heart disease, stroke, and some cancers seem to be influenced by factors
acting across the entire life course.
4.7.3
‘At least five a week: Evidence on the impact of physical activity and its relationship to
health’ Chief Medical Officer report 2004, refers to the life course approach to the
promotion of physical activity. The report states that such an approach is necessary
because the benefits of physical activity to health and the impact of different types of
physical activity are different at different stages of childhood and adolescence,
adulthood and older age. Exposure to risk through inactivity begins in childhood,
however it is not until middle to older age that the resultant increase in morbidity and
eventual premature mortality are seen.
4.7.4
The life course approach is also highlighted in the document ‘Start Active, Stay Active’
which updates the guidance contained in the 2004 Chief Medical Officer report and
establishes new guidelines for early years and older people. It also highlights the need
to reduce sedentary behaviour across the life course, from limiting the time infants
spend restrained in buggies and car seats, through to encouraging older adults to
stand up and move frequently. The report has a dedicated chapter for Early Years
(under 5s), Children and Young People (5-18years), Adults (19 – 64 years) and Older
Adults (65+ years). Appendix 1 attached to the full report sets out the guidelines for
each group.
40
Section Five – How policies, strategies and plans to improve
health and wellbeing and increase levels of physical activity are
developed and delivered at local, regional and national level
5.1
Introduction
5.1.1
Increasing physical activity, reducing health inequalities and improving the quality of life
are key priorities at national, regional and local level and are recognised in key policy
and strategy documents and delivery plans.
Policy Development at Local Level
5.2
County Durham Health and Wellbeing Partnership
5.2.1
At a local level, the County Durham Health & Wellbeing Partnership brings together
different organisations in County Durham to improve people's health and wellbeing. Its
members are focused on reducing the pervasive and persistent health inequalities in
the county.
County Durham
Partnership
Partner
Agencies
PCT Public Health
Health and Well-Being
Partnership
DCC Health
Improvement
Plan
Durham County Council
Many of the wider
determinants of
health are the
work of the local
authority
Health Improvement
Group
Sports and leisure strategy
5.2.2 They ensure that all services are delivered cohesively and in line with their priorities,
which are as follows:
•
Increasing life expectancy targeting Cardio Vascular Disease and Cancers
•
Reducing health inequalities, focusing upon tobacco cessation, alcohol, diet and
exercise
•
Improving mental health and wellbeing
41
5.2.3
Aligned to the above priorities, the Partnership has 9 programme objectives. Two of
the objectives are:
•
To reduce obesity levels
•
To increase physical activity
5.2.4
The Health & Wellbeing Partnership has recently introduced five Health Networks
across County Durham, which are aligned to the current geographies of the Practice
Based Commissioning (PBC) clusters and Local Children’s Boards (LCBs). The Health
Networks provide a vehicle for joining up local partnership planning, delivery,
involvement and participation from local partners and communities. They are
consistent with the recommendations of the Marmot Review on recognising the
importance of decision making and participation at a local level.
5.2.5
Actions identified in the Altogether Health Delivery Plan relating to physical activity and
health, include:
•
Implementing the Achieving Marmot Project relating to health inequalities.
•
Implementing the Cardio Vascular Disease Healthy Hearts Programme by training
DCC staff to carry out health checks, and delivering a programme of physical
activity events to promote heart health.
•
Increasing capacity across local organisations to effectively market physical activity.
•
Developing mobile resources to target low participating groups/areas and creation
of legacy resources.
•
Implementing the DCC Sport and Leisure Strategy.
5.2.6
It is underpinned by the County Durham Sustainable Community Strategy 2010 – 2030
(SCS), the priorities of its Partners and the Joint Strategic Needs Assessment (JSNA)
2009/10.
5.3
Sustainable Community Strategy
5.3.1
The Sustainable Community Strategy is the overarching plan for County Durham. It
takes account of all other local and sub-regional plans, and sets out the Council’s long
term vision for County Durham and ambitions for the area. It was developed by
partners following significant consultation with residents, communities and key
partners.
5.3.2
The JSNA describes “the big picture” in terms of the health and wellbeing needs and
inequalities of the local population. It has also been informed from the
recommendations from the Audit Commission report: Tackling health inequalities in the
North East; the Comprehensive Area Assessment for County Durham 2009 (CAA) and
The Marmot Review: A Strategic Review of Health Inequalities in England Post-2010.
42
5.4
Council Plan 2011 -14
5.4.1
The Council Plan sets out the corporate priorities for improvement and the key actions
that the Council will take in support of the delivery of the long term goals in the
Sustainable Community Strategy. It covers a three year time period and links closely
to the Medium Term Financial Plan. The actions within the plan are structured around
the following priority themes for County Durham:
•
•
•
•
•
•
Altogether wealthier - focusing on creating a vibrant economy and putting
regeneration and economic development at the heart of all our plans
Altogether healthier - improving health and wellbeing
Altogether safer - creating a safer and more cohesive county
Altogether better for children and young people - enabling children and young
people to develop and achieve their aspirations, and to maximise their potential in
line with Every Child Matters
Altogether greener - ensuring an attractive and ‘liveable’ local environment, and
contributing to tackling global environmental challenges
Altogether better council - ensuring corporate improvements are achieved
against the five priority themes.
5.4.2
With regard to the Altogether Healthier theme, the Council has identified five objectives
together with actions to achieve the objectives. One of the objectives is to reduce
health inequalities and its related actions are to reduce obesity levels and increase
physical activity and participation in sport and leisure.
5.5
Durham County Council Health Improvement Plan 2010 - 2013
5.5.1
Durham County Council Health Improvement Plan sets out how the Council will
harness its resources and skills to work in partnership with other agencies to improve
the health and wellbeing of people within the County and address health inequalities.
5.5.2
The plan is based on the regional health strategy ‘Better Health, Fairer Health’ and
complements the Marmot Review into Health inequalities, stressing the importance of a
preventative approach, addressing the wider, social determinants of health. The plan is
divided into 10 themes detailing the different areas of work delivered by the Council
that impact on health and wellbeing. Theme 3 of the Plan deals with Physical Activity,
Food and Nutrition.
5.5.3
With regard to physical activity, the plan states – ‘Together with partner agencies we
want to see more people of all ages taking up physical activity and enjoying exercise
as part of their day to day life, particularly to minimise the risk factors associated with
coronary heart disease, cancers and long term conditions and list a number of actions
that will be taken to achieve this. Some of the actions included are:
•
Implement the County Durham Physical Activity Strategy
•
Establish a robust delivery system for sport in the County which engages all
stakeholders
•
Deliver Exercise on Prescription, helping people to stay well for longer
43
•
Commission services for people aged 50 and over to help them to maintain physical
wellbeing and prevent falls
•
Take national planning regulations into account to make it easier for people to enjoy
outside spaces
•
Deliver a programme of events that promote greater use of our parks and
countryside
•
Provide National Standard Cycle Training (Bikeability) for 9-11 years
5.6
5.6.1
The above strategy was commissioned by County Durham Sport and developed by
pmpgenesis consultancy. This involved extensive independent consultation with local
partners, stakeholders and a County Durham Sport Partnership Steering Group. An
evidence based review of physical activity conducted by Sheffield Hallam University
was also commissioned as part of the process, to inform the content and direction of
the final strategy.
5.6.2
The strategy, which was approved by the Health and Wellbeing Partnership in
February 2010, aims to:
•
Raise the profile of physical activity opportunities and the benefits of increased
participation amongst the population of County Durham.
•
Identify a number of key principles to increasing participation in physical activity
•
Coordinate, inform and influence the way in which individuals and organisations
work
•
Inform where future investment should be channelled
•
Secure and coordinate the development of physical activity resources across the
County
•
Ensure effective delivery and removal of duplication
•
Strategically influence the development of intervention programmes to increase
physical activity levels within key target groups to address health inequalities
•
Help to enable children and young people to migrate seamlessly from the school
environment to community sport
Help to achieve the regional vision as outlined in ‘Better Health, Fairer Health’ A
Strategy for 21st Century Health and Wellbeing in North East of England’ to be the
most physically active in the country, both in its activities of daily living and in its
recreational choices
•
•
Help to reduce health inequalities and achieve the vision and priorities set out within
the ‘Sustainable Community Strategy: Altogether Better’ particularly the theme of
‘Altogether Healthier’,
44
5.6.3
County Durham Sport has the lead responsibility for co-ordinating the implementation
of 'A Physical Activity Strategy for County Durham', as one of 49 County Sport
Partnerships previously identified by the Department of Health. It was appointed by the
County Durham Health & Wellbeing Partnership as the local guarantor for NI008 (Adult
participation indicator.)"
5.7
Durham County Council Sport and Leisure Service Strategy 2011- 2014
5.7.1
The above strategy, approved by the Council’s Cabinet on 2nd March 2011, intends to
deliver modern well-equipped sports centres, investment in and better support for
grassroots sports clubs and associations and better value for money. This should lead
to increased participation by making better use of outside space and community-based
programmes, supporting and expanding club activity, linking school participation to
community settings and working more closely with the voluntary sector.
5.7.2
Sport and leisure cuts across a number of agendas, such as health, regeneration and
education and is key in achieving performance targets and delivering against the
Durham Partnership agendas. By focusing on increasing participation in physical
activity, the Council’s Sport and Leisure Service will be better placed to transform the
lives of County Durham residents.
5.7.3
Whilst there will always be a proportion of residents who will remain uninterested in
being physically active, the Service will work with its partners to address the issues
where possible in order to remove these barriers.
5.7.4
The aim of the strategy is to:
‘Transform the lives of individuals and communities through their participation in a
wide and inclusive range of sport and leisure activities that provide positive life
experiences and opportunities.
5.7.5
To achieve the aim, the following objectives have been developed:
•
Altogether Better: Participation Levels
•
Altogether Better: Prosperity from Sport and Leisure Related Economic Activity
•
Altogether Better: Equality of Participation
•
Altogether Better: Sustainable Participation
•
Altogether Better: Community Participation
5.7.6
A number of key actions over the next 3 years are detailed in the strategy to meet
these objectives.
5.7.7
The strategy recognises the important role that the Council’s Sport and Leisure Service
has in promoting a preventative approach to well-being and addressing health
inequalities. The Service works within communities, directly providing services as well
as co-ordinating and enabling others to deliver activities, which target and encourage
45
disadvantaged individuals and groups to participate, in particular:
•
Those living in disadvantaged neighbourhoods
•
Those affected by physical and mental health issues
•
Those suffering from a disability
•
Women and girls
•
Adults and young carers
•
Looked after children
•
Ethnic minorities
Conclusion
The Council and its partners are clear about the direction of travel to improve health
and wellbeing. They have good plans and strategies in place to improve physical
activity and promote health. The partnerships that exist demonstrate a strategic
approach (that is joined up) in responding to the challenges facing action to reduce
health inequalities and action to promote physical activity. The plans and strategies
have been informed by local need and policy priorities.
The Council’s Sport and Leisure Service Strategy recognises the Council’s important
role as a community leader, often co-ordinating and enabling others to deliver, directly
working within communities to increase participation and promoting a preventative
approach to well being.
46
Policy Development at Regional Level
5.8
Public Health North East
5.8.1
Public Health North East is accountable to the Department of Health, however it is not
part of the NHS. Its job is to improve the health and wellbeing of people living in the
region by working alongside other government departments and public sector
organisations, as well as community and voluntary groups. These networks help to get
a public health perspective built into regional programmes for crime, transport,
education and skills, housing, environment and regeneration. It leads efforts in the
region to reduce obesity, increase physical exercise, improve diet, cut rates of smoking
and improve mental wellbeing.
5.8.2
Public Health North East also aims to build expertise in the region by developing the
skills of health professionals and others through support and training programmes.
It works closely with North East Public Health Observatory, which has an important role
in conducting research, increasing awareness of public health issues and identifying
wider causes of illness.
5.9
North East Public Health Observatory (NEPHO)
5.9.1
North East Public Health Observatory (NEPHO) is the regional health intelligence
organisation, providing information and analysis to improve health and reduce
inequalities in the North East.
5.9.2
NEPHO is one of nine public health observatories in England. It provides a health
intelligence service to support commissioners – ie. the Primary Care Trusts, Strategic
Health Authority and in the future to GP Commissioning Groups.
5.9.3
Public Health Observatories have access to a wide variety of data sources such as
Hospital Episode Statistics (HES), mortality data and primary care data. These are
used for standard outputs such as the Health Profiles, GP practice profiles and
smoking profiles as well as for individual information requests.
5.9.4
With regard to physical activity, details of the ‘Mapping Physical Activity in the North
East Region’ September 2006 report, commissioned by Sport England North East, can
be found on NEPHO website. This is a report of a survey of projects, initiatives and
policies in the North East around sport, exercise and physical activity. The 228 projects
identified were grouped according to project type and setting to provide an insight into
the nature of the work around sport, exercise and physical activity in the North East
region.
5.9.5
At the time of the survey, the most common types of projects taking place in the region
were walking schemes, community health/physical activity initiatives, sport and leisure
development programmes and weight management programmes. The majority of
projects focused on the whole population, followed by projects that specifically focused
on children and young people. Relatively few programmes exclusively targeted
sedentary people, people from disadvantaged areas, people with disabilities or people
with mental health problems. The majority of programmes and initiatives were
47
delivered in partnership with other agencies, such as Primary Care Trusts, Local
Authorities, particularly leisure departments, Countryside Agencies, Charities and a
whole host of others. Seventy per cent of all projects were linked to a local physical
activity strategy or part of a wider programme.
Policy Development at National Level
5.10
Fair Society, Healthy Lives
5.10.1 In February 2010, the Marmot Review Team published ‘Fair Society, Healthy Lives’.
This was the culmination of a year long independent review into health inequalities in
England which Professor Sir Michael Marmot was asked to chair by the Secretary of
State for Health. The review proposes the most effective evidence-based strategies for
reducing health inequalities in England from 2010.
5.10.2 Central to the review is a life course perspective. Disadvantage starts before birth and
accumulates throughout life. The first proponents of the ‘life course perspective’
concentrated on events and exposures in fetal life, but later studies showed that
circumstances throughout childhood and adult age influence health in old age. A
number of chronic diseases such as coronary heart disease, stroke, and some cancers
seem to be influenced by factors acting across the entire life course.
5.10.3 Some of the key messages of the Marmot Review are:
•
Action taken to reduce health inequalities will benefit society in many ways. It will
have economic benefits in reducing losses from illness associated with health
inequalities. These currently account for productivity losses, reduced tax revenues,
higher welfare payments and increased treatment costs.
•
Reducing health inequalities will require action on six policy objectives:
o
o
o
o
o
o
Give every child the best start in life
Enable all children young people and adults to maximise their
capabilities and have control over their lives
Create fair employment and good work for all
Ensure healthy standard of living for all
Create and develop healthy and sustainable places and communities
Strengthen the role and impact of ill health prevention
•
Delivering these policy objectives will require action by central and local
government, the NHS, the third and private sectors and community groups.
National policies will not work without effective local delivery systems focused on
health equity in all policies.
•
Effective local delivery requires effective participatory decision making at local level.
This can only happen by empowering individuals and local communities.
48
5.11
Healthy lives, healthy people White Paper: Our strategy for public health in
England
5.11.1 The above White Paper, published on 30th November 2010, sets out the Government’s
long-term vision for the future of public health in England. It outlines the Government’s
commitment to protecting the population from serious health threats; helping people
live longer, healthier and more fulfilling lives; and improving the health of the poorest,
fastest.
5.11.2 The Paper responds to Professor Sir Michael Marmot’s ‘Fair Society, Healthy Lives’
report and adopts its life course framework for tackling the wider social determinants of
health. It also complements ‘A Vision for Adult Social Care: Capable Communities and
Active Citizens’ in emphasising more personalised, preventive services that are
focused on delivering the best outcomes for citizens and that help to build the Big
Society.
5.11.3 Public health is about everything society does to prevent people getting ill, rather than
treating sickness. Dirty water, hunger and infection are no longer major killers in the
UK. “Diseases of lifestyle” like heart disease, obesity and depression are the issue.
Smoking, drinking, lack of exercise and poor diet play a big part.
5.11.4 A new service called Public Health England will bring together the functions undertaken
at national level. From 2012, Public Health England as part of the Department of
Health will have responsibility for protecting the health of the population from infectious
disease and biological, chemical and radiological threats and helping people and
families to take care of their own health and wellbeing.
5.11.5 From 2013, councils will be responsible for public health in local areas. Their job will be
to help improve people’s health, particularly those with the worst health.
5.11.6 Health and Wellbeing Boards will be established in every local authority comprising of
GP consortia, Director of Public Health, Directors of Adult and Children’s Services,
local Health Watch and NHS Commissioning Board.
5.11.7 Directors of Public Health will be employed by the Local Authority and will be the
ambassadors on health issues for the local population. They will lead discussion about
how the ring-fenced money is spent to improve health. This will include influencing
investment decisions right across the Local Authority, with the goal of enhancing health
and wellbeing. To make sure that progress is made on issues like obesity and
smoking, Public Health England will set a series of outcomes to measure whether
people’s health actually improves.
5.11.8 A new health premium will take into account health inequalities and reward progress on
specific public health outcomes. The premium will be simple and driven by a formula
developed with key partners. Disadvantaged areas will see a greater premium if they
make progress, recognising that they face the greatest challenges.
49
5.11.9 The Secretary of State for Health in his foreword to the White Paper: stated that:
‘Health inequalities between rich and poor have been getting progressively worse.
We still live in a country where the wealthy can expect to live longer than the poor.
The dilemma for government is this: it is simply not possible to promote healthier
lifestyles through Whitehall diktat and nannying about the way people should live.
Recent years have proved that one size-fits-all solutions are no good when public
health challenges vary from one neighbourhood to the next. But we cannot sit back
while, in spite of all this, so many people are suffering such severe lifestyle-driven ill
health and such acute health inequalities. We need a new approach that empowers
individuals to make healthy choices and gives communities the tools to address their
own, particular needs. The plans set out in the White Paper put local communities at
the heart of public health.’
Conclusion
The Marmot Review identified the role of local government as pivotal in renewal of
local democracy and giving citizens voice in developing the prospects for their local
area. Local councils hold the power to secure the economic, environmental & health
and wellbeing of their population.
This calls for the effective exercise of community leadership in drawing together
citizens, communities and key partners to build health, wellbeing and resilience,
through transformational leadership of Sustainable Community Strategies and Health
and Wellbeing Boards. These roles become even more important as understanding of
the social determinants of health has developed. If inequalities in early child
development and education, housing, employment and working conditions, place and
the built environment, and sustainability are driven by the same causes, it requires a
concerted effort across the whole system. A number of policy strands are being
developed as part of the transition process for public health moving into local
government. It is hoped that this will strengthen what the Marmot review concludes.
Recommendation 1
That Cabinet ensures that the Government’s Public Health Strategy (which should
include the Marmot Review six policy objectives) informs the Council’s contribution to
planning and delivery of a public health agenda within the context of proposals
contained in the Health and Social Care Bill (and Act as appropriate).
50
Section Six - The Impact of the Built and Natural Environment on
Physical Activity Levels
6.1
Built Environment
6.1.1
Local authorities have a significant role to play in improving health. Through their
services, they can contribute to the quality of the built and social environment. They
have specific duties and powers to promote equality and social inclusion and social,
economic and environmental well-being. They work in partnership with the NHS and
other agencies such as the police, to support public health.
6.1.2
The Marmot Report ‘Fair Society, Healthy Lives’ 2010 stressed the importance of
creating and developing healthy and sustainable places in communities. This could be
achieved by fully integrating planning, transport, housing, environmental and health
systems. This could also be achieved by prioritising policies and interventions that
reduced both health inequalities and mitigated climate change i.e. active travel and
improving availability of good quality open and green spaces across the social
gradient.
6.1.3
One of the most important ways of encouraging more active travel such as walking and
cycling is to get the built environment right at the outset. The Chief Medical Officer
Professor Sir Liam Donaldson in his report, ‘At least five times a week. The evidence
on the impact of physical activity and its relationship to health’ makes the connection
between physical activity and the environment. The report states that
‘A mass shift in current activity levels is needed. This will only be achieved if
people see and want the benefits but also if opportunities are created by
changing the physical and cultural landscape and building an environment
that supports people in more active lifestyles’.
6.1.4
6.1.5
Planning Policy Guidance Note 13 - Transport, sets out statutory provisions and
guidance on planning integrated, sustainable transport for new developments. When
preparing development plans and considering planning applications, the guidance
states that local authorities should:
•
Locate day to day facilities which need to be near their clients in local centres so
that they are accessible by walking and cycling
•
Accommodate housing principally within existing urban areas, planning for
increased intensity of development for both housing and other uses at locations
which are highly accessible by public transport, walking and
cycling.
Consequently engagement between the Council’s planners and developers at an early
stage will make it easier and more cost effective to integrate walking and cycling into
the design of new developments.
51
6.1.6
The National Institute For Health And Clinical Excellence Guidance (NICE), Sport
England, Commission for Architecture and the Built Environment (CABE) and Play
England have issued guidance on the planning of new developments in relation to
encouraging physical activity and play. Details are set out below.
6.2
National Institute For Health And Clinical Excellence Guidance
6.2.1
The National Institute for Health and Clinical Excellence (NICE) issued public health
guidance 8 in 2008 - ‘Promoting and creating built or natural environments that
encourage and support physical activity’. This guidance provides evidence-based
recommendations on how to improve the physical environment to encourage physical
activity to improve health. The recommendations are not only for the NHS and local
authorities, but for all those who have a role or responsibility for a built or natural
environment including planners, transport authorities, building managers, designers
and architects. The recommendations cover the following:
•
Strategies, Policies and Plans
Those responsible for all strategies, policies and plans involving changes to the
physical environment should involve all local communities and experts at all
stages of the development to ensure the potential for physical activity is
maximised. This includes the development, modification and maintenance of
towns, urban extensions, major regeneration projects and the transport
infrastructure. It also includes the siting or closure of local services in both urban
and rural areas.
Planning applications for new developments should always prioritise the need for
people (including those whose mobility is impaired) to be physically active as a
routine part of their daily life. Local facilities and services should be easily
accessible on foot, by bicycle and by other modes of transport involving physical
activity and children should be able to participate in physically active play.
•
Transport
Planning and transport agencies, including regional and local authorities should
plan and provide a comprehensive network of routes for walking, cycling and
using other modes of transport involving physical activity. These routes should
offer everyone (including people whose mobility is impaired) convenient, safe and
attractive access to workplaces, homes, schools and other public facilities. (The
latter includes shops, play and green areas and social destinations.) They should
be built and maintained to a high standard. Data from the ‘National travel survey’
shows that the distance people walk and cycle has declined significantly in the
past three decades (Department for Transport 2007).
•
Public Open Spaces
Designers and managers of public open spaces, paths and rights of way
(including coastal, forest and riverside paths and canal towpaths), planning and
transport agencies including regional and local authorities should ensure that
public open spaces and public paths can be reached on foot, by bicycle or public
52
transport and are maintained to a high standard. They should be safe, attractive
and welcoming to everyone.
•
Buildings
All public buildings including universities, schools and business parks should have
appropriate access to physical activity. This could include something as simple as
indicating in public buildings where staircases were located to encourage people
to use them rather than the lift.
•
Schools
Children in the UK can have up to 600 break periods at school per year providing
valuable opportunities to take part in daily physical activity. Children’s services,
School Sport Partnerships, school governing bodies and head teachers should
ensure school playgrounds are designed to encourage varied, physically active
play. Research has found that environmental changes eg providing playground
markings, obstacle courses and equipment increases breaktime physical activity.
Many schools in County Durham have achieved a positive reduction in the
number of pupils travelling by car through innovative ideas, creative campaigns
and fun initiatives. Examples are the walking bus operating at Butterknowle and
Byers Green Primary Schools, Shield Row Primary School – 5 Minute Walking
Zone
6.3
Sport England - Active Design
6.3.1
Sport England believes that being active should be an intrinsic part of everyone’s life
pattern. Active Design is aimed at urban designers, master planners and the architects
of our new communities. The guidance promotes sport and activity through three key
Active Design principles of - improving accessibility, enhancing amenity and increasing
awareness.
6.3.2
Improving accessibility refers to the provision of easy, safe and convenient access to a
choice of opportunities for participating in sport, active travel and physical activity for
the whole community. Enhancing amenity involves the promotion of environmental
quality in the design and layout of new sports and recreational facilities, the links to
them and their relationship to other development and the wider public realm. Increasing
awareness highlights the need for increased prominence and legibility of sports and
recreation facilities and opportunities for exercise through the layout of the
development.
6.4
Commission for Architecture and the Built Environment (CABE) – Future Health:
Sustainable Places for health and wellbeing
6.4.1
The above guidance explains how good design makes healthy places by bringing
together what CABE knows about sustainable, health-promoting design with the latest
thinking about individual health and well-being. Drawing on examples and research,
Future health shows how good planning can have a positive impact on public health,
how health trusts can cut carbon and costs by co-locating services, and how designers
can influence people's well-being.
53
6.5
Play England – Better Places to Play through Planning
6.5.1
The above guidance supports planning and transport authorities to ensure children and
young people can access high quality, local play spaces and playable public space.
6.5.2.
The publication, funded by the Department for Culture, Media and Sport (DCMS), gives
advice on setting local standards for access, quantity and quality of playable space. It
also shows how provision for better play opportunities can be promoted in planning
policies and processes and gives detail of how local development frameworks and
planning control can be utilised in favour of child-friendly communities.
Natural environment
6.6
Green Infrastructure as a natural health service
6.6.1
Green Infrastructure includes parks, open spaces, playing fields, woodlands,
allotments and private gardens. Natural England defines Green Infrastructure (GI) as a
strategically planned and delivered network of high quality green spaces and other
environmental features.
6.6.2
The natural environment has a role to play in maintaining healthy lives. It provides for
physical activity which reduces obesity and heart disease, and improves air quality by
filtering pollutants, thus reducing respiratory problems, such as asthma. If every
household in England had good access to quality green space an estimated £2.1 billion
could be saved in healthcare costs. (Our Natural Health Service–The role of the
natural environment in maintaining health lives, Natural England 2009). The social
costs of the impacts of air pollution were estimated at £16 billion per year in the UK.
6.6.3
The Green Infrastructure Strategy is being introduced within the Council’s Local
Development Framework (LDF) or County Durham Plan. Key policies are being taken
from the Green Infrastructure Strategy to be included in the LDF. There will be
consultation on a draft of the whole LDF between March and June 2012. At the local
level, the Green Infrastructure Strategy will look at priority locations and actions within
the 14 Area Action Partnership (AAP) areas.
6.6.4
Durham County Council, in partnership with a range of organisations have employed a
Green Infrastructure Coordinator to create Green Infrastructure Implementation Plans
for County Durham and instigating such projects. This work will ensure GI is
incorporated into new development, and through instigating new projects with a range
of partners, with a view to addressing health issues, along with the many other benefits
Green Infrastructure can result in. O is a Green Infrastructure project in East Durham
looking at improving Green Spaces in urban areas to make them more accessible and
inviting with a view to reducing health inequalities in the area.
6.6.5
County Durham has an almost unique pattern of large villages and small towns set in a
wide range of landscapes, providing real choice for living in and enjoying the County.
According to research, used in preparation of the County Durham Plan – core strategy,
people in County Durham value natural environments and open space, and therefore,
one of the priorities identified in the work being undertaken on the Green Infrastructure
is supporting the work of landscape partnerships such as Limestone Landscapes, the
54
Heart of Teesdale, the Derwent Valley and the Heritage Coast Partnership. The latter
received the first UK Landscape Award in November 2010.
6.6.6
The Government’s commitment to protecting and improving the natural environment is
set out in the White Paper ‘The Natural Choice’ published on 7th June 2011. The White
Paper sets out a detailed programme of action to repair damage done to the
environment in the past and urges everyone to get involved in helping nature to flourish
at all levels – from neighbourhoods to national parks. Key measures include
designating green areas, enabling more children to experience nature by learning
outdoors, strengthening local public health activities and a new environmental
volunteering initiative ‘Muck in 4 Life’.
6.6.7
The Government intends to issue further guidance to make it clear that the wider
determinants of health, including the natural environment, will be a crucial
consideration in developing joint strategic needs assessments and joint health and
wellbeing strategies.
6.7
Local Transport Plan 3 and its contribution to health improvement
6.7.1
Easy access throughout the county to goods and services in towns and villages by
car, public transport, walking and cycling helps to promote sustainable and healthy
lifestyles.
6.7.2
The use of public transport requires active travel to get to interchanges so improving
appeal will contribute to greater physical activity.
6.7.3
Walking and cycling both promote feelings of good health and wellbeing and social
inclusion. However, in Britain the average time spent traveling on foot or by bicycle
has decreased, from12.9 minutes per day in 1995/97 to 11 minutes per minutes in
2007. (Department of Transport 2010). Cycle use in Britain is lower than in other
European Union countries. It is estimated that bicycles are used for 2% of journeys in
Britain compared to about 26% of journeys in the Netherlands, 10% in Denmark and
5% in France (Ministry of Transport, Public Works and Water Management 2009).
6.7.4
Studies by Davison & Grant 1993, US Dept of Health 1996, British Heart Foundation
2000 show that walking can reduce the risk of coronary heart disease, stroke, high
cholesterol, cancer of the colon and non insulin dependent diabetes. Walking also
lowers blood pressure, increases bone density, helps to control body weight, flexibility
and coordination hence reducing the risk of falls.
55
6.7.5
Cycling also offers numerous health benefits. The publication ‘Cycling and Health What’s the evidence?’ 2007 by Nick Cavill and Dr. A Davis includes facts and figures
on cycling and presents a concrete justification for promoting cycling. Cycling is a low
impact activity that can significantly improve individual fitness. It burns at least 5
kilocalories per minute (depending on a number of factors, notably the body weight of
the cyclist) offering the potential to expend considerable amounts of energy over the
course of a journey.
6.7.6
Cycling England has also calculated the economic value of cycling. It is estimated that
a 20% increase in cycling by 2015 would provide savings of £107m in decreased
mortality, £52m to the NHS and £87m to employers. (Macdonald 2007)
6.7.7
Cycling has an increasingly important role to play in future transport strategies as the
impact of climate change encourages people to look for more benign modes of
transport to reduce their carbon footprint.
6.7.8
Historically the main focus of concern over walking and cycling is the potential road
traffic accidents. With regard to cycling, the actual risk is small. There is one cyclist
death per 33 million kilometres of cycling. It would take the average cyclist 21,000
years to cycle this distance. ‘Bikeability’ – cycling proficiency training for 21st century is
designed to give the next generation the skills to tackle a variety of traffic conditions.
6.7.9
The real and perceived physical danger posed by motor traffic is one of the main
barriers. Reducing speeds in urban areas to under 30 mph provides a safer
environment for active travel. It directly reduces casualties and could decrease injuries
by 40%. There is also increasing evidence for the phenomenon of safety in numbers.
Studies suggest that policies leading to increases in the number of people walking or
cycling appear to be effective in improving safety.
6.7.10 Local Authorities can through their transport policies/plans actively promote walking,
cycling and the use of public transport. In Bolton the PCT worked closely with the local
authority and a cycling charity to offer ten week cycling programmes and Liverpool
PCT employed a full time cycling officer to promote cycling and co-ordinate a
programme of led rides for priority groups.
6.7.11
Durham County Council is responsible for managing nearly 2,200 miles (3,500km) of
footpaths, bridleways and byways in the county, which provide opportunities for daily
exercise in natural green spaces, affordable green routes to work and increase a sense
of community, all of which can enhance quality of life and improve health. The
Council’s Rights of Way Improvement Plan 1, published in 2007, won an award from
Natural England in 2009 in the category ‘Best contribution to Local Prosperity and
Quality of Life’.
6.7.12 With regard to local measures to promote walking and cycling as a form of transport or
recreation, the National Institute for Health and Clinical Excellence has issued a draft
scoping document for consultation in response to a request from the Department of
Health for public health guidance to be developed. Following the consultation, the final
version of the scope will be available on NICE website in July 2011.
56
6.7.13 It is intended that the guidance will provide recommendations for good practice, based
on the best available evidence of effectiveness and cost effectiveness in terms of
health, environmental and economic outcomes (such as air pollution and time lost
through traffic congestion). It will also complement other NICE guidance and consider
local interventions which aim to raise awareness of, encourage or increase uptake of,
walking and cycling for recreational and transport purposes, including those targeted at
particularly vulnerable and high risk groups.
6.7.14 The Government White Paper ‘Creating Growth, Cutting Carbon’, published on 19th
January 2011, also aims to encourage greater use of public transport and more
walking and cycling. Key measures in the White Paper include a £560m Local
Sustainable Transport Fund to address the urgent challenges of building economic
growth and tackling climate change, as well as delivering cleaner environments,
improved safety and increased levels of physical activity and specific funding for
‘Bikeability’ and the 2011/12 Cycle Journey Planner to encourage cycling. The
Government will provide £11m funding for Bikeability cycle training in 2011/12, to allow
275,000 ten to eleven-year-olds to benefit from ‘on-road’ cycle training and gave a
commitment to support Bikeability for the duration of the current parliament to allow as
many children as possible to undertake high quality cycle training.
6.7.15 Durham County Council’s Local Transport Plan 3, effective from April 2011, has the
following six goals:
•
•
•
•
•
•
Support Economic Growth
Maintain the Transport Asset
Reduce Carbon Emissions
Promote Equality of Opportunity
Contribute to Better Safety, Security and Health
Improve Quality of Life and Healthy Natural Environment
6.7.16 The Plan was subject to various assessments to develop its content and policies
including Strategic Environmental Assessment, Equalities and Health Impact
Assessments.
6.7.17 Funding in Local Transport Plan 3 up to 2015 in relation to contributing to better health
is allocated as follows:
Supporting the Rights of Way
Improvement Plan by investing
in walking and cycling routes/
facilities
£500,000 in each of the first
3 years
Continuing to invest in bus
Infrastructure and Travel
Information/awareness
£495,000 in Year1
£350,000 in Year 2
£250,000 in Year 3
Bishop Auckland Rail Station
Improvement
£900,000 in Year 1
57
New Station on Durham Coast
Rail Line
£3m over Years 2 and 3
Reducing Congestion/better air quality
In Durham City by extending Park &
Ride sites
£250,000 in Year 1 – Belmont
£400,000 in Year 3 - Sniperley
Continuing to invest in casualty reduction
And driver education
£200,000 in each of the first 3
years
Continuing to support workplace travel
Planning, car sharing/club and
Attitudinal change - healthier workforce
£40,000 in each of the first 3
years
Maintaining roads and footways Preventing trips and slips
Circa £23m over 3 years
6.8
Health Impact Assessments (HIA)
6.8.1
The purpose of a Health Impact Assessment (HIA) is to identify the potential health
consequences of a proposal on a given population.
6.8.2
The preferred starting point for HIA is a proposal (policy, programme, strategy, plan,
project or other development) that has not yet been implemented. Its primary output is
a set of evidence-based recommendations to inform the decision-making process
associated with the proposal. These recommendations aim to highlight practical ways
to enhance the positive aspects of a proposal, and to remove or minimise any negative
impacts on health and inequalities (known as a prospective HIA).
6.8.3
HIA is typically used to assess the health impacts of proposals that are not directly
health care related. It is widely accepted that health is affected by factors such as the
built environment, social regeneration, education or transport policy. Determinants of
health including transport, housing, education, the environment and economic activity
have major effects on the current and future health of a population.
58
6.8.4
A wide range of stakeholders can be involved in a HIA, so it typically requires a high
level of engagement by interested parties: recipients of services, planners, staff,
voluntary organisations, etc., and should seek to balance views and experience with
quantitative and qualitative research information from routine or other sources. A HIA
may include a significant level of community involvement and consultation, where
appropriate and where resources are available.
6.8.5
Some HIAs may take several months and involve a large number of people; others
could be done in a day. The procedures, methods and tools that are used in HIA
include policy analysis, demography, collation and analysis of evidence of health
impacts, quantitative and qualitative research, and community consultation. HIA
attempts to draw these elements together to enable a systematic identification of health
impacts.
6.8.6
A Health Impact Assessment consists of 6 steps
•
•
•
•
•
•
6.8.7
Decide whether a proposal requires assessment by HIA – often called screening.
Clarify the questions to be answered by the HIA and how the assessment will be
carried out – often called scoping
Decide what the health impacts will be and how big by considering each pathway
by which the proposal could impact on health – often called appraisal and
assessment.
For each option make recommendations as to how good health consequences
could be enhanced how bad health consequences could be avoided or minimised
and how health inequities could be reduced.
Communicate the findings of the HIA to the decision makers.
Evaluate the quality of the HIA highlighting lessons for future HIAs. Monitor which
proposals and if possible assess whether any predictions made were correct.
It should be pointed out that unlike a Strategic Environmental Assessment being a
requirement under national and EU legislation or Equality Impact Assessments as a
requirement of the Equality Act 2010, there is no similar statutory requirement to
undertake a Health Impact Assessment.
Conclusion
The evidence base is overwhelming that planning, transport, housing, the built
and natural environmental, in short socio–economic and environmental factors
have a significant impact on action to reduce health inequalities, action to promote
physical activity and action to promote health.
The Health Impact Assessment (HIA) process potentially is a valuable
assessment tool that is able to support action to improve health and quality of life.
It is a staged process involving screening of a policy or strategy in the first
instance. It should be pointed out that unlike a Strategic Environmental
Assessment being a requirement under national and EU legislation or Equality
Impact Assessments as a requirement of the Equality Act 2010, there is no similar
statutory requirement to undertake a Health Impact Assessment.
59
In the final analysis, the Council through its strategic and community leadership
role recognises the link between environmental, social and economic
sustainability to health and well being outcomes. An example of this can be seen
through the development of County Durham Sustainable Community Strategy,
where health outcomes linked to socio-economic priorities have come to the fore.
The Council’s vision for a better place for people explicitly recognises the need for
a healthier community. Health outcomes and health improvement are seen as
core business and are progressed through existing organisational arrangements,
ensuring that health implications and action on health inequalities are challenged
at the corporate, cabinet and indeed scrutiny level. It is core business.
With the transfer of public health to local government, the Council’s approach to
embed health improvement as core business through its thematic priorities and
organisational arrangements in making sure the system is applied effectively, puts
it in a very good place for the transition.
60
Section Seven – Delivery of Physical Activities in County Durham
7.1
Sport and Leisure Provision in County Durham
7.1.1
The four core sports and leisure areas and main areas of service activity are:
Indoor Sport and Leisure Facilities
• 14 facilities internally managed
• 6 managed by external organisations
Outdoor Sport & Leisure
• Play areas
• Playing pitches
• Parks and Open Spaces
• Allotments – 175 sites with 3,630 plots across the County
• Events - Organising sport & leisure events and providing an advisory role
to other services regarding event management
Sport and Leisure Development
• Voluntary sports club development
• Health intervention programmes
• Coach and volunteer development
• Holiday activities
• Workforce development
• Partnerships and community engagement
The Countryside
• Countryside services:
• 45 areas of nature conservation importance
• 150 km of railway paths
• Three Country Parks
• 30 Picnic Areas
Indoor Facilities
7.2
Leisure Centres
7.2.1
The Council provides a wide range of indoor sport and leisure facilities from small local
community focused centres to facilities with regional appeal. The centres attract 3.75m
visitors. Six are managed by external organizations.
7.2.2
Cabinet (13 July 2011) considered a report of the Corporate Director, Neighbourhood
Services that provided feedback on the findings of the consultation on the review of
Indoor Facilities, approved by Cabinet 2 March, 2011, and made recommendations as
to how the Council should conclude the review. Indoor facilities form only part of the
sport and leisure offer alongside sport and leisure development, outdoor sport and
countryside services; all of which have a focus on participation. The Sport and Leisure
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Strategy (approved March 2011) is explicit in proposing a shift in emphasis from indoor
facilities to alternative service approaches, such as maximising the use of the outdoor
environment and targeted interventions, more able to engage hard-to-reach groups.
Similarly, the Strategy proposes a greater emphasis on raising participation via
community settings and, specifically, through voluntary sector sports clubs. Cabinet
agreed that four of the seven centres under consideration should be retained.
Outdoor Sport and Leisure Facilities
7.3
Play Areas
7.3.1
There are over 300 fixed play sites in County Durham which are owned, managed and
maintained by various organisations. Play is however, much more than fixed sites and
can take place in both formal and informal settings. The Council’s Sports and Leisure
Department play a lead role in developing a new Play Durham Partnership, which is a
strategic decision making body for play in County Durham and work with Town and
Parish Councils and Area Action Partnerships. Over £1m is being invested as part of
the Playbuilder scheme.
7.4
Outdoor pitches and facilities
7.4.1
Many sports/recreation grounds are owned or leased by clubs or fall under the
responsibility of Town and Parish Councils. Standards vary significantly. Facilities
include: Multi-use games areas (MUGAs) which are fully fenced, non-turfed areas,
marked out and an adequate size for at least two of the following sports; tennis, netball,
basketball, or five-a-side football, and recreation grounds, bowling greens, skate parks,
athletics track, football and cricket pitches and tennis courts.
7.4.2
The Council’s Sports and Leisure Department is producing a playing pitch strategy in
line with national guidance ‘Towards a Level Playing Field’, which will assist in ensuring
that the supply of sports pitches meets demand and maximise the use of all pitches.
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7.5
Parks and Open Spaces
7.5.1
The ownership and management of parks and open spaces falls to a variety of
organisations, which leads to various standards and financing issues. The Council is
embracing the green flag quality standard for parks and open spaces in order to set
and aspire to high standards of service provision. The latest assessment of Durham
County Council parks and green spaces has resulted in ten sites being awarded green
flags in 2010. Ranging from railway paths and cemeteries to picnic sites and traditional
parks, the awards reflect the high standards of maintenance needed to keep the sites
looking good and also the involvement of local communities.
7.6
Allotments
7.6.1
Allotment gardening provides a wide range of benefits to communities and the
environment. This includes providing fresh home grown vegetables, fruit and flowers,
low-cost food, fresh air and exercise a chance to meet new friends. Nationally there is
a shortage of available allotments and there are waiting lists for most sites in the
County. A county wide policy for the management of allotments is being developed
which will encourage better use of available plots and cut waiting lists.
7.7
Events
7.7.1
Events play a major role in the economic regeneration of the County and can aspire
people to become involved in sport. Mass participation events such as Fundraising
Midnight Walks can motivate people to be active.
7.8
Sports Development
7.8.1
The Council’s Sports Development Team works in partnership with a variety of different
organisations, including NHS County Durham and Darlington and Durham Health
Improvement Team to tackle health inequalities, with the primary aim of improving
health and wellbeing through physical activity opportunities, lifestyle advice and
education. It also works with Sport England, County Durham Sport, school-sport
partnerships, national governing bodies, and local sports clubs to improve the quality
and quantity of sports provision.
7.8.2
The Council’s Sports and Leisure Service supports five Community Sports Networks to
engage with partners from the education sector, community safety sector, community
voluntary sector and traditional sports clubs. It also has links with the Area Action
Partnerships to ensure strong planning and avoid duplication. Appendix 1 gives details
of the physical activity projects supported by the Area Action Partnerships.
7.8.3
The Team provides a wide range of sport and physical activity opportunities for women
of all ages and abilities to encourage them to become more physically active. Current
female focused activities include pole dance fitness, boxing, fitness classes, netball,
and running. In Teesdale, the Pink Ladies Running Group was established in October
2009, for ladies new to running. It’s a non-competitive group where runners run at their
own pace, making progress in their own time and no one is ever left to run alone.
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7.8.4
Work is progressing on the following to ensure a high quality sport and physical activity
programme across the whole county:
•
•
•
•
Mapping exercise of current provision to ensure an equitable service.
Identifying and supporting clubs and voluntary organisations to increase the range
of provision.
Increasing awareness and understanding of opportunities available to change
individuals lifestyles.
Linking with the personalisation agenda to ensure a varied ‘menu of services’.
7.8.5
With regard to the 2012 Olympics, the ‘join in…programme’ for residents of all ages
has been launched by the Council to encourage participation in sport and physical
activity, inspire people to expand their horizons and aim as high as they can,
encourage excellence in the county and celebrate the olympic values.
7.8.6
To encourage as many people as possible to ‘join in’ the Council will:
•
Work with schools, the university, grassroot sports clubs and governing bodies to
foster talent and encourage excellence.
•
Work with key partners to encourage residents to be more active.
•
Launch a new programme of sport and leisure volunteering.
•
Work with partners to host mass participation events, such as the Halfords Cycle
Tour.
•
Support schools to develop international links.
7.8.7
County Durham will also be hosting the Olympic Flame on its journey across the UK
providing the opportunity for residents to get involved in the celebrations and share on
the Olympic spirit.
7.8.8
It is hoped that the London Olympic Games and Paralympic Games 2012 and the
Glasgow 2014 Commonwealth Games will have a beneficial influence on health and
wellbeing. The greatest health potential of the Games is as a mechanism to increase
physical activity and to inspire young people to participate in sports.
7.8.9
The Olympic Delivery Authority (ODA) is encouraging walking and cycling to help
London 2012 meet its aim of being the most sustainable Games to date and set the
standard for future large-scale events. It is encouraging walking and cycling to all
events in the lead-up to 2012 and is aiming for 100% of spectators to get to the Games
by public transport, or by walking or cycling. The ODA is investing £11.5m in improving
walking and cycling routes and promoting active travel, including 80km of walking and
cycling route improvements within London, and 20km outside London, to be delivered
by December 2011.
7.8.10 There are, however, risks to be mitigated - The tension between elite performance
sports and wider participation will need to be handled to prevent worsening of
inequalities. - There is a tradition of consuming alcohol and high fat foods while
watching sports on television which will need to be guarded against. - If plans are not
embedded in current strategies there is a risk of reversal once the games are over.
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7.9
Countryside Facilities
7.9.1
Durham County Council’s countryside estate comprises of 30 picnic areas, 3 country
parks, 45 areas of nature conservation importance, including 8 sites of special scientific
interest and a railway path network comprising some 16 routes, totaling 150km in
length. The Council’s Countryside Team promotes the countryside through events and
guided walks, runs environmental education sessions and works with volunteers and
community groups.
7.9.2
In 2010, there were 600 walks available. Most of the walks are Natural England
accredited. The countryside estate receives almost 4 million visits each year, with
Hardwick Park, the flagship site being the second highest visitor attraction in the
County.
7.10
Volunteering
7.10.1 The Countryside Service has over 280 active volunteers. They undertake
practical work - building steps, repairing paths, mending fences, help with guided
walks, pick litter, assist at events, patrol sites and footpaths and reporting any
problems, tree planting and help with environmental education.
7.11
Physical activity projects funded by Area Action Partnerships
7.11.1 A number of the Area Action Partnerships have used their Area and Neighbourhood
budgets to fund physical activities for all age groups, but primarily children and young
people. Details of the projects sponsored are listed in Appendix 2 attached to the full
report.
Conclusion
A range of facilities (indoor and outdoor) supported by good infrastructure exists to
support people to participate in physical activity.
The next four years (2011 – 2014) will be extremely challenging with the Council
having to make savings of £123.5 million as part of the Medium Term Financial Plan.
The Council will need to achieve a reduction in budgets but still deliver effective and
efficient services to residents. Within this context of severe financial constraints, the
Council will be faced with having to make very difficult decisions in relation to the
provision of leisure services.
Indoor facilities should not be seen as the only mechanism through which participation
in sport and leisure can be grown. More of our parks and open spaces for example,
can provide great opportunities to be active and at very little cost.
It is hoped that the Olympic and Paralympic Games 2012 will inspire and increase
participation in sport and physical activity. To this end the Council is launching a brand
new community campaign which aims to recruit and support at least 200 new
volunteers to grassroots sport and leisure across the county, in eighteen months. Be a
sport…volunteer Durham’ is part of the Council’s ‘Join in…’ 2012 Olympic legacy
programme. Under the authority’s Olympic offer, it has pledged to provide community
based support for the huge range of local sports clubs and groups right across County
Durham, encouraging more people of all ages and abilities to try something new or
simply pick up an old hobby.
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Joint DCC / NHS Commissioned Programmes / Projects
7.12
Health Improvement Service
7.12.1 The Health Improvement Service provides a range of commissioned programmes to
nearly 600,000 people. The service is part of the local NHS and works in partnership
with Durham County Council, Darlington Borough Council, other statutory partners and
the voluntary and community sector to plan, design and evaluate collaborative
sustainable solutions to improve health.
7.12.2 The Get Active Team delivers and facilitates a diverse range of physical activity
opportunities to encourage the local population to increase participation in physically
active lifestyles. Get Active Community Programmes include cycling, walking and
multi-activity sessions, equipment loan scheme, living well and a workforce training and
development programme. The programmes have or are being delivered in community
and school settings, targeting all ages, needs and abilities including young people and
adults with disabilities.
7.12.3 Get Active Get Walking, in partnership with Walking the Way to Health Initiative, aims
to encourage more people to walk more often to improve the health and wellbeing of
local people and involves weekly Health Walks, Health Walk taster sessions and
district wide walking events.
7.12.4 Get Active Get Cycling aims to encourage more people to cycle more often and
involves weekly cycle tours, cycling taster sessions and district wide cycle events.
7.12.5 Get Active Equipment Loan Scheme is a completely free service where organisations
or groups can borrow an item or items of their choice for 2 weeks from a wide range of
physical activity, sport and play equipment in order to plan and deliver their own
physical activity, sport and play sessions. The equipment will be delivered and
collected by a member of Get Active Team.
7.12.6 Get Active Training and Development Scheme is aimed at building the capacity of local
people to increase the sustainability of physical activity opportunities via the provision
of training and essential resources. Training is offered for Volunteer Walk Leaders,
Cycle Marshalls and Community Sports Leaders.
7.13
Changing the Physical Activity Landscape Programme
7.13.1 NHS County Durham (NHS CD) has commissioned County Durham Sport (CDS) to
develop, co-ordinate and manage the CPAL project (Changing the Physical Activity
Landscape) a physical activity intervention project in support of the NHS Health Check
Programme. The project’s long term outcome is to increase the level of participation in
physical activity for people (and their households) in County Durham aged 40-74, with
an estimated and actual risk calculation of cardiovascular disease (CVD) greater than
20%. It aims to reach a target audience of over 5,800 people.
7.13.2 The project has a budget of £4.5m over a three year period, ending in September 2012
and has a management group made up of representatives from CDS and NHS CD,
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who have been engaged in a detailed process to develop the scope of the project,
identifying the key outcomes based on existing national and regional evidence. The
scope and outcome for the project were endorsed by the County Durham Health and
Wellbeing Partnership in May 2009. £3.45m has been awarded so far across 23
different organisations, forming 27 discrete projects. Durham County Council has
received just under £1m investment through CPAL.
7.13.3 Helmepark Ltd. is in the process of carrying out analysis on the data collected to
provide a clear picture on the impact CPAL. This will include health and economic
impact assessment to demonstrate return on investment (ROI) i.e. every £1 invested in
CPAL produces a return of £x amount. It will involve using a model employed in Be
Active, Be Healthy to calculate cost savings over time. It is explained in detail in
Section 8. The projects range from small clubs/community/voluntary projects to large
NHS/local authority projects covering activities such as tennis, rowing, dance and
walking. Examples of CPAL projects are:
7.13.4 SHINE - Durham University's Strengthening Hearts in the North East project aims to
deliver a diverse range of traditional physical activity interventions including walking,
swimming and gym sessions, complemented by golf, bowls and other activities .The
project will be managed by a project co-ordinator based and supported by qualified
Durham University student volunteers.
7.13.5 Healthy Horizons - is a collaborative partnership project delivered by Age UK County
Durham in partnership with Durham County Council and Leisureworks - Derwentside
Trust for Sports and the Arts and is funded by CPAL. It is focused on increasing levels
of participation in physical activity for men and women aged 50+, particularly those
living in disadvantaged areas who may be more restricted in their ability or likelihood to
access traditional service provision. Activities include seated exercise, gentle circuit
classes, tai chi, yoga, aqua aerobics, zumba, keep fit to music and walks. Healthy
Horizons was launched in Durham City and Chester le Street in 2005 and in
Derwentside area in 2008. 14 instructors are employed. During 2009/10 272 new
clients took part and overall 1,017 classes were offered, resulting in 15,978 visits to
classes over the year.
7.13.6 Get Walking Keep Walking is a project that helps people do more regular local
walking to improve their health and well-being. The project provides free locally based
walking programmes combining information and motivation with led walks and
independent walking. All walks are short (usually an hour or less) and are taken at an
easy pace. They start from and return to local centres that are easy for people to get
to. Each programme lasts 12 weeks and participants receive a free Get Walking pack
and stepometer.
7.13.7 Durham Swim Active Scheme is a programme led by the Amateur Swimming
Association in partnership with Durham County Council, to use swimming to tackle
health challenges.
7.13.8 Wellness on Wheels - launched in 2005 in the former Wear Valley area, promotes
the benefits of physical activity and encourages key lifestyle changes within local
communities, particularly those that are more isolated or evidence high levels of social
67
deprivation. It is a mobile fitness trailer, containing state-of-the-art equipment, which
will be located in agreed communities for a 10 week period, during which time
residents will be encouraged to take up exercise opportunities, and consulted about the
potential to establish a community managed 'legacy' fitness suite in the locality, utilising
local community facilities.
7.13.9 Qualified instructors are on hand to offer advice about health and food. The trailer has
disability access and is accredited by the Inclusive Fitness Initiative. It provides
affordable and supported opportunities very locally for GP's and other health
practitioners to refer patients who are being encouraged to increase their level of
participation in physical activity, including those with increased CVD risk. In Year 1
(February 2010 to January 2011) the project was delivered in 5 separate communities,
spread countywide, with the intention being to target 12 different locations throughout
the life of the project (to end September 2012), with a minimum of 9 'Legacy Gyms' to
be subsequently established.
7.14
Legacy gyms
7.14.1 As mentioned above, Wellness On Wheels (WOW) also aims to create permanent
opportunities for people to take part in physical activities, particularly for those who live
in isolated and socially deprived areas. WOW looks at the demand for activities
and potential locations for permanent facilities, which the community can then run
itself. These are called legacy gyms and they have over 3,000 members.
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7.14.2 There are currently nine legacy gyms at:
•
•
•
•
•
•
•
•
•
7.15
St John's Chapel Community Fitness Suite, St John's Chapel Town Hall
Bishop Auckland Workplace Fitness Suite, Bishop Auckland College
Chilton Community College
Parkside Community Fitness Suite, Parkside School, Willington
Tow Law Community Fitness Suite (TREX – Tow Law Recreation Exercise Club),
Tow Law Community Centre
Coundon Community Fitness Suite (Trainers), Grey Gardens Community Centre,
Tindale and Woodhouse Community Fitness Suite (The Fit and Healthy Gym),
Aucklandgate Centre, Tindale Crescent
Phoenix Community Fitness Suite, Community Centre, Hunwick.
Stanhope Community Fitness Suite Stanhope Town Hall, Stanhope
Health Trainers
7.15.1 NHS Health Trainers are trained to offer information and support to help people make
changes to improve their health and wellbeing. They work with individuals on a one to
one basis who would like help and advice to stop smoking, eat healthily and become
more physically active. They can put the individual in touch with other services in the
local area.
7.15.2 Through funding from ‘Communities for Health’ the trainer service has being modified
to support the NHS Health Checks Programme in targeted communities for referral into
lifestyle programmes. About 25% of those who use the Health Trainer service are
aged 50 plus.
7.16
NHS Health Check Programme
7.16.1 Free NHS Health Checks are part of a national programme, introduced across England
in 2009, aimed at identifying those who had a high risk of developing heart disease,
stroke, type 2 diabetes and kidney disease. Together these four diseases are the
largest cause of death in the UK. They affect more than 4 million people in the UK and
are the reason for one fifth of all hospital admissions.
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7.16.2 NHS County Durham and Darlington is working to provide Health Checks for one fifth
of the eligible population per year by 2012/13.
7.16.3 The programme supports individuals to lower the risk of developing these diseases and
improve the chances of a healthier life. The checks are available to anyone aged
between 40 and 74, who are registered with a GP. Adults who have already been
diagnosed with one of the four diseases will not be invited for the check and their
condition will continue to be managed as usual.
7.16.4 The Health Check takes no more than 30 minutes and involves simple questions about
family history and any medication being taken, recording height, weight, sex, ethnicity
and age, measuring blood pressure and a blood test to check cholesterol level. Body
mass index will also be calculated. The checks can be delivered in different settings to
suit local needs.
7.16.5 Following the health check, a personal report, including the test results and individual
lifestyle advice would be generated for the patient to take away. Some risk factors are
fixed, such as age and a family history of vascular disease, however other risks are
influenced by lifestyle, including diet, physical activity, consumption of alcohol and
smoking. These are all things individuals can change, with the right support if
necessary.
7.16.6 In the 2 years since the health check programme commenced, 55,748 checks have
been undertaken which equates to 66% of the expected numbers. 26% of the target
group has been reached, of which 24% are in the high risk group. There is however a
wide variation between GP’s undertaking health checks in the Easington area and a
wide variation on achievement. The health check programme had as at 11th March
2011, 40 trained community based staff, who were still undergoing training and were
waiting for their Hepatitis B vaccinations. Marketing also needed to be completed with
key stakeholders. The health checks could be carried out in community settings, such
as community pharmacies to increase access to the programme.
7.16.7 A pilot programme is being developed to improve the detection of atrial fibrillation (AF),
an irregular heart rhythm that is a risk factor for stroke. It has been agreed locally that
the heart rate and rhythm will be assessed at the time of the NHS health check. Work
is underway to assess the subsequent risk of stroke in AF patients and develop
appropriate management options to reduce it.
7.17
Life Style Change Programme
7.17.1 The County Council is piloting the Lifestyle Change programme where participants
received phone calls, motivational texts and e-mails for 10 weeks as well as physical
activity information packs and monthly newsletters. The Listening Company delivered
the intervention and Northumbria University is evaluating the pilot. The cost of the
scheme is low and up to now excellent results have been obtained. The social support
appears to be the main reason for many participants continuing to attend classes.
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7.18
County Wide Exercise on Prescription
7.18.1 Exercise on prescription has been around for more than ten years. There are now
more than 800 schemes, mostly run by councils and/or primary care trusts, that
encourage patients to take more exercise.
7.18.2 Patients most likely to be referred are those deemed high risk for heart disease or are
recovering from a heart attack. Obesity/weight management, diabetes, and mental
health may also lead to a referral being made. The long term objective is to help people
to attain sustainable healthy lifestyle changes.
7.18.3 Exercise on prescription is provided by Leisureworks in Derwentside, County Durham
and Darlington NHS Foundation Trust in the East of Durham and Durham County
Council Leisure Services provide a service for the rest of the County.
7.18.4 Patients are assessed by an appropriately trained instructor and a programme of
exercise is developed. This could include gym based activities, community based
exercise classes, walking, cycling aquatics. All patients will have their physical health
monitored e.g. blood pressure, weight and waist over the period of the programme.
7.18.5 Around 5,000 people were referred in 2010 across the three hubs operating in the
County. Between 35% and 50% completed a 10 week scheme and between 28% to
40% were still active 6 months after being referred. Around 50% of the surgeries within
the County are actively referring patients to the scheme. Referrals are made by GPs
and other health professions, including physiotherapists, mental health workers and
occupational therapists. This percentage could be increased through GPs being made
more aware of the scheme, and there being more flexibility to cater for an individual’s
work commitments.
7.19
Healthy Heart Programme
7.19.1 This is a joint initiative between Durham County Council, NHS and British Heart
Foundation, which is aimed at improving the heart health of the whole community in
specific locations within County Durham. The programme supports individuals who
have a high risk of cardiovascular disease to make informed choices about their
lifestyle and reduce the risk of cardiovascular through evidence based medical
interventions. It is a new way of delivering the national vascular checks programme
within the community.
7.20
Family Initiative Supporting Children’s Health (FISCH)
7.20.1 The above initiative was delivered by a Health Adviser (PCT) and Physical Activity
Officer (Lifestyle Initiative) in 123 schools from September 2009 to December 2010 to
tackle the problem of childhood obesity. It aimed to increase children’s participation in
physical activity inside and outside of school, engage with families of target children,
supporting them to develop and maintain a healthy lifestyle and promote a whole
school approach to a healthy lifestyle in support of the National Healthy School Status.
There were 5,642 children involved in the project. 535 were identified as obese. The
majority (80% schools) are looking at continuing FISCH’s work now the project has
71
ended. Over half (60%) teachers questioned felt that the school attitude to exercise
had improved after the project.
7.21
IMPACT Social Prescribing Website www.health-improvement.cdd.nhs.uk
7.21.1 There are now more than 800 activities (some are physical) on the IMPACT social
prescribing website for better physical and mental health. Members of the public and
professionals can access information on activities that aim to improve the population's
health in County Durham and Darlington. Most of the activities are free and the majority
do not require medical referral. The website welcomes organisations in County Durham
and Darlington to submit activities for inclusion on the site. Activities on IMPACT
include physical activity, arts and creativity, learning, volunteering, befriending and self
help.
7.21.2 The IMPACT project grew out of a desire by several GPs in the Sedgefield area to
have a means of prescribing social activities for their patients as an alternative to
prescribing medicines. Members of the public as well as health professionals can use
the website. The ultimate goal of the project is to develop a source of information that
will help to improve well-being and mental health and reduce social exclusion.
Conclusion
There are a number of lifestyle interventions aimed at targeting and engaging people
through creative and innovative ways. The range of interventions focus on population
groups e.g. older people, health conditions e.g. cardiovascular disease, geographical
area e.g. areas of deprivation and life course. Delivery seems less planned and
disjointed, even though we have a very clear direction of travel.
The impact of many of these interventions is not fully understood and requires more
detailed evaluation that would assist in better understanding its impact, cost
effectiveness, health benefit and return on investment.
What is required is an evaluative model that can easily and simply support
organisations to determine the impact of the programmes that they deliver so that
investment is more targeted, delivers value for money (return on investment) and
demonstrates outcomes in the short and long term.
Secondly, in order to ensure that delivery is better planned and co-ordinated, partners
involved in “health improvement” planning need to look to pool their resources so that
they may jointly commissioning physical activity programmes based on what works.
Recommendation 2
That Cabinet requests that the Director of Public Health, on behalf of the Council and
the NHS, to commission an evaluative framework to assess the impact of physical
activity programmes and other lifestyle interventions, as appropriate, and to explore,
through existing partner arrangements, further opportunities to pool budgets to jointly
commission physical activity programmes that work, based on evaluation results.
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Section Eight – Level of participation in physical activities and
effectiveness, benefits and returns on interventions/investment
8.1
Why do some people participate in sport and physical activity? And why do
some simply not want to join in?
8.1.1
Qualitative research may provide the answer as to why adults, teenagers and young
children do or do not participate in sport and physical activity.
8.1.2
A paper by S. Allender, G. Cowburn and C. Foster ‘Understanding participation in sport
and physical activity among children and adults’, 2005 examines published and
unpublished qualitative research studies of UK children’s and adult’s reasons for
participation and non participation in sport and physical activity.
8.1.3
The research found that although most people recognised that there were health
benefits associated with physical activity, this was not the main reason for participation.
Weight management, social interaction and enjoyment were the main reasons for
participation in sport and physical activity.
8.1.4
With regard to young children, participation was found to be more enjoyable when they
were not being forced to compete and win, but encouraged to experiment with different
activities. Enjoyment and support from parents were also crucial. Parents were found
to be more supportive of activity with easy access, a safe play environment, good
‘drop-off’ arrangements and activities available for other members of the family.
8.1.5
Concerns about maintaining a slim body shape, motivated participation among young
girls. A number of studies reported pressure to conform to popular ideals of beauty as
important reasons for teenage girls being physically active. Support from family and
significant others at ‘key’ transitional phases such as changing schools, was essential
to maintaining participation and having peers to share their active time.
8.1.6
Research found that adults exercised for a sense of achievement, skill development
and to spend ‘luxury time’ on themselves away from daily responsibilities. For disabled
men, exercise provided an opportunity to positively reinterpret their role following a
disabling injury. For this group, displaying and confirming their status as active and
competitive was beneficial.
8.1.7
Studies of GP exercise referral schemes found that the medical sanctioning of
programmes was a great motivator for participation. Other benefits reported by referral
scheme participants were the social support network created and the general health
benefits of being active.
8.1.8
Older people identified the importance of sport and physical activity in staving off the
effects of aging and providing a social support network. A study of ballroom dancers in
London found that the social network provided by the weekly social dance, encouraged
the maintenance of participation across major life events such as bereavement,
through the support of other dancers in the group.
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8.1.9
Barriers to participation in physical activity include high costs, poor access to facilities
and unsafe environments. Anxiety and lack of confidence about entering unfamiliar
settings such as gyms and having to show others an unfit body were the main barriers
to participation in GP referral schemes.
8.1.10 Negative experiences during school physical activity physical education classes were
the strongest factor discouraging participation in teenage girls. For many girls wanting
to impress their peers/boyfriends was more important than the physical activity. While
many girls wanted to be physically active, a tension existed between wishing to appear
feminine and attractive and the sweaty muscular image attached to active women.
Many girls preferred non traditional PE activities that provided opportunities for fun
rather than competition.
8.1.11 A number of studies showed that tight, ill-fitting PE uniforms were major impediments
to girls participating in school sport. These concerns over image and relationships with
peers led to an increased interest in non-active leisure.
8.2
Sport England’s Active People Survey
8.2.1
Information on the number of people undertaking physical activities can be accessed
through the Active People Survey, commissioned by Sport England and conducted by
IPSOS MORI.
8.2.2
The Active People Survey is a national five year survey to measure levels of
participation in sport and active recreation for those 16 plus and its contribution to
improving the health of the nation. The survey provides by far the largest sample size
ever established for a sport and recreation survey and allows levels of detailed analysis
previously unavailable. It identifies how participation varies from place to place and
between different groups in the population. It also measures; the proportion of the adult
population that volunteer in sport on a weekly basis, club membership, involvement in
organised sport/competition, receipt of tuition or coaching, and overall satisfaction with
levels of sporting provision in the local community. The questionnaire was designed to
enable analysis of the findings by a broad range of demographic information, such as
gender, social class, ethnicity, household structure, age and disability. The data will be
used to inform organisational and joint planning, targeting of interventions and
investment.
8.2.3
The first year of the survey, Active People Survey 1, was conducted between October
2005 and October 2006. Active People Survey 2, began on 15 October 2007 and was
completed on 14 October 2008. Active People Survey 3 (2008/9) commenced on 15
October 2008 and was completed on 14 October 2009. Active People Survey 4 ran
until 14 October 2010, the results were published on 16 December 2010.
8.2.4
Active People Survey 5 has been running since October 2010 and will be completed in
October 2011. The results are expected around December 2011, however the sample
size for County Durham will drop from approximately 3,500 to 500 and there is a
concern that the data will be become unreliable as a result.
74
8.2.5
The number of adults in England who participate in sport and physical activity at least
three times a week has reached 6.93 million, an average of 21.6%. County Durham’s
participation rate is in line with the national average, however there is a disparity
across the former district areas.
8.2.6
The table below shows the how the County is performing for a number of key
performance indicators compared with the average for England.
Key
Performance
Indicators
KPI 1 – At least 3
days X 30 minutes,
moderate intensity
participation (sport
and recreational
walking and Cycling
per week (all adults)
KPI 2 At least 1 hour
of volunteering to
support sport per
week (all adults)
KPI 3 Member of a
sports club
KPI 4 Received
sports tuition or
coaching (all adults)
KPI 5 Taken part in
organised
competitive sport (all
adults)
Active People
Survey 2
Oct 2007 - 08
A
Active People
Survey 3
Oct 2008 - 09
A
Active People
Survey 4
Oct 2009 - 10
A
County
Durham
England
County
Durham
England
County
Durham
England
20.8%
21.3%
21.7%
21.6%
22.2%
21.8%
5.3%
4.9%
5.3%
4.7%
4.9%
4.5%
22.2%
24.7%
22.2%
24.1%
21.8%
23.9%
14.4%
18.1%
14.4%
17.5%
15.1%
17.5%
12.8%
14.6%
12.8%
14.4%
12.5%
14.4%
14.
8.2.7
With regard to KPI 1 – Participation in sport and recreational walking and cycling,
Active People Survey 2 showed that the former district of Easington and the borough of
Sedgefield had the lowest participation rates (between 13.3% and 19.4%) whilst
Durham City and Chester-le-Street has the highest (between 23.9% - 30.9%). This
physical activity profile mirrors the deprivation profile within the county. (i.e. those
areas with lowest physical activity levels are also those with multiple deprivation
issues.)
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8.2.8
The map below shows participation rates for the north east region.
8.3
Sport England’s Market Segments Tool
8.3.1
Sport England has produced a practical guide, using nineteen sporting segments to
help understand the nations’ attitudes to sport and motivations for doing it (or not).
8.3.2
Sport England’s market segmentation provides those working in community sport with
an insight into the sporting behaviours and the barriers and motivations to taking part
amongst existing participants, and those that we wish to engage in a more active
lifestyle.
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8.3.3
The market segmentation data builds on the results of Sport England’s Active People
Survey and the Department of Culture, Media and Sport's Taking Part survey.
Demographic data was inputted into a mathematical model to explain sport and active
recreation behaviour and attitudes. Further data on media consumption, health and
fitness levels and affluence was added, as well as hospital episode indices and British
Crime Survey data.
8.3.4
Segment information can be used to:
•
Develop initiatives to meet customer needs.
•
Target investments efficiently
•
Effectively market sport to attract more customers.
8.3.5
For example – Leanne is a Supportive Single – she is the least active segment
amongst 18-25 year olds. We know that she is likely to be single, living in
private/council rented accommodation and is very likely to have children. We now also
know what motivates her, what brands she aspires to, how we can overcome things
that stop her taking part in sport and how to get her involved in sports she likes - such
as the gym and keep-fit. From this we can work out which sporting interventions are
likely to be more successful for Leanne.
8.3.6
The main barriers to participation in sport and physical activity identified by Sport
England and local consultation during the development of the Durham County Physical
Activity Strategy are:
Lack of awareness of what is
available/appropriate
Time
Lack of role models
Low Aspirations
Need for more childcare
Suitability of offer
Club capacity
Image/perceptions
Health or perceptions of health
Transport
Competing priorities
Cost
8.3.7
Working with partners across the country, case studies have been developed by Sport
England to illustrate how the segments can be practically applied to sports delivery on
the ground. A case study was undertaken to analyse the segment profile of the
registered users of ‘Wellness on Wheels’, a mobile gym facility working in Wear Valley.
Details are available on Sport England website.
8.4
Social marketing
8.4.1
‘Social marketing is the systematic application or marketing alongside other concepts
and techniques to achieve specific behavioural goals for a social or public good.’
(National Social Marketing Centre).
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8.4.2
Social marketing is the use of marketing principles to influence human behaviour in
order to improve health or benefit society. Growing evidence and experience shows
that when social marketing is applied effectively, and in the appropriate context, it can
be a powerful tool for achieving tangible and measurable impact on behaviours.
Improving the level of understanding and application of social marketing is therefore
critical if we are to achieve real and measurable impacts on peoples behaviour(s)
across a range of different policy and practice agendas.
8.4.3
Interestingly, the House of Lords Science and Technology Select Committee has
appointed a sub committee (19 May 2011) to investigate the use of behaviour change
interventions to achieve policy goals. The Select Committee will look at the evidence
base that supports current behaviour change interventions and at the effectiveness of
those interventions. The enquiry will seek to determine whether there is sufficient
expertise within public services to ensure that interventions are evidence-based, and
implemented and evaluated effectively.
Conclusion
County Durham’s participation rate is in line with the national average.
Barriers to participation need to be taken into account when planning for physical
activity. Importantly levels of participation correspond to areas of deprivation which
directly relate to health opportunities and heath inequalities.
The Sport England Survey (4) provides good information to assist planners and
provides relevant benchmarking information to monitor trends and improvements.
Analysis of children’s participation is however lacking (up to16).
Tools exist for example, market segment information that can be used to develop
initiatives to meet customer needs, target investments efficiently and effectively
market sport to attract more customers. However, these tools focus more on sport
than physical activity. Opportunities to use social marketing techniques to influence
human behaviour should be explored.
The House of Lords Science and Technology Select Committee’s report (when
completed) should provide an evidence base with associated case study material that
will be worth considering, to assist the Council and its partners with approaches/
interventions that support behaviour change.
Investment in people’s participation, for example in volunteering may well increase
levels of participation. Anecdotal evidence suggests that volunteering and or buddy
schemes motivate and help people to be more active. Impact of such interventions is
unclear.
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Recommendations 3a and 3b
a) That Cabinet requests the Director of Public Health, in conjunction with the Council
and the NHS, to bring forward proposals on interventions that support behaviour
change reflecting on the evidence base that exists including the outcome from the
House of Lords Science and Technology Select Committee. Analysis of such
interventions should include for example, social marketing techniques and best
practice regarding volunteering.
b) That Cabinet ensures that details of such approaches are cascaded to all partners
and partnerships, namely all physical activity providers and commissioners; the
Councils Area Action Partnerships (irrespective of whether they have or do not
have health priorities), the NHS Health Networks and the Health and Wellbeing
Partnership/Board.
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8.5
Benefits and returns of investment/interventions to improve levels of physical
activity
8.5.1
One of the challenges for preventative interventions to promote physical activity is to
evaluate their impact. There have been a number of attempts recently to identify the
potential and actual return on investment for initiatives aimed at preventing or reducing
the risk of ill health. Where this is related directly to costs, the concept of return on
investment is used.
Return on investment (ROI) is the ratio of money gained or lost (whether realised or
unrealised) on a project investment – relative to the amount of money invested in that
project
8.5.2
The return on investment may be considered in relation to the improvement of quality
of life. Current terminology describes this in terms of quality adjusted life years or
‘QALY’.
8.5.3
A year of life adjusted for its quality or its value. A year in perfect health is considered
equal to 1.0 QALY. The value of a year in ill health would be discounted.
For example, a year bedridden might have a value equal to 0.5 QALY
8.6
How a QALY is calculated?
8.6.1
Patient x has a serious, life-threatening condition.
8.6.2
8.6.3
•
If he continues receiving standard treatment he will live for 1 year and his quality
of life will be 0.4 (0 or below = worst possible health, 1= best possible health)
•
If he receives the new drug he will live for 1 year 3 months (1.25 years), with a
quality of life of 0.6.
The new treatment is compared with standard care in terms of the QALYs gained:
•
Standard treatment: 1 (year's extra life) x 0.4 = 0.4 QALY
•
New treatment: 1.25 (1 year, 3 months extra life) x 0.6 = 0.75 QALY
Therefore, the new treatment leads to 0.35 additional QALYs (that is: 0.75 -0.4 QALY =
0.35 QALYs).
•
The cost of the new drug is assumed to be £10,000, standard treatment costs
£3000.
80
8.6.4
The difference in treatment costs (£7000) is divided by the QALYs gained (0.35) to
calculate the cost per QALY. So the new treatment would cost £20,000 per QALY.
Calculating the costs of interventions is usually relatively simple and some examples
are given below:
•
Obesity:Weight watchers - £1,022 per QALY
Anti-obesity drugs - £3,200 to £24,431 per QALY
•
Physical Activity - £40 to £400 per QALY
•
Statins cost - £10,000 to £17,000 per QALY
•
Smoking cessation costs – £221 to £9,515 per QALY
8.6.5
The difficulty is to identify the potential health effects and health benefits of the
intervention. It is also important to recognise that there will be a delay between
increase in physical activity and measurable benefits. Where this appears to relate
directly to the reduction in prevalence of a particular symptom, disease or illness, or a
reduction in users of a service, this may be clear. However, in the case of physical
activity, the impact may not be identifiable for some time after the intervention has
been implemented.
8.6.6
For example, research was undertaken in Sweden over a 35 year period into the effect
of physical activity in men aged 50 to 82. The study identified that whilst men who
engaged in moderate or high activity had reduced risk of death than those engaged in
low activity, those men who increased their level of physical activity between the ages
of 50 and 60 did not reap the benefits of this in terms of reduced mortality for some
years.
8.6.7
The Social Return on Investment (SROI) is another useful approach for those who plan
and deliver public services to make judgments about the best ways of achieving
savings and improvements based on value not cost. Technical guidance on using this
technique can be found in the ‘Guide to Social Return on Investment’ published by the
Cabinet Office. SROI can help increase understanding about the impacts of policies,
projects and services. It identifies and values those impacts from the perspective of
people affected. Using a SROI approach helps to include those things that do not
result in changes to income or costs but are nonetheless important. The aim is to give
the people who are most affected a voice about allocating resources.
8.6.8
The seven principles of SROI are:
•
Involve stakeholders
Inform what gets measured, how it is measured and valued by involving relevant
stakeholders, especially people directly affected.
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8.6.9
•
Understand what changes
Describe how change is created and evaluate this through evidence gathered,
recognising positive and negative changes as well as those that are intended and
unintended.
•
Value the things that matter
Use financial proxies to recognize the value of outcomes. Many outcomes are
not traded in markets and as a result their value is not recognised.
•
Only include what is material
Decide what information and evidence must be included to give a true and fair
picture, so that stakeholders can draw reasonable conclusions about impact.
•
Do not over claim
Only claim the value that organizations are responsible for creating.
•
Be transparent
Demonstrate the basis on which the analysis may be considered accurate and
honest and show that it will be reported to and discussed with stakeholders.
•
Verify the result
It is important to consider appropriate independent assurance of the process, in
order be able to present findings that decision-makers will find credible.
The CPAL project has implemented a process of evaluation to allow SROI to be
calculated. This model employed is based on the following:
•
An assessment of the economic value of the project in terms of job creation (or
retention), and any secondary spending effects from this, which shows that the
project is expected to provide peak employment for 17 people on a full time basis
and 29 people on a part time basis. This then has a knock on effect, where the
spend by these individuals creates a small second tier of employment (the
multiplier effect) bringing the total numbers employed or supported by the project
to 19 full time equivalents and 32 part time equivalents.
•
An assessment of the economic return on the overall financial investment being
made in the project has currently been applied to the CVD risk group only. This
sets out a case, built on a range of widely respected evidence, that increased
exercise by individuals will lead over time, to a reduction in direct public
healthcare costs. It also leads to associated benefits in terms of some of these
individuals remaining in work, and hence continuing to contribute to society
through taxation and spending and by not requiring informal care to be delivered
by members of their family. The model then goes on to identify the likely value of
each of these benefits, and the extent to which the CPAL programme can lay
claim to these. The final model which is not yet finalised, will include the family
members of the CVD risk groups targeted and ‘other’ adults who may fall into the
40-74 age group, but who have not been identified as being at risk. However, in
the current format, it would suggest that the economic return from the CVD risk
82
group alone may already be in the order of £680,000, with the project due for
completion in September 2012. This is based on 304 people to date from the
CVD group increasing their levels of exercise after six months, and the savings
and benefits this can be expected to bring over a five year period. This has then
been compared with the project expenditure to date of £1,287,717, which
represents a return of £0.53 for every £1 invested so far. In SROI terms, this
currently represents a return of less than one, but there a number of important
factors to consider before drawing any immediate conclusions at this stage:
o The unit costs of delivery can be expected to fall as the start up costs
become more evenly spread, and based on the people already known to be
in the system but not yet at six months
o The model has erred on the side of caution in any assumptions and has only
considered the CVD group to date and although the benefits will be smaller
from the family and other groups, these can be expected to have a positive
effect
o Even if, as seems unlikely, an ultimate return of less than £1 was achieved
for each £1 invested this might still be acceptable to funders - subject to the
importance they place on other outcomes, including the learning points
which are already emerging from the programme and the qualitative benefits
being reported by participants.
8.6.10 It is also possible to make some very early predictions of the value of the overall
project by applying the three year target figures, noting the various qualifications which
have been set out. Based on this, if the projects recruits to the expected target of
3,300 in the CVD group, and 58% of this group (1914 people) increase their levels of
participation, this would give a return of approximately £1 of benefit for each £1
invested. By contrast if the programme reaches its projections for recruitment which
could actually be in the region of 6,600 people to be recruited to the CVD group, and
58% (3828 people) increase their levels of physical activity, this would potentially give
a return of £2 of benefits for every £1 invested.
8.6.11 Whilst the above data should be treated with caution, the picture can only improve as
unit costs should reduce as the programme continues and the effect of the start up
costs at the project’s beginning become more evenly spread out.
Conclusion
A common by-line being used to promote physical activity is ‘the cure of ills is not to
sit still’ and “eat less, do more”.
This apparent common sense approach to physical activity needs to be supported by
organisations and professionals to help individuals and communities recognise the
health benefits of regular and sustained physical activity. By emphasising and
promoting flexible approaches to physical activity that can be incorporated into
existing lifestyles, there are opportunities for improving physical activity levels. To
achieve this, there is a need to promote the health benefits to all ages and groups;
and all organisations and agencies.
83
A number of tools have been developed that demonstrate Social Return on
Investment (SROI) .These need to be incorporated into any future work to develop an
effective evaluative framework.
84
Section Nine - Best Practice/Guidance/Research
9.1
Best practice methods/guidance on promoting the take up of physical activity
9.1.1
A number of international and national guidance documents have been produced
aimed at promoting physical activity. All emphasise the need for evaluation and
monitoring to ensure that participants benefit from interventions.
9.2
National Institute for Health and Clinical Excellence Guidance
9.2.1
In March 2006, the National Institute for Health and Clinical Excellence (NICE) issued
guidance on the four commonly used methods to increase physical activity. These are:
•
Brief interventions in primary care – basic advice to more extended, individually
focused attempts to identify and change factors that influence activity levels,
•
Exercise referral schemes- referral to a tailored physical activity programme,
•
Pedometers – common aid to increasing physical activity through walking
•
Community based walking and cycling schemes – organised walks or rides
9.2.2
The aim of the guidance is to help practitioners deliver effective interventions that will
increase people’s physical activity levels and therefore benefit their health. The
guidance is particularly aimed at those who develop and commission services –
directors of public health and senior managers within health trusts.
9.2.3
With regard to brief interventions in primary care, NICE established that the
incremental cost per quality adjusted life year ranged from between £20 to £440.
When including the healthcare savings from preventing disease and other conditions,
all brief interventions result in net cost savings to the health service compared with no
intervention. They also result in a better quality of life for participants. The incremental
net costs saved per QALY gained vary from around £750 to around £3,150.
9.2.4
With regard to the exercise referral schemes, evidence from two randomised controlled
trials suggests that they can have positive effects on physical activity levels in the short
term – 6 to 12 weeks. However, evidence from 4 trials indicates that such referral
schemes are ineffective in increasing activity in the longer term – over 12 weeks.
9.2.5
The guidance recommends that practitioners, policy makers and commissioners should
only endorse exercise referral schemes, the use of pedometers and walking and
cycling schemes to promote physical activity that are part of a properly designed and
controlled research study to determine effectiveness.
9.2.6
In addition to the above guidance, NICE also produced in 2008 complementary
guidance on how to encourage employees to be physically active - ‘Workplace health
promotion: how to encourage employees to be physically active’.
9.2.7
The guidance is for employers and professionals in small, medium and large
organisations, especially those working in human resources or occupational health.
Investing in the health of employees can bring business benefits such as reduced
sickness absence, increased loyalty and better staff retention.
85
9.2.8
In 2005/06, an estimated 30.5 million working days were lost as a result of work related
illnesses and injuries. On average, each sick person took 16 days off work in that 12
month period.
9.2.9
The guidance recommends developing an organisation-wide plan and introducing and
monitoring an organisation programme to encourage and support employees to be
more physically active, encouraging employees to walk, cycle or use another mode of
transport and helping employees to be physically active during the working day. The
provision of showers and secure storage will help promote active travel to work.
9.2.10 NICE is currently (May 2011) undertaking a consultation on updating the guidance to
take account of, and reflect both cost effective and non cost effective interventions and
new research into the health effects of sedentary time at work as an independent risk
factor.
9.3
Toronto Charter for Physical Activity
9.3.1
The Toronto Charter for Physical Activity outlines the direct health benefits of investing
in policies and programmes to increase levels of physical activity. Already translated
into 11 languages, the Toronto Charter makes a strong case for increased action and
greater investment on physical activity as part of a comprehensive approach to non
communicable disease prevention. The charter refers to seven “best investments” for
physical activity, which are supported by good evidence of effectiveness and have
worldwide applicability.
9.3.2
The seven best investments are:
•
Whole of school programme
Schools can provide physical activity for the large majority of children and are an
important setting for programmes to help students develop the knowledge, skills
and habits for life-long healthy and active living. A ‘whole of school’ approach to
physical activity involves prioritising: regular, highly-active, physical education
classes; providing suitable physical environments and resources to support
structured and unstructured physical activity throughout the day (e.g., play and
recreation before, during and after school); supporting walk/cycle-to school
programmes and enabling all of these actions through supportive
school policy and engaging staff, students, parents and the wider community.
•
Transport policies and systems that prioritise walking, cycling and public
transport
‘Active transport’ is the most practical and sustainable way to increase physical
activity on a daily basis; and increased active transport will achieve co-benefits
such as improved air quality, reduced traffic congestion, and reduced CO2
emissions. Increasing active transport requires the development and
implementation of policies influencing land use and access to footpaths, cycleways
and public transport, in combination with effective promotional programs to
encourage and support walking, cycling and use of public transport for travel
purposes.
86
•
Urban design regulations and infrastructure that provide for equitable and
safe access for recreational physical activity, and recreational and transportrelated walking and cycling across the life course
The built environment provides opportunities for or barriers to safe,
accessible places for people to be involved in recreation, exercise sports, walking
and cycling. National, regional, and local planning and design regulations
should require mixed-use zoning that places shops, services, and jobs
near homes, as well as highly connected street networks that make it
easy for people to walk and cycle to destinations. Access to public
open space and green areas with appropriate recreation facilities for all
age groups are needed to support active recreation. Complete networks
of footpaths, bikeways, and public transit support both active travel and active
recreation.
•
Physical activity and non communicable disease prevention integrated into
primary health care systems
Doctors and health care professionals are important influences of patient behaviour
and key indicators on non communicable disease prevention actions within the
health care system and can influence large proportions of the population. Health
care systems should include physical activity as an explicit element of regular
behavioural risk factor screening. Positive messages about physical activity are
important.
•
Public education, including mass media to raise awareness and change
social norms on physical activity
Mass media provide an effective way to transmit consistent and clear messages
about physical activity to large populations. In most countries, physical activity
promotion is absent from mass media. Both paid and non-paid forms of media can
be used to raise awareness, increase knowledge, shift community norms and
values and motivate the population to be more active. Public education can involve
print, audio and electronic media, outdoor billboards and posters, public relations,
point of decision prompts, mass participation events, mass distribution of
information as well as new media such as text messaging, social networking and
other uses of the internet.
•
Community-wide programmes involving multiple settings and sectors and
that mobilise and integrate community engagement and resources
Whole-of-community approaches to physical activity across the life course will be
more successful than a single programme to increase population levels of physical
activity. Using key settings provides the opportunity to integrate policies,
programmes and public education aimed at encouraging physical activity. Whole-ofcommunity approaches where people live, work and recreate have the opportunity
to mobilise large numbers of people.
•
Sports systems and programmes that promote ‘sport for all’ and encourage
participation across the life span.
Sport is popular worldwide and increased participation in physical activity can be
encouraged through implementation of community sport or ‘Sport for All’ policy and
programmes. Building on the universal appeal of sport, a comprehensive sport
system should be implemented that includes the adaption of sports to provide a
87
range of activities to match the interests of men and women, girls and boys of all
ages, in addition to well coordinated coaching and training opportunities.
Toolkits/Frameworks
9.4
Let’s Get Moving (LGM) Commissioning Framework
9.4.1
This national initiative provides a physical activity care pathway which can be used by
service providers systematically to recruit patients and screen for inactivity using a
validated questionnaire. Patients identified as not meeting the Chief Medical Officer’s
recommendations for physical activity will be offered a brief intervention, drawing upon
motivational interviewing techniques, which:
9.4.2
•
takes a patient-centred approach to highlighting the health benefits of physical
activity;
•
works through key behaviour change stages; and
•
concludes with a clear physical activity goal set by the patient, identifying local
opportunities to be active, including exercise on referral schemes where
appropriate.
The pathway uses a 5 stage model for all interventions
1)
2)
3)
4)
5)
recruit
screen – assessment using an accredited questionnaire
intervene – helping to build confidence to start activity
active participation – participant sets goal and becomes active
review - participating patients are then followed up over 3, 6 and 12 months after
the brief intervention to check progress, encourage and reset goals.
9.4.3
LGM has been tested in a feasibility trial in 14 surgeries by the British Heart
Foundation National Centre for Physical Activity and Health, Loughborough University.
The results of the trial demonstrated that LGM is feasible for delivery in primary care
and is suitable for wider implementation.
9.5
Promoting Activity Toolkit
9.5.1
The Promoting Activity toolkit has been developed by Make Sport Fun on behalf of the
NHS, Department of Health, Transport for London and other partners. It is a community
project, with many partners contributing and with all resources available to all users.
9.6
British Heart Foundation Exercise Referral Toolkit
9.6.1
This toolkit was been developed by the BHF National Centre for Physical Activity and
Health, to support professionals in designing, delivering, commissioning and evaluating
exercise referral schemes. Its aim is to provide an easy-to-read, practical guide for all
those professionals involved in the delivery, coordination, commissioning and
evaluation of exercise referral schemes. These professionals include general
practitioners, practice nurses, community nurses, allied health professionals
(physiotherapists, dieticians etc), exercise professionals, health promotion/ public
health specialists, commissioners and researchers
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Research
9.7
‘Movement as Medicine’
9.7.1
Following research undertaken with GP’s and patients, Newcastle University has
developed the UK’s first clinically accredited professional development programme for
physical activity. The programme is designed to advise doctors and nurses on methods
that worked in getting people with Type 2 diabetes to become more active.
9.7.2
On average people are living 5 to 10 years longer than their parents would have.
However, there is a cost associated with managing an older population. Diseases such
as Type 2 diabetes and CVD are lifestyle driven and whilst drugs are available to
manage the conditions, they are expensive.
9.7.3
People tend too eat too much and move too little. The challenge is to try and reduce
obesity by studying the links between social networks i.e. social links, family ties and
physical proximity of people with the disease network, which included type 2 diabetes,
CVD, non fatty liver disease and exercise intolerance and the metabolic network.
Essentially movement is at the core of maintaining a healthy lifestyle.
9.7.4
A study undertaken by Professor Jerry Morris in the 1950’s and 1960’s to compare the
relative incidence of myocardial infarction between bus drivers and bus conductors,
showed that the drivers who had a higher sit time compared to conductors, had a
higher rate of myocardial infarction. The key determining factor was their movement
patterns so the aim is to prevent people becoming sedentary by undertaking simple
everyday movement.
9.7.5
People with diabetes can also limit the impact of the condition simply by walking for an
extra 45 minutes a day. Research by Dr Michael Trenell, Director, Physical Activity
and Exercise Research and colleagues from the Diabetes Research Group at
Newcastle University found that exercise helped to keep blood sugar levels in check.
9.7.6
Walking 30 to 45 minutes a day could help people with Type 2 diabetes control the
disease and prevent further weight gain. Over a period of time this would help control
their blood glucose levels. People often found the thought of going to a gym daunting,
however most people with diabetes are able to become more active through walking.
This could be something a simple as getting off the bus a few stops earlier.
9.7.7
Physical activity provides an immediate way to help control diabetes without any
additional drugs by building it into everyday life. It is an important and simple health
message – walking 45 minutes extra a day helped burn about 20% more fat, increasing
the ability of the muscles to store sugar and help control the diabetes.
9.7.8
The challenge is to find ways to help and encourage people to move more and the
programme catered for all types of people, i.e. there are chair based activities. It is the
quality of the movement that is important.
89
9.7.9
The University of Newcastle upon Tyne has worked with County Durham Primary Care
Trust to develop a physical activity package for use with people with Type 2 diabetes in
primary care. This programme targets the clinical care teams and patients and has
resulted in the production of the UK’s first professional and patient development
pathway for people with Type 2 diabetes. The programme is being further applied to
cardiovascular disease through funding from CPAL and will be piloted in County
Durham and Darlington over the next two years.
Conclusion
A number of toolkits and frameworks exist internationally, nationally and locally. Whilst
each may suggest slightly different interventions, there are a number of core themes
that are repeated across the world:
•
The need for good communication and support between individuals and health
professionals;
•
The need for choice in the type of physical activity undertaken;
•
The need to think about physical activity within lifestyles leading to gentle lifestyle
change
A number of national guidance documents have been produced in Britain aimed at
promoting physical activity. All emphasise the need for evaluation and monitoring to
ensure that participants benefit from interventions.
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Section Ten – Conclusions and Recommendations
10.1
Conclusion
10.1.1 Improving physical fitness helps prevent and manage over 20 conditions and diseases
including cancer, coronary heart disease, diabetes and obesity and can also help to
promote mental wellbeing. It should be seen as an effective means of providing value
for money and return on investment. It should deliver significant savings on the cost of
treating chronic diseases when you think treating cardio vascular heart disease (CHD)
cost approximately £23 million in County Durham in 2009/10.
10.1.2 Liam Donaldson, former Chief Medical Officer said that ‘inactivity pervades the country.
It affects more people in England than the combined total of those who smoke, misuse
alcohol or are obese. Being physically active is crucial to good health. If a medication
existed that had a similar effect on preventing disease, it would be hailed as a miracle
cure’.
10.1.3 Evidence of the health benefit for physical activity is seen throughout the life course. In
cardiovascular disease, cancer, type 2 diabetes and obesity. ‘Start Active, Stay Active’
2011 - a report on physical activity for health by the four home countries’ Chief Medical
Officers, stresses the importance of investing in a lifecourse approach to the
promotion of physical activity and reducing sedentary behaviour at different key life
stages of childhood and adolescence, adulthood and older age.
10.1.4 Reducing health inequalities will require action on six policy objectives identified in the
Marmot Review:
o
Give every child the best start in life.
o
Enable all children young people and adults to maximise their
capabilities and have control over their lives.
o
Create fair employment and good work for all.
o
Ensure healthy standard of living for all.
o
Create and develop healthy and sustainable places and communities.
o
Strengthen the role and impact of ill health prevention.
10.1.5 For most people the easiest and most acceptable forms of physical activity are those
that can be incorporated into everyday life. Examples include walking or cycling
instead of travelling by car and taking up active leisure pursuits and hobbies such as
gardening or social sporting activities. Even shopping regularly, according to recent
research reported in the Journal of Epidemiology and Community Health (2011), has
the potential to increase physical and mental wellbeing.
10.1.6 Physical activity makes a significant contribution to reducing health inequalities.
Consequently, increasing physical activity and participation in sport and leisure and
reducing obesity levels are identified in the Altogether Healthier Section of Council Plan
2011 – 14 as the two main actions to reduce health inequalities.
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10.1.7 The over-riding aim of the Council’s Sport and Leisure Strategy 2011 – 2014 is to
increase participation in physical activity by 0.5% per year in accordance with the
Sustainable Community Strategy and Council Plan, whilst anticipating a significant
reduction in funding over the plan period. The strategy generally seeks to reduce
dependence on built facilities, by refocusing on the natural environment and
development of targeted activities as a resource for people to take part in physical and
recreational activity, as part of either sport or day to day routines.
10.1.8 Changing inactive lifestyles presents a tremendous challenge for key partners i.e. the
workplaces, parents and families. Current levels of physical activity reflect personal
attitudes about time use and how conducive our homes, neighbourhoods and
environments have become for more inactive living.
10.1.9 Growing evidence and experience shows that when social marketing is applied
effectively, and in the appropriate context, it can be a powerful tool for achieving
tangible and measurable impact on behaviours. Sport England’s Market Segments
Tool will help those working in community sport to understand the nation’s attitudes to
sport, motivations for doing it (or not) and will assist with the development of initiatives
to meet customer needs, target investment efficiently and attract more customers.
10.1.10 Local authorities, through their planning powers, management of traffic, parks and
open spaces, leisure and cultural services can contribute to the quality of the natural,
built and social environment. They have specific duties and powers to promote equality
and social inclusion and social, economic and environmental well-being. They work in
partnership with the NHS and other agencies such as the police, to support public
health. The National Institute for Health and Clinical Excellence in its public health
guidance No. 8 – ‘Promoting and creating built or natural environments that encourage
and support physical activity’, provides evidence based recommendations covering,
strategies / policies / plans, transport, public open spaces, buildings and schools.
10.1.11 The natural environment has an important role to play in maintaining healthy lives. It
provides for physical activity which reduces obesity and heart disease, and improves
air quality by filtering pollutants, thus reducing respiratory problems such as asthma.
10.1.12 In the White Paper ‘Healthy Lives, Healthy People: Our strategy for public health in
England’ the Government recognises that the quality of the environment, including the
availability of green space and the influence of poor air quality and noise affects
people’s health and wellbeing. It states that the social costs of the impacts of air
pollution are estimated at £16 billion per year in the UK. The White Paper details plans
for a shift of power to local communities, including new duties and powers to local
authorities to improve the health of local people. The Government is of the view that it
is simply not possible to promote healthier lifestyles through Whitehall diktat and
nannying about the way people should live. It therefore proposes a new approach
which empowers individuals to make healthy choices and gives communities the tools
to address their own, particular health needs, which is a significant shift of policy
direction from the previous government. The Government is pursuing a policy of less
nannying by the state in favour of individual responsibility and potentially a culture of
victim blaming if people are unable to actively engage for whatever reason. According
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to the Marmot review action to reduce health inequalities requires both individual and
collective responsibility.
10.1.13 The Government’s commitment to protecting and improving the natural environment is
also set out in the White Paper ‘The Natural Choice’. Key measures included in the
White Paper are designating green areas, enabling more children to experience nature
by learning outdoors, strengthening local public health activities and a new
environmental volunteering initiative ‘Muck in 4 Life’.
10.1.14 The proposed public health system, as outlined in the White Paper ‘Healthy Lives,
Healthy People -Our strategy for public health in England’, includes Health and
Wellbeing Boards, which will be charged with assessing and agreeing local health
priorities. The Boards will comprise of GP Consortia, Director of Public Health,
Directors of Adult and Children’s Services, local Health Watch and NHS
Commissioning Board. The Director of Public Health will be employed by the Local
Authority and will be the ambassador of health issues for the local population.
Historically, money for public health has disappeared into other services. Under new
arrangements, the flow of money will change so that: money will be allocated from the
NHS budget and ring-fenced for public health. Local Authorities will receive an
incentive payment or health premium, which will depend on the progress made in
improving the health of the local population and reducing health inequalities, based on
elements of the Public Health Outcomes Framework.
10.1.15 Promoting physical activity in the workplace is vitally important as physically active
employees are less likely to suffer from major health problems, less likely to take
sickness leave and less likely to have an accident at work. Employers therefore need
to develop employee initiatives with a range of organisations to increase participation in
physical activity and wherever possible provide and promote opportunities to travel to
and from the workplace by walking and cycling.
10.1.16 It is important that all preventative interventions to promote physical activity are
effective. The use of cost-utility analysis – where the outcomes are expressed in one
measure that combines information on life expectancy and health related quality of life
(quality adjusted life years or ‘QALYs) can be used to make comparisons across
different programmes, for example prevention and treatment.
10.1.17 Health impact assessments also influence decision-making in favour of health. By
completing a Health Impact Assessment, decision-makers should have evidencebased recommendations to maximise the positive and minimise the negative health
impacts of theirs proposals.
10.1.18 In the final analysis, the Council through its strategic and community leadership role
recognises the link between environmental, social and economic sustainability to
health and well being outcomes. An example of this can be seen through the
development of County Durham Sustainable Community Strategy, where health
outcomes linked to socio-economic priorities have come to the fore. The Council’s
vision for a better place for people explicitly recognises the need for a healthier
community. Health outcomes and health improvement are seen as core business and
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are progressed through existing organisational arrangements, which ensure that health
implications and action on health inequalities are challenged at the corporate, cabinet
and indeed scrutiny level. This approach puts the Council in a good position for the
transfer of public health to local government.
Recommendations
1.
should include the Marmot Review six policy objectives) informs the Council’s
contribution to planning and delivery of a public health agenda within the
context of proposals contained in the Health and Social Care Bill (and Act as
appropriate).
2.
appropriate, and to explore, through existing partner arrangements, further
3a. That Cabinet requests the Director of Public Health, in conjunction with the
Council and the NHS , to bring forward proposals on interventions that support
3b. Secondly, that Cabinet ensures that such approaches are rolled out to all
partners and partnerships, namely all physical activity providers and
commissioners; the Councils Area Action Partnerships (irrespective of whether
they have or don’t have health priorities), the NHS Health Networks and the
Health and Wellbeing Partnership/Board.
4.
recommendations should be undertaken 6 months after it has been considered
by Cabinet.
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Section Eleven – Appendices
Appendix 1 - Recommended exercise guidelines as set out in the report ‘Start Active,
Stay Active’ July 2011
Appendix 2 - Details of physical activity projects supported by the Area Action
Partnerships
Appendix 3 – Equality Impact Assessment
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Appendix 1
Recommended exercise guidelines as set out in ‘Start Active, Stay
Active’ - A report on physical activity for health from Chief Medical
Officers for England, Scotland, Wales and Northern Ireland
Early Years (under 5s)
1. Physical activity should be encouraged from birth, particularly through floor-based play and
water activities in safe environments.
2. Children of pre-school age who are capable of walking unaided should be physically active
daily for at least 180 minutes (3 hours), spread throughout the day.
3. All under 5s should minimise the amount of time spent being sedentary (being restrained or
sitting) for extended periods (except time spent sleeping)
Children and Young People (5-18 years)
1. All children and young people should engage in moderate to vigorous intensity physical
activity for at least 60 minutes and up to several hours every day.
2. Vigorous intensity activities, including those than strengthen muscle and bone, should be
incorporated at least three days a week.
3. All children and young people should minimise the amount of time spent being sedentary
(sitting) for extended periods.
Adults (19 – 64 years)
1. Adults should aim to be active daily. Over a week, activity should add up to at least 150
minutes (2 hr 30 min) of moderate intensity activity in bouts of 10 minutes or more – one
way to approach this is to do 30 minutes on at least 5 days a week.
2. Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity
activity spread across the week or a combination of moderate and vigorous intensity activity.
3. Adults should also undertaken physical activity to improve muscle strengthen on at least two
days a week.
4. All adults should minimise the amount of time spent being sedentary (sitting) for extended
periods.
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Older Adults (65+ years)
1. Older adults who participate in any amount of physical activity gain some health benefits,
including maintenance of good physical and cognitive function. Some physical activity is
better than none and more physical activity provides greater health benefits.
2. Older adults should aim to be active daily. Over a week, activity should add up to at least
150 minutes (2hours 30 minutes) of moderate intensity activity in bouts of 10 minutes or
more – one way to approach this is to do 30 minutes on at least 5 days a week.
3. For those who are already regularly active at moderate intensity, comparable benefits can
be achieved through 75 minutes of vigorous intensity activity spread across the week or a
combination of moderate and vigorous activity.
4. Older adults should also undertake physical activity to improve muscle strength on at least
two days a week.
5. Older adults at risk of falls should incorporate physical activity to improve balance and
co-ordination on at least two days a week.
6. All older adults should minimise the amount of time spent being sedentary (sitting) for
extended periods.
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Appendix 2
4Together Area Action Partnership
Area and Neighbourhood Budget schemes
1. Planting/environmental schemes with the schools, and older people ,
intergenerational projects to promote healthy outdoor activities
• Chilton, Ferryhill and West Cornforth roundabouts and village entrance schemes
• Ferryhill Allotments Scheme
• Cornforth Community gardens
2. Community Food enterprise Scheme, gardening and healthy eating project
• West Cornforth Community Partnership
3. Trampoline adults and children & young people, including specialised equipment
for special educational needs, providing exercise sessions , up to Olympic
standards
• Sedgefield Springer's , Ferryhill Leisure centre
4. Children & young peoples projects, including residential and sporting activities ,
canoeing, walking, climbing, swimming etc, award schemes linking to CV enhancement
and employment opportunities. Well being clinics and advice sessions.
• John Muir Scheme Ferryhill
• Ferryhill Youth Activities Project
• Keep us busy and off the streets projects
• Big Wide World Project
• Life choices
• The Reach Project
5. Children & young people dance and education projects and weekly
sessions, involving music, dance drama and art
•
•
Saturday Project
AAp Theme Tune
6. Skate Park Facilities
•
Chilton
7. Refurbishments, to provide healthy lifestyle equipment and resources and
sessions
•
Chilton Community Centre
•
Ferryhill Scouts Hall
•
Chilton Legacy Gym
8. Football pitch regeneration
•
West Cornforth Junior Football Club
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Great Aycliffe and Middridge Partnersip
Some GAMP projects (from 2009-10 and 2010-11) which have linked to physical
activity are as follows:
Area Budget
- Ice Rink
- Friday Night Activities (Youth Centre) - street dance coaching, football, basketball etc
- 7-13 Year Old Activities (Youth Centre) - e.g. climbing wall
- School Theatre Project - dance element
- Dance Events (13-17 years)
- Fiesta Events (Wii games, rodeo bulls etc)
Neighbourhood Budget
- Dance Mats
- The Sunday Project - dance element
- Jayenell Gymnastics Club - provision of new flooring for gymnasts
Small Grants Fund - various grants provided to groups, e.g. scuba diving, walking,
fishing.
Teesdale Area Action Partnership
For Teesdale Action Partnership:
2009/10 Area Budget:
• Redevelopment of Eggleston Recreation Area Phase1
• Over 50's Healthy Living Project (Tailor-made Healthy eating courses for older people)
• Teesdale Older People Support (TOPS) Small Grants Scheme - has supported groups
with grants to improve health and well-being
In 2009/10 the County Cllrs supported a number of projects that are health and sport
related (can get them if they are needed).
2010/11 Area Budget:
• TOPS Continuation
• Children & Young People Small Grants Fund - will no doubt have health/physical activity
and well-being links once established
• Hub Cycle Link
• Sustainable Sports Project in Evenwood and Cockfield
2010/11 County Cllrs Neighbourhood Budget:
• Barnard Castle Rugby Union Football Club - supported the Club with their plans to re-site
the Rugby Club (very early days)
• Barnard Castle Bowling Club
Again in 2010/11 the County Cllrs have supported a number of projects that are health
and sport related (can get them if they are needed).
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Spennymoor Area Action Partnership
Projects 2009
Area Budgets
•
Dance Centre- The Area Budget contributed to the conversion of a room within
Spennymoor Leisure Centre into a Dance Studio, The new facility has the
necessary height, mirrors, flooring, and be suitable for a variety of activities that
involve physical movement. .
•
Fiesta- the main Fiesta took place in Spennymoor Leisure Centre in February
2010 and was attended by 326 young people. Activities during the night that
involved physical excursion included: Games Zone ( A variety of physical
activities) Circus Skills, Football Coaching, Dance Workshops, Boxing
Demonstration 1 hour free swim dedicated to young people.
•
Extended School Summer trips- A variety of trips throughout the summer of
2010, a feature of all the trips was that a level of walking was undertaken by all
participants, however individual trips such as ‘Forest Fun’ involved lots of
physical activity such as making shelters and woodland walks etc.
•
Detached Youth Work- This project involves a range of activities and young
people have taken part in kayaking, rock climbing and walking.
•
Young Peoples Publicity Project- This project promoted a variety of physical
activity such as swimming, baby gymnastics, Basketball, kayak training and
football.
•
Show Racism The Red Card- In the course of the Show Racism The Red Card
workshops children from primary school age were given football training and
took part in small sided football tournaments in their schools, in addition a ‘finals
event’ will take place at Spennymoor Town FC ground when a suitable date can
be arranged with the schools.
Neighbourhood Budgets
•
Boxing Academy- A local member contributed to training equipment for
Spennymoor Boxing Academy, which was designed to enhance cardio vascular
strength.
•
100 talents of Spennymoor- Contribution to a scheme that covers a range of
activities which included promoting sport dance and fitness activities
•
Croxdale Play Area- A contribution to the construction of a play area for the
residents of Croxdale
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Projects 2010
Area Budgets
•
Spennymoor International Boxing Tournament- An international Boxing
tournament between England and Denmark which is used to promote the
Boxing Academy and the sport in general
•
Detached Youth Workers- As in 2009 young people engaged in range of
activities that improve fitness and reduce obesity
•
Spennymoor Ice Rink- Spennymoor AAP provided support to allow for the
provision of a temporary Ice Rink in Spennymoor Leisure Centre for five days a
total of 2,228 residents used the ice rink with local schools visiting throughout
the week.
Neighbourhood Budgets
• Tudhoe detached Youth Work- A local member paid for specific work
undertaken at Tudhoe Community Centre, activities included dancing and
sports.
Additional
Spennymoor AAP have also worked with several other partners whose activities
have an impact on health issues such as
•
Spennymoor Town FC
•
South Durham Gymnastics
•
Spennymoor Chi Taekwondo
•
Tudhoe Cricket club
Weardale Area Action Partnership
Area Budget
Weardale Open Air Swimming Pool – improve facilities
Witton-le-Wear Community Centre – resurfacing of play area used for tennis, football,
basketball etc.
Westgate Play Area – Project in development
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Neighbourhood Budget
Wolsingham Junior Youth Club
Wolsingham Sports Hall Management System
Weardale Ski Club
Small Grants Fund
Wolsingham Second Rainbows – Purchase of a Nintendo Wii
Weardale Open Air Swimming Pool – Training of Lifeguards
Wolsingham School Activity Day – promoting Healthy living
Weardale Gymnastics Club – Purchase of Asymmetric Bars
Stanhope Town FC – refs expenses etc
Lions of Zululand Visit St Johns Chapel – Dance workshops
Wolsingham Football Academy – Transport to / from matches
Wolsingham School – Karting outing
Edmundbyers Village Hall – Table Tennis Table
Phoenix Badminton Club – venue hire, club kit and equipment
Bishop Auckland and Shildon Area Action Partnership
Alcohol Outreach Worker
The Bishop Auckland and Shildon AAP (BA & S AAP) Sub Group identified alcohol
misuse by young people as an issue and have created an innovative programme to
deal with this, funded from the BA & S AAP Area Budget. Match funding was provided
by the Safer Stronger Communities Link Fund. The project will target hot spot areas
identified from LMAP and PACT meetings. An outreach alcohol worker (as well as a
part time detached youth worker see ABC&CS0910-03) will be employed to engage
young people in these areas, and educate them about the risks of their behaviour.
Initial contact will be followed up with engagement and intervention activity. Workers
will link with community and police to target activity. The project will operate alongside
existing alcohol
services and bring “added value” to services commissioned through County Durham
DAAT and delivered from Community Treatment Centres.
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Carer Support Worker
The role of the Carer Intervention Worker is to identify and engage carers in the
preliminary stages of caring for a substance misuser living within the Bishop Auckland
and Shildon area. The worker will address problems identified by carers and working
with families in crisis. The worker will deliver education involving coping strategies,
drug/alcohol awareness, harm minimisation, peer support work and implementation of
boundaries. Education will enable carers to make informed choices, reapply family
structure and values. The worker will liaise with relevant professionals and encourage
community involvement, participation with support groups and build bridges. The long
term outcome will be the establishment of a Substance Misuse Carer Support Scheme
which will assist with crime reduction and reducing anti social behaviour.
Alcohol Outreach Worker - Young persons
The Bishop Auckland and Shildon AAP Sub Group has identified alcohol misuse
amongst young people as an issue and have created an innovative programme to deal
with this, funded from the Bishop Auckland and Shildon AAP Area Budget. The
intention is to identify hot spot areas and employ a part-time detached youth worker (as
well as an outreach alcohol worker see ABC&CS0910-01) to educate young people
about the risks of their behaviour. Workers will develop links with local community
groups and the police to target activity towards problem locations and people regularly
consuming alcohol. Initial contact will be followed up with engagement and intervention
activity. The project will operate alongside existing alcohol services and bring “added
value” to services commissioned through County Durham DAAT and delivered from
Community Treatment Centre’s.
Canoe/Kayak Club
The club will be independently managed by a committee of volunteers and will be
constituted in line with British Canoe Union (BCU) recommendations. Qualified, CRB
cleared coaches will deliver an exciting programme of water based activities, including
slalom and canoe polo. The project will move children and young people from school
based activities into a community club where they can continue to participate on a
sustainable basis. The project aims to establish a club for an initial membership of 20.
(This is based on current restrictions on the number of canoes allowed to access the
river Wear as advised by the Environment Agency).
The club will be open to all residents of the Shildon and Bishop Auckland area.
Family Contact Centre Project Coordinator
This is a contact centre for children of estranged parents, who are the subject of a
court order to allow access to the 'other' parent. It only takes referrals from the courts
or solicitors. It caters for parents who are often so antagonistic that they refuse to see
each other. This project therefore caters for a group whose needs could easily be
forgotten. There is always a waiting list, which at present runs at eight families. It has
been run by volunteers for the past ten years. Those volunteers are now in urgent need
of a
coordinator so that the project can continue.
Bishop Auckland Theatre Hooligans
To write, devise and perform a Christmas production to allow the young people taking
part to form bonds and learn new skills as well as understanding how a large show is
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put together. A cast of 120 young people aged 10 to 19 will perform a show mixing
comedy, dance, singing and music. The show will be produced by our older students
(16-17 year olds) and performed at the King James I Community Arts College Theatre,
Bishop Auckland. The project is aimed at the whole community, including ethnic
minority groups and people with disabilities. It will let children who would not normally
see a live show have this opportunity (2 free afternoon performances for 11local
primary schools, including a special needs school) and 4 ticketed evening
performances for friends, family and the general public to raise funds. The show is
recorded on DVD and these are used in the group to inform for future performances
and critique so that performers can improve and a permanent record of the show is
kept.
Breakfast Club
The project is a breakfast club which takes place in the community centre. The club
runs during school term from 7am until 8:45am where the children and young people
receive a healthy breakfast, engage in various activities under supervision and are then
transported to the local primary school. The community centre is in Eldon Lane which
is in the Dene Valley area near Bishop Auckland. The area suffers high levels of
deprivation, e.g. unemployment, benefit dependant, people lacking in qualifications and
basic skills. The money will help buy new play equipment and materials for this much
needed project.
Football equipment
To buy enough footballs and equipment for every child to participate. St Mary’s offers 2
training sessions per child per week (1 mid week and 1 Sat). League and Cup matches
are either played on a Saturday or Sunday .The training sessions give all of the
children somewhere to go and something to do as well as a focus and structure to their
week. The club works with both girls and boys to raise their aspirations. The Club is
committed via its management committee, volunteers and coaches to supporting and
nurturing children with a range of needs, from gifted and talented to children with
complex health issues. They support families of minority children, of children with
English as an additional language and of children who are in the looked after system
and families of children from disadvantaged backgrounds. The club volunteers and
parents provide transport for those without their own, strips and training kits are
provided so no child or family is excluded.
Badminton equipment
The funding will allow the Red Badminton Club to buy new equipment, train first aid
volunteers and facilitate aspiring badminton stars to reach county standards. Red
Badminton Club holds sessions in the school sports hall on Woodhouse Lane and aims
to get more young people between the ages of six and 17 into sport and physical
activity and give them the confidence to take part in tournaments with a view to
progressing to county level. The young people are involved in discussions about how
activities are structured. This involvement in decision making as well as the team
activities improves their social skills. Parents are encouraged to get involved as
volunteers.
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Pre-nursery/pre-school communication skills
The playgroup has been running for 28 years from Woodhouse Close Church. Two
sessions per week are offered. The funding will enable another session per week to be
offered and continue to run the service to capacity of 20 pre-school children aged from
26 months and over. The children come from various backgrounds from the
surrounding area with a large minority coming fromWoodhouse Close Estate. There is
no other provision in the ward targeting pre-nursery children in this way. The funding
will help provide organised activities which centre on developing social skills, language,
communication, sharing skills, and creative skills to ease the transition into the school
system.
Healthy Lifestyle Project
The project will provide clubs to help children want to pursue a healthy lifestyle by
encouraging healthy food cooking and more active lifestyles. Activities to engage
young people will include cooking, gymnastics, football, rugby, athletics, dancing,
swimming,
and other activities.
Young Peoples Activities
2 Projects. DJ course for 13-19 yr olds: instruction in correct use of equipment, DJ
techniques and information about setting up business.
Arts course: to produce piece of artwork facilitated by qualified artist. Both accredited
courses.
Respect Agenda
Initial funding from the Children’s Fund employed a member of staff from the antibullying service for two additional days per week to support children in schools in
Shildon by working with them to increase self respect. Student, staff and parent
feedback is extremely positive and the project has been a success. To have a lasting
impact the programme needs to be rolled out in the community, as the schools serve
some of the most deprived areas nationally and experience shows that adults and
children are slow to trust. The staff involved have already built up strong relationships
in the community. The AAP felt that funding should be provided to continue the good
practice set up in the schools and roll this out into the community. Without this, the
existing good practice established and recorded benefits for the community will end,
adding to the burden of services working with families in crisis.
Bollywood Dance
The project provided the opportunity for every child and young person in Shildon to
participate in celebrating and experiencing South Asian Arts by learning Bollywood
Dance during the February 2010 half term. The week consisted of workshop sessions
delivered by skilled facilitators, dance development and performance. The children also
learned about the history and origins ofdifferent kinds of Indian Dance. At the end of
the week the children performed a short programme for an audience.
Play Development Officer Funding
Top up funding for Play Development Officer who will
• Provide line management to part-time and sessional staff and volunteers involved
within a play team.
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•
•
•
•
Develop and support other groups and organisations involved in the delivery of after
schools, holiday play schemes, fun days and events, and the national play day.
Work in partnership with Sure Start, Local Schools, Churches, Positive activities for
young people and other relevant groups delivering play opportunities.
Provide a range of activities including, arts & crafts, sport, environmental projects,
intergenerational activities etc.
Continue providing activities to the travelling community on Green Lane.
Derwenthill Outdoor Education Centre Visit
This project will ensure that every child who wishes to can participate in a residential
weekend at the Derwenthill Outdoor Education Centre. The importance of this activity
is that it plays a critical part in preparing children for the transition to secondary school.
The outdoor activities build the children’s confidence, and enhance their social skills,
which has been proven to make an easier transition.
3 Towns Area Action Partnership
SLAM CATZ ™
Objective
Focusing on health inequalities reducing childhood obesity.
SLAM CATZ™ is a physical activity programme with an educational message attached to each
of the 5 sessions that are delivered to primary school children in years 5/6. The physical activity
sessions are delivered by way of dance mats and vue du boards, with the educational sessions
being delivered across of Meet the Team, Healthy Eating, Healthy Living, Physical Activity and
Emotional Wellbeing. Each child that takes part in the programme, which is delivered in
curriculum time, is issued with a booklet at each session. In the booklets are the messages
appropriate to the delivery subject, and on the next visit to the school the booklets are collected
and the diary information gathered in respect of physical activity so that the data can be analysed
to message the calorific burn of the participants as well as any increase in physical activity.
This information is then processed to provide the relevant monitoring information that may be
required. The programme will be delivered to all 12 primary schools within the three towns area.
Take care not risks
Similar to above using Slam Catz but with a focus also on Alcohol and Smoking delivered to
Pupils in Year 7 in the Two Comprehensive Schools
21st Century Tea Dance
Objective- Focusing on health inequalities, increase number of adults and children
engaged in physical activity.
Linked directly to SLAM CATZ™ with the specific aim to target health and well being as
'a whole family experience'. Specifically target the over 35 age group using the 'Adopt and
Adult' way. 3 sessions per week delivered in community venues for 48 weeks (144 sessions).
West Durham Youth and Community Resource
West Durham Youth and Community Resource has been offering opportunities for young
people and other members of the community for a number of years. They currently offer
Boxing sessions 3 times per week. Duke of Edinburgh awards, drop in session, embroidery
project, outreach work for Parkside School. They also offer an advice and guidance session
106
through their partner organisations (connexions). Through their ongoing work they offer
young people sexual health advice, healthy eating programme, fitness programme, basic drugs
and alcohol awareness sessions and sexually transmitted infection screening sessions.
Their area of benefit is primarily the communities of the three towns partnership. The AAP
priorities which their work covers are children and young people, healthy lifestyle, crime and
disorder, support for the voluntary sector. Their work has a direct impact on all 4 of the main
priorities. To continue to offer this high level of service to young people and members of the
community, in this increasingly difficult financial climate they need support with no ongoing
running costs.
Three Towns Trip Club
This Project was identified through consultation with over 400 Young People
The prime aim of the project is to establish a trips and visits club, targeting young people
11 - 18 year old, who live in the Three Towns Area Action Partnership area.
An extensive programme of trips and visits will be organised, particularly during the school
holiday periods initially and then after guaging demand extending into weekend periods.
The range and variety of trips and visits have been identified through extensive consultation
with young people. The programme of activities will be advertised extensively across the
Three Towns AAP area with particular emphasis on young people who do not get involved
in existing opprtunities and/or who are disadvantaged through living in remote or outlying places.
The trips and visits will be delivered in partnership with existing agencies (both statutory
and voluntary) working with young people.
What's happening leaflets
Objective-Increase awareness of opportunities for young people. Ensure that what is
already available to young people is clearly identified and publicised.
This project aims to produce fun and attractive leaflets which sign post to a range of events.
This will increase the take-up of activities to children, young people and their families and
showcase the activities and events that are on offer during the school holidays. The leaflet
is the underpinning work of the children and young people's activity planning group which is
a varied range of professionals and activity providers in the Willington and Crook areas who
meet to plan and co-ordinate activities and events during the school holidays. The group takes
on board feedback from children, young people, and their families when planning activities.
Friday Night Activity- Football
The project is a Friday night football session at Willington Parkside Muga. The project aims
to attract young people from within the Town of Willington itself and also transport young
people in from Crook and the surrounding areas. The overall aim of project is to provide
a diversionary activity for young people, ensuring that they are not hanging round the street
on a Friday night drinking alcohol and raising the fear of crime among residents in those towns.
This is a crime and anti social behaviour priority. The activity itself contributes to a number of
priorities - health - the people will be physically active and learn new positive activities. The
activity will also help develop young people in terms of team building developing skills and
building self confidence.
Friday Night Activity- Youth Club
The project is to continue the delivery of a youth club provision for young people from Willington
and surrounding areas. The club provides for young people aged 11 to 16 years old and provides
a range of activities. The club is based at the Spectrum Leisure Complex in Willington and is the
107
result of consultation with both young people and the local police beat team. The club is run on
a Friday night at the times designated when young people are most likely to be involved in
antisocial behaviour or even crime.
Area Budget 2010/11
Treks Gym
Renovation and extension of Tow Law Treks Gym to create a mini gym for young people aged
between 11yrs and 16yrs.
Durham Wildcatz BasketBall Programme
5x1 hour sessions into all 12 primary schools targeting health, communication skills, and team
building skills as well as individual skills. Regular competitions based at the spectrum Leisure
Centre. This project will run for 45 weeks and will link into other similar clubs that have that
have been established. The total cost of the project is £8690 with secured match funding of
£2915 with a request from the AAP of £4900
Neighbourhood Budget Projects 2009/10
Pea Hill Park
Improve access and facilities including a natural sheltered seating area to look over the beautiful
panoramic views, develop wildlife ponds, install benches and picnic tables, install natural and
creative play using boulders and wood features, new raised circular footpaths along with living
willow arches and a hide screened by willow to observe the wildlife in the new small ponds.
Burnhill Butterfly Conservation Project
The project will extend capacity through the construction of a timber outside classroom including
perimeter fencing and outdoor study benches for the use of schools and Community groups.
Children are involved in a range of activities that involve physical activity including, planting,
pond dipping, nature walks.
Woodland Walks and Cycle Trails
The project aims to provide the community with an area to walk, cycle and play. The site will
have new access paths in the woodland area, with a new cycle route for all ages to enjoy
including the installation of a bike skills trail and picnic area. This will hopefully encourage
the community to walk and cycle more, where this has not previously been an option and
take part in gentle exercise.
Adult Learning Classes
Providing opportunity for local people to engage in 3 courses, 2 accreditied Making Story
sacks and Creative activities with children. This links to the existing playgroup which operates
from the centre. The third a Tai Chi course again specifically requested by local people which
will link to Healthy lifestyles and wellbeing for those who participate.
West Durham Boxing Academy
The Grant as been used to purchase new equipment. The boxing club offers an activity for
young people including advice and activities around healthy lifestyle and wellbeing and is
accessible three nights per week, young people have gone on to become coaches, members
of the management team and take up volunteering opportunities and have completed or
a working towards accredited courses for coaching and the Duke of Edinburgh awards.
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Neighborhood Budgets 2010/11
Crewcial Kent Dance Project
Crewcial Kent Dance is to enable five young people, their dance instructor and an additional
worker to travel to Kent to take part in a dance competition called the ‘Kent Dance Challenge’.
The competition will provide a focus and challenge for the group to enjoy and achieve; to improve
their dance styles both individually and together and to work as a group to achieve recognition
through performance and competition.
Howden le Wear Community Centre
The centre purchased a new computer system to run the organisation - including software,
printer and etc. and a range of equipment including table tennis and excersise mats as mentioned
above.
Howden Allotment Association
The association are setting up a community garden for the benefit of the wider community
with a long term goal of running regular activities to schools, community groups.
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Report of the Northern AAP Area - Review into Health Inequalities
Chester le Street and District AAP
Stanley AAP
Derwent Valley AAP
Mid Durham AAP
Chester le Street and District Area Action Partnership
Overview – Chester-le-Street & District AAP is one of the few AAPs that have health
as a priority topic. However, the focus that the partnership has taken on health relates
more to mental health and wellbeing. The Board funded an ambitious project about
counseling linked to the recession and job losses locally. Given the focus of the
Scrutiny Review this information hasn’t been included at this stage. The area where we
have seen many good quality proposal develop through the AAP is through local
councilors working with partners on their Neighbourhood Budget allocation. The
summary includes;
Making a Healthier Lifestyle - Lumley
This project is being developed to enhance all areas into the village of Lumley and to
erect new seating facilities for the benefit of the local residents in particular, dog
walkers and walkers will be able to rest and relax and enjoy the views. The added
features will also enhance and regenerate the area making encouraging people to take
short walks. Additional support for this project comes from DCC Neighbourhood
Services.
Project cost - £8,101 funded through Cllr Willis’ Neighbourhood Budget
Making a Healthier Lifestyle – Riverside Park
This project addresses some of the priorities identified by the AAP young people and
town and village centre’s task group. It is aimed at benefiting all the local community,
visitors and tourist visiting the Riverside Park.
This project consists in the erection of an Open Air Fitness Gym. The fitness
equipment will consist of a series of fitness apparatus easy to use and placed in an
area of the park popular with joggers.
Two pieces of equipment already exists in the park for fitness work outs this is popular
with all ages. The new facilities will help to enhance what’s already there as well as
help to promote a healthy lifestyle and the use of the park.
Additional support for this project comes from DCC Neighbourhood Services.
Project cost £5,509
PlaySpace area fitness and well being
This project involves the development of a physical play area for young people at the
Riverside Park for people age 10 and over by using the PlaySpace incorporating this
facility into a trail. It’s envisaged this health and fitness trail will be great fun to local
visitors to the park and as an added attraction to visitors and tourist visiting the park
110
giving new meaning to a healthy lifestyle. Additional support from this project comes
from DCC Leisure Services.
Project costs £13,004
Everyone’s Park Area
A project designed to enhance the Riverside Park area and to promote play and
exercise with extra equipment for children ages from 1 to 10yrs in the play area. Also
more picnic and seating facilities to promote outdoor open air activities walks and
children games.
An extensive consultation took place in the park and surrounding area with young
people including members of Chester le Street Youth Club and members of the Youth
Forum. Intelligence gathered from these sources was fundamental in ensuring the
project’s success.
The collected information gave us a balance of need requirement in the park to provide
a well equipped play area, for a healthier life style and well being.
This project addresses the young people’s group priorities for enhancement of the play
provision in Chester le Street Park.
Project Cost £49,592 - £25,000 from Cllr B Bainbridge’s £24,592 from DCC Leisure Services
Indoor Winter Training Project and 1 x Coaching Qualification Level 3
Fyndoune School
This project consists of an indoor winter programme for junior cricketers (U11, U13,
U15, U18) which will be held at Fyndoune School, Sacriston from 9th January until
14th April 2011.
The project is expected to attract up to 60 young people to each session.
The project will support the young cricketer’s boys and girls with a winter training
programme as well the necessary training to up grade to level 3 for one training coach.
This project addresses the Activities for Young People and the Health and Well Being
priority of the AAP.
Developed in association with Bourmoor Cricket Ground.
Project cost £2,215 funded from Councillor Alan Bell’s Neighbourhood Budget
Gymnasium Mats Project
The aim of this project is to support Great Lumley Community Centre with gymnasium
equipment – Gym Mats and Trolleys, to further support activities for children and adults
alike in the way of floor exercises these being gymnastics, tumbling, MMA (Mixed
Martial Arts) Yoga, Pilates, etc.
Evidence gathered shows a lack of exercise facilities within Great Lumley and
surrounding villages.
This equipment will also make better use of the Lumley Community Centre Sport Hall.
This project addresses the Activities for Young People Health and Well Being.
Developed in association with Lumley Community Centre.
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Project cost £3,031 funded from Councillor Alan Bell’s Neighbourhood Budget.
Stanley Area Action Partnership
Although Stanley AAP doesn't have Health and Wellbeing as a priority the Board
has supported some projects which could be considered health related here are some
project examples from last year:
Arts Activities for Young People – This project will be delivered by The Derwentside
Trust for Sports and the Arts. It aims to expand and build on a programme of youth
focussed arts events and activities identified by young people. These include alcohol
free live music nights, film nights and dance/drama events amongst others. These
events will recognise and celebrate the achievements and skills of young people in the
area, whilst reducing alcohol consumption and misuse by young people and
improving/expanding the provision of things to do and places to go for young people.
Funding from AAP Match funding
£19,450
£18,950
Kids United Junior Club – This project is based at Stanley Youth Centre, and
provides extra youth work and play for children aged between 8 and 11 and 11 to 13
years. Youngsters will have the opportunities to take part in sport, drama, arts and
crafts as well as just having the chance to play in a safe environment. The AAP is
funding this for three years.
Funding from AAP Match funding
£28,248
£4,680
Small Grants Fund – this fund is being administered by the Derwentside Community
and Voluntary
Service with the aim of ensuring the sustainability of small groups in existence within
the Stanley area and in
doing so maximise their potential and provision. The project will address all the AAP
priorities.
Funding from AAP
Match funding
£20,560
£29,354
I am awaiting the list of projects that have been supported using this money, some of
which may be health related and I will let the OS team have it as soon as it comes to
me from the CVS.
Derwent Valley Area action Partnership
School Garden and Allotment Project - Healthy Eating and Physical Exercise
This project is being developed by the Health Improvement Partnership and will enable
all schools in the Derwent Valley Partnership area to participate. The aim of the project
is to involve children in the growing of their own food and develop an understanding of
where food comes from and the importance of healthy eating. The school gardens,
once developed, will be an educational and lifestyle resource which the children will
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benefit from for many years. All school age pupils in the schools which participate will
be involved.
A Tale of Three Cities - Physical Exercise
The Derwent Valley Partnership has allocated funding to contribute to this project
which will take 50 boys (aged between 16-18) drawn from all the schools in the
Derwent Valley area to play rugby and witness the 'American Dream' and to investigate
the US University Programme that is available via the scholarship system. The trip will
take in the cities of Chicago, New York and Toronto lasting 10 days in total. A similar
party went in 2004 and all agreed that it was one of their best ever experiences. Two
boys subsequently gained a scholarship to US universities. As part of the project a
DVD will be developed and circulated to local schools which will highlight the benefits
of the sport as a way of keeping fit and healthy and the experiences of the young
people who have been on the trip which may encourage others to get involved.
Drug, Alcohol and Wellbeing Awareness Sessions - Health and General
Wellbeing
The project will be delivered by the Consett YMCA who will encourage participants
from local schools, youth clubs and other youth organisations to attend one or more of
the sessions. The sessions will educate young people from 10-19 years to make
informed decisions about their lifestyles and the dangers of drug and alcohol abuse.
An extensive resource library will be used in conjunction with the sessions to further
support the information provided. The project will focus primarily on anti-social
behaviour/crime but will also provide signposting opportunities for the young people.
Derwent Valley Sports Club Coaches - Physical Exercise
TheValley Partnership has contributed funding towards the Derwent Valley Sports Club
Coaches project. The aim of this project is to offer sports qualifications to young
people in the Derwent Valley area. In return for this the young people then provide
coaching at sports clubs throughout the area. The project will provide the opportunity
for 76 young people to access sports qualifications in activities including golf, tennis,
cricket, football, netball, swimming, rugby, gymnastics, trampolining and squash. For
every £10 of funding provided, the Club Coaches will provide one free hour of
volunteering in the local area.
Mid Durham Area Action Partnership
Sportstart - this is a 3 year funded project designed to get young people involved in
sport and recreational activity. Headed up by DCC Leisure and Leisureworks the
project entails working closely with existing youth groups and the final year of primary
school to introduce young people to different sports and sports that are available within
the area - links to existing sports clubs.
Project Costs - £39,750 - AAP Funding 22,500 (over 3 years)
3 Railway Paths Master Plan - The AAP have commissioned via the DCC
Countryside team a consultant firm to look at developing a master plan for the 3 rail
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paths that cut through the mid Durham patch. The aim of the plan is to look at getting
more people using the paths (walking, running, cycling and horse riding); increase
community pride and ownership of the rail paths next to their relevant villages and to
develop focal points for each village along the paths that have been designed and will
be looked after by the local community.
Project Costs - £21,000 - AAP Funding £15,000
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East Durham (Easington) AAP
Physical Activity Projects.
Project
Description
Peterlee Skate Park
This facility has been developed to
encourage social, leisure and
recreational provision for the local
community of Peterlee and the
surrounding villages. The project will
provide a platform that will benefit
peoples health and wellbeing.
South Hetton Cricket
Club
The aim of the project is to provide an
activity that caters for young people of
South Hetton, aged under 13 years.
The project is designed to introduce
young people to an activity that
encourages team sport and will
increase there long term health and
well being.
Robin Todd Centre
Sports Hall Flooring
Finance for this project will be used to
resurface the sports hall flooring which
will provide a facility that offers
opportunities for the local community
to participate in a wide range of
activities that will that will encourage a
healthy lifestyle.
Activities that are programmed in the
sports hall include Curling, Badminton,
Keep Fit Classes.
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Seaham Skate Park
The aim of this facility is to encourage
social, leisure and recreational
provision for the local community of
Seaham and the surrounding villages
that will provide a platform and allow
people to live a healthy lifestyle.
Blackhall Community
Centre Manager
Funding for this project will contribute
to the cost of the Centre Manager at
Blackhall Community Centre, who is
crucial to the centres long term
developments and sustainability. The
Centre Manager has been successful
in attracting funding to develop new
projects and allow expansion of
existing
programmes.
These
programmes offer a wide range of
opportunities for local people to
participate in a wide range of social,
recreational and sporting activities that
would normally not be available to
them at an affordable cost.
Future projects being developed at the
centre are: Youth Football Team,
Residential/Outward Bound course for
the hard to reach youths (NEETS),
Breakfast and Afternoon Clubs and
Family Socialising Evenings.
Getting Ready For work This scheme is to address the
concerns of the employer that many
young people entering the work place
are unable to cope with the levels of
fitness and stamina required to fulfill a
full days work. Through this project
young people aged 16-19 years will
increase their level of fitness and give
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them the opportunity to acquire the
necessary work based skills and
understanding making them more
attractive to an employer .
Blackhall Welfare park
Changing Rooms
Financial support to this project was to
provide changing facilities within the
grounds of the Welfare Park. The aim
of these new facilities was to provide
the opportunity for the local community
to participate in a range of outdoor
sporting activities.
Wheatley Hill Angling
Club
Support has been given to this project
which plays an active part of
encouraging the local community of all
ages to participate in this outdoor
facility.
The project not only offers angling
facilities but also opens it’s self up to
the local community as a beauty spot
with local walkways on hand.
Shotton Community
Centre Manager
Like the Blackhall Centre Manager
project. Financial support will allow the
centre manager to develop a
programme that will include sporting,
fitness activities that will be available
to the local community.
Funding for this project will be used to
employ a Social Regeneration Officer
to operate within the boundaries of
Murton. The Officer will develop and
deliver a range of activities that will
benefit identified individuals / groups
within the community e.g. elderly. The
Officer will work within Murton Village
and encourage the community to
collectively bring about social change
and improve quality of life.
Community Social
Regeneration Officer
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Peterlee dance Floor
Protectiion.
Funding for this project will be used to
purchase protective covering to the
floor at Peterlee Leisure Centre which
hosts a number of dance nights that
are available to young people living in
the East Durham area. The success of
the dance nights has seen substantial
damage to the surface of the leisure
Centre floor. New flooring has now
been laid and activities such as dance,
five a side football are once again
available to the community.
Shotton Play Artea.
Funding for this project was used to
purchase play equipment for the local
play area. The purpose of this area is
to encourage young people to engage
in exercise through play at an early
age.
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Durham County Council – Altogether Better equality impact
assessment form
NB: Equality impact assessment is a legal requirement for all
strategies plans, functions, policies, procedures and services. We
are also legally required to publish our assessments.
You can find help and prompts on completing the assessment in the
guidance from page 7 onwards.
Section one: Description and initial screening
Section overview: this section provides an audit trail.
Service/team or section: Overview and Scrutiny, Assistant Chief Executive’s Office
Lead Officer: Overview and
Start date: May 2011
Scrutiny Manager
Subject of the Impact Assessment: (please also include a brief description
of the aims, outcomes, operational issues as appropriate)
Health Inequalities in County Durham – Scrutiny Review of Physical Activity
The remit for the review was to:
• assess the scale of the inactivity and its impact on health inequalities.
• assess how local policies, strategies and plans are developed and delivered.
• determine the impact of the built and natural environment on physical activity
levels.
• consider the role of leadership – links to the 2012 Olympics, services and
commissioning, strengthening communities, organisational level activity,
measuring wellbeing outcomes.
• understand the effectiveness of interventions, their sustainability and return on
investment.
• understand the life course approach to the promotion of physical activity.
• review best practice internationally, nationally, regionally and locally with a focus
on return of investment.
Evidence was gathered via a working group in the form of presentations from Council
Officers and partners, NICE public health guidance, literature reviews, site visits, local
policies / plans, joint strategic needs assessment and best practice.
Findings are supported by policies, plans, strategies, NICE public health guidance,
national surveys, presentations and site visits.
119
Recommendation 1
should include the Marmot Review six policy objectives) informs the Council’s
contribution to planning and delivery of a public health agenda within the
context of proposals contained in the Health and Social Care Bill (and Act as
appropriate).
The Marmot Review proposes the most effective evidence-based strategies for
reducing health inequalities in England. The key messages from the review are that
action taken to reduce health inequalities will have economic benefits in reducing
losses from illness associated with health inequalities and that reducing health
inequalities will require action on six policy objectives. They are: give every child the
best start in life, enable all children young people and adults to maximise their
capabilities and have control over their lives, create fair employment and good work for
all, ensure healthy standard of living for all, create and develop healthy and sustainable
places and communities and strengthen the role and impact of ill health prevention.
Recommendation 2
That Cabinet requests the Director of Public Health, on behalf of the Council and
the NHS, to commission an evaluative framework to assess the impact of
physical activity programmes and other lifestyle interventions, as appropriate
and to explore through existing partner arrangements, further opportunities to
pool budgets to jointly commission physical activity programmes that work,
based on evaluation results.
It is important that all preventative interventions to promote physical activity are
effective. What is required is an evaluative model that can easily and simply support
organisations to determine the impact of the programmes that they deliver so that
investment is more targeted, delivers value for money (return on investment) and
demonstrates outcomes in the short and long term.
There are a number of lifestyle interventions aimed at targeting and engaging people
through creative and innovative ways. The range of interventions focus on health
conditions e.g. cardiovascular disease, geographical area e.g. areas of deprivation and
life course. To ensure that delivery is better planned and co-ordinated, all partners
involved in ‘health improvement’ planning need to look to pool their resources so that
they may jointly commission physical activity programmes, based on what works best.
Recommendation 3a
That Cabinet requests the Director of Public Health, in conjunction with the
Council and the NHS , to bring forward proposals on interventions that support
Barriers to participation need to be considered when planning activity. Most
importantly levels of participation relate to areas of deprivation which directly relate to
120
health opportunities and heath inequalities. The Sport England Survey (4) provides
good information to assist planners and provides relevant benchmarking information to
monitor trends and improvements. Analysis of children’s participation is however
lacking (up to16).
Tools exist for example, market segment information that can be used to develop
initiatives to meet customer needs, target investments efficiently and effectively market
sport to attract more customers. However these tools focus more on sport than
physical activity. Opportunities to use social marketing techniques to influence human
behaviour should be explored.
The House of Lords Science and Technology Select Committee’s report (when
completed) should provide an evidence base with associated case study material that
will be worth considering to assist the Council and its partners with approaches/
interventions which support behaviour change.
Investment in people’s participation, for example in volunteering may well increase
levels of participation. Anecdotal evidence suggests that volunteering and/or buddy
schemes motivate and help people to be more active.
Recommendation 3b
That Cabinet ensures that such approaches are cascaded to all partners and
partnerships, namely all physical activity providers and commissioners; the
Council’s Area Action Partnerships (irrespective of whether they have or don’t
have health priorities), the NHS Health Networks and the Health and Wellbeing
Partnership/Board.
The impact of interventions to support behaviour change will be greater if they are
rolled out to all providers and commissioners.
Recommendation 4
recommendations should be undertaken 6 months after it has been considered
by Cabinet.
Who are the main stakeholders: General public / Employees / Elected
Members / Partners/ Specific audiences/Other (please specify) –
The main stakeholders are Elected Members, Employees/ Partners including NHS
County Durham and Darlington, Groundwork Northeast, County Durham Sport ,
Newcastle University, Centre for Public Scrutiny, General Public
`Is a copy of the subject attached? Yes
If not, where could it be viewed?
Initial screening
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Prompts to help you:
Who is affected by it? Who is intended to benefit and how? Could there be a different
impact or outcome for some groups? Is it likely to affect relations between different
communities or groups, for example if it is thought to favour one particular group or
deny opportunities for others? Is there any specific targeted action to promote
equality?
Is there an actual/potential negative or positive impact on specific
groups within these headings?
Indicate :Y = Yes, N = No, ?=Unsure
Gend Y Disabilit Y Ag Y Race/ethnici Y Religio Y Sexual
Y
er
y
e
ty
n or
orientatio
belief
n
How will this support our commitment to promote equality and meet
our legal responsibilities?
Reminder of our legal duties:
o Eliminating unlawful discrimination & harassment
o Promoting equality of opportunity
o Promoting good relations between people from different groups
o Promoting positive attitudes towards disabled people and taking account of
someone’s disability, even where that involves treating them more favourably
than other people
o Involving people, particularly disabled people, in public life and decision making
The recommendations fully support our commitment to equality through a number of
lifestyle interventions aimed at targeting and engaging people through innovative and
creative ways in order to widen participation in physical activities and promote health
and wellbeing for all.
What evidence do you have to support your findings?
County Durham is amongst the most deprived unitary authorities nationally, particularly
in relation to health and employment. Rates
of obesity are rising in both children and adults and are higher in County Durham than
the national average, with areas such as the
former districts of Easington, Sedgefield and Wear Valley being significantly higher.
Death from circulatory diseases, heart
diseases, stroke and cancers occur across the county at a younger age, than the
national average. County Durham has some of
the lowest sport and physical activity participation levels in the country, which is
reflected in the wide range of health inequalities
experienced within the population.
Changing inactive lifestyles presents a tremendous challenge for the Government,
workplaces, parents and families. For most people the easiest and most acceptable
122
forms of physical activity are those that can be incorporated into everyday life.
Examples include walking or cycling instead of travelling by car and taking up active
leisure pursuits and hobbies such as gardening or sporting activities. There is also
growing recognition that physical environments that support and encourage physical
activity can help improve the public’s health. Local authorities, through their planning
powers, management of traffic, parks and open spaces, leisure and cultural services
can contribute to the quality of the built and natural environment and thereby improve
health and wellbeing.
The Council’s Health Inequalities in County Durham Task and Finish Review Group
has undertaken a review of physical activity, focusing particularly on the impact of the
built and natural environment on physical activity levels and the effectiveness and
value for money considerations in the delivery of physical activity to improve health and
reduce health inequalities. The report concludes with a number of recommendations.
They include ensuring that the Government’s Public Health Strategy informs the
Council’s contribution to planning and delivery of a public health agenda,
commissioning an evaluative framework to assess the impact of physical activity
programmes, bringing forward proposals on interventions that support behaviour
change and rolling them out to all partners and partnerships, namely all physical
activity providers and commissioners; the Council’s Area Action Partnerships
(irrespective of whether they have or don’t have health priorities), the NHS Health
Networks and the Health and Wellbeing Partnership/Board.
Decision: Proceed to full impact assessment – Yes
Date:
June 2011
If you have answered ‘No’ you need to pass the completed form for
approval & sign off.
Section two: Identifying impacts and evidence- Equality and Diversity
Section overview: this section identifies whether there are any
impacts on equality/diversity/cohesion, what evidence is available to
support the conclusion and what further action is needed.
Identify the impact: Explain your
What further
does this increase conclusion, including action is
differences or does relevant evidence
required?
it aim to reduce
and consultation you (Include in
gaps for particular
have considered.
Sect. 3
groups?
action plan)
Coul d be mor e c ost effecti ve
Gender
Recommendations will
lead to increase in
levels of participation.
Male participation in
County Durham has
increased, however
female participation has
decreased.
Weight management,
social interaction and
enjoyment are common
Equality
measures
considered as
part of the
development of
the evaluative
framework
assessing
impact of
123
reasons for participation
in sport and physical
activity. However,
barriers for participation
include lack of
awareness, time, low
aspirations, transport,
cost, suitability, lack of
role models, and in
particular for women,
lack of childcare.
Age
Recommendations will County Durham has an
lead to increase in
ageing population. By
2026, the numbers of
people aged 65 and
over will increase by
More activities for a
almost 50 percent,
broader age range
from early years to
whilst those aged over
65+
85 will increase by over
115 percent.
physical
activity
programmes
As above
The health profile for
County Durham 2010
identifies that many of
its health indicators are
significantly worse than
the England average.
These include: obese
adults, early deaths:
heart disease and
stroke, early deaths:
cancer, deaths from
smoking, adults who
smoke, hip fractures in
over 65’s, binge drinking
adults, hospital stays for
alcohol related harm
and mental illness.
Life expectancy for men
living in the most
deprived areas of the
County is over 6 years
lower than for men living
in the least deprived
areas. For women it is
nearly 5 years lower
124
(Health Profile 2010).
The distribution of
premature death across
County Durham is
unequal. It is greater in
the more deprived
wards.
Disability
lead to increase in
levels of participation
and may prevent or
delay certain
disabilities.
Close partnership
working with the NHS
will ensure targeted
activities for the
disabled.
Race/Ethnicity
Religion or
belief
Sexual
orientation
lead to increase in
Social marketing will
promote inclusivity.
lead to increase in
lead to increase in
Weight management,
social interaction and
enjoyment are common
reasons for participation
in sport and physical
activity. Barriers to
participation include
time for adults with work
and caring
responsibilities, and
often cost and transport
for children and young
people.
County Durham has a
higher percentage of
permanently sick and
disabled people than the
North East average,
representing a quarter of
the working age
population.
Barriers for participation
for people with
disabilities include
access and lack of
transport.
As above
Needs of
disabled
people needs
to be taken into
account when
developing
lifestyle
interventions
that support
behaviour
change
As above
As above
As above
125
How will this promote positive relationships between different communities?
Physical activity has a significant role to play in contributing to the health and wellbeing
being of individuals and ultimately communities. The recommendations of this report
aim to help to increase physical activity, reduce health inequalities and improve quality
of life. Action taken to reduce health inequalities will have economic benefits within
communities in reducing losses from illness associated with health inequalities. Action
to widen participation in physical activity, particularly targeted and tailored activity will
benefit communities of interest e.g. younger and older people, LGBT community,
gender specific activity etc.
One of the most important ways of encouraging more active travel such as walking and
cycling is to get the built environment right at the outset. Engagement between the
council and developers at an early stage will ensure the integration of walking and
cycling routes into the design of new developments.
Section three: Review and Conclusion
Summary: please provide a brief overview, including impact, changes, improvements
and any gaps in evidence.
For most people the easiest and most acceptable forms of physical activity are those
that can be incorporated into everyday life. However the needs of disabled people
should to be taken into account when developing lifestyle interventions that support
behaviour change.
It is important that all preventative interventions to promote physical activity are
effective. In terms of commissioning an evaluative framework to assess the impact of
programmes and lifestyle interventions equality measures need to be built in as part of
the evaluation process. A separate equality impact assessment should be carried out
as part of the development of such a framework.
Evidence suggests social marketing can be a powerful tool for achieving tangible and
measurable impact on behaviours. A separate equality impact assessment needs to
be carried out on the use of social marketing.
Action to be taken
Officer
responsible
Systematic review of all
recommendations
October 2011
Overview and
Scrutiny Officer
Equality measures considered
as part of the development of
the evaluative framework
assessing impact of physical
activity programmes
Director of Public
Health
Target
In which plan will
Date
this action appear
March 2012 Overview and
Scrutiny
Service
Improvement
Plan
To be
determined
Joint Strategic
Needs
Assessment/
Health
Improvement Plan
126
Needs of disabled people
should to be taken into account
when developing lifestyle
interventions that support
behaviour change
When will this assessment be
reviewed?
Are there any additional
assessments that need to be
undertaken in relation to this
assessment?
Lead officer: Feisal Jassat
Service equality representative:
All physical
activity providers
and
commissioners
To be
determined
Joint Strategic
Needs
Assessment/
Health
Improvement Plan
Date: March 2012 as part of the systematic review of
the report
Yes:
1) Evaluative framework assessing impact of physical
activity programmes; and
2) Use of social marketing
Overview and Scrutiny Manager
Date: 18.08.10
Date:
Please email your completed Impact Assessment to the Equality team [email protected].
127

Health inequalities review of physical activity

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