Associate feature: Time to put physical activity higher up the agenda

COVID-19 has reshaped priorities and brought many things in focus, and nowhere more so than in health.

From the First Minister naming exercise as a key reason to leave the house during lockdown, to the reduction in traffic making walking and cycling safer, the impact of lockdown on mental health, to the growing evidence that being overweight is a risk factor for severe effects of COVID-19, there’s every reason for physical activity to be high on the public health agenda.

But while concerns about obesity have led to more focus on diet, physical activity has received far less attention, even though it has a clear role to play, both in maintaining a healthy weight and in other aspects of health, such as reducing the risk of heart disease, stroke, diabetes and cancer, decreasing stress and boosting mental health.

While physical activity features in one of the Scottish Government’s six public health priorities – “a Scotland where we eat well, have a healthy weight and are physically active” – and there is also an Active Scotland framework, underpinned by public health, setting out the government’s aims for Scotland to become more physically active, there is still more to do.

However, the benefits are clear, with research showing that physical activity also has a positive effect on the immune system and that those who meet the minimum levels of physical activity for health have a decreased risk of infectious disease or mortality as a consequence of infections.

Recent public health reforms which culminated in the setting up of a new national public health body, Public Health Scotland, provide an opportunity to renew the focus on physical activity and sportscotland is keen to see that happen.

“We followed the public health reform process really closely with a great deal of interest because we really felt there was an opportunity for physical activity to play a greater role in population health and public health in Scotland,” says sportscotland chief executive Stewart Harris.

“We do see this as a fantastic opportunity,” he adds. “I think there needs to be more visibility in public health policy right now about physical activity and its benefits to COVID recovery and beyond.

“Even in public health priority number six, which focuses on diet, healthy weight and physical activity, the bulk of the conversation and resource seems to remain on food.”

One of the real positives, Harris says, is that there is already an Active Scotland policy in place. T

hat brought together a range of agencies and sectors such as transport, the environment, health and education alongside sport to give more opportunity for people in communities across the country to be active, but Harris believes we can make more of it.

“Now is the time to put more emphasis and drive behind the Active Scotland framework,” he says. And it’s not just about sport, physical activity has many dimensions.

Harris explains: “Probably for too long sport has been seen as the outlet for people being physically active. There is physical education in schools, active travel options, active living and you can dance, play, walk, swim and cycle.”

sportscotland has a strong partner and advocate in SAMH (Scottish Association of Mental Health), who passionately believe in the positive benefits of physical activity on mental health.

Together they aim to strengthen the physical activity policy landscape as well as working hard   together on partnership activities.

So, Scotland needs a collaborative approach, with partners working across key sectors to collectively drive change that will enable delivery of the Active Scotland outcomes.

“The responsibility of creating an active nation shouldn’t just sit with sport,” says Harris. “Public Health Scotland is primely placed to provide national leadership for physical activity across sectors, acting as a central hub in a wheel, aligned to a range of spokes, coalescing with partners such as transport, education, sport, health, the environment and academia to create collaborative plans which are part of both national and local policy.

Obesity now causes more cases of cancer than smoking

“That in time gives us a better chance of being a more active nation, and therefore a more resilient nation in terms of population health, and begin to tackle some of these health problems, which are almost pandemics in themselves, such as inactivity, type two diabetes and obesity.”

He adds: “I don’t think there’s enough understanding of the benefits that being physically active can offer to the population.

“If Public Health Scotland were able to have that at the centre of their strategy, it’s then a lot easier for agencies like ourselves to connect with them on a health outcome as well as a participation outcome, as we would normally look for.”

Launched in March, Public Health Scotland has had the toughest of starts dealing with coronavirus, but in October it will publish its strategic plan setting out its future priorities.

Harris is disappointed that although physical activity is in part a national priority, it does not feature strongly in the draft Public Health Scotland strategy.

He explains: “We are very positive about the public health reform process, we’re very positive about Public Health Scotland becoming a leader, and we will work hard to support them, but when we look at the strategy now, which has just been consulted on, it could be much stronger than it currently is.”

However, Harris is clear this is not about creating new policy. The physical activity policy is already in place; it’s just about enacting it.

“I am drawing attention to the fact there is a strong policy framework in place,” Harris says. “And that that would be very useful in terms of the development and support of communities across the country if it was better enacted, both nationally and locally.

“There would just be a strong driver if that policy was the purpose behind both national and local activity.”

Having this at the centre of public health policy would mean that organisations like sportscotland, and others across education, health, environment and transport would be more accountable to ministers for their own actions to make people active, Harris says, but it would also increase collaboration.

“The part that’s probably missing is the collaboration, which I think would take it to another level.

“If there was clear collaboration between all of those agencies, that would be another strength. So we need to drive the policy. That’s not happening right now, but the opportunity is there.”

Public health and sport minister Joe FitzPatrick is “very receptive to the conversations I’ve been having with him” says Harris, and in September, he will convene a meeting of the Active Scotland Delivery Group to have a “fundamental conversation” about the place of physical activity in public health policy.

If it goes well, this could be a gamechanger in terms of driving this up the agenda.

Harris says: “For me, that’s what it takes. If that conversation is positive, we will make progress; if it isn’t, nothing will change.

“But … that’s what it needs, it just requires an honest, upfront, straightforward conversation from everyone around the table, including the departments inside government.”

For all this to be effective, Harris is adamant that a systems-based approach is what is needed. This means all the organisations involved being viewed as parts of one system, all working together to achieve the same purpose.

“A huge strength of the public health reform piece was that all of the conversation was about that systems-based approach, which we were loving because we believe that is the way that a national agency like Public Health Scotland could actually make itself more effective, by being the orchestrator of a whole host of other different players for the same end, which is a more healthy, more active nation.

“Our own strategy, Sport for Life, is based on a systems-based approach as well.

“Things are static just now, but we would have a chance at turning that around and being more progressive if we could get a greater driver in national policy and more organisations connected in and accountable for playing a part in that change,” he says.

Harris adds: “If we’re going to make communities more resilient, we need to do something different.

“And it needs to be upfront in my book, it needs to be supportive at the front end to try and help people be active … But as long as its place is weak within public health policy, and currently it is, then I don’t think we’re going to make enough progress in using the benefits of physical activity for the benefit of the population.”

There is a sense that if ever there was a time to do this, it is now.

As we come out of the biggest health crisis the country has experienced in a century and a new public health agency launches its priorities for the first time, the time is ripe for change and a shift in approach.

This article was sponsored by sportscotland