2 Public health need and practice

Children and young people's participation in physical activity is important for their healthy growth and development. It can reduce the risk of chronic conditions (for example, obesity) and improve their general health and wellbeing. Current guidelines recommend that children and young people should do a minimum of 60 minutes of at least moderate-intensity physical activity each day. At least twice a week, this should include activities to improve bone health (weight-bearing activities that produce high physical stresses on the bones, such as running and jumping), muscle strength and flexibility (DH 2004).

The best way to encourage children and young people to be physically active may differ according to their age, developmental stage, culture and gender. For example, improving their physical skills and general ability to participate may make physical activity more enjoyable. It may also help increase their activity levels throughout childhood and into adulthood.

Physical inactivity in England is estimated to cost £8.2 billion a year. This includes both the direct costs of treating major, lifestyle-related diseases and the indirect costs of sickness absence (DH 2004). A sedentary lifestyle is also estimated to cause 54,000 premature deaths a year (Department for Culture, Media and Sport 2002). These costs are predicted to rise.

Children and young people's activity

Objectively measured physical activity data collected in a regional study between 2003 and 2005 suggests that a large majority of children aged 11 are not active enough. Only 2.5% (boys 5.1%, girls 0.4%) did more than 60 minutes of moderate to vigorous physical activity daily (the internationally recognised minimum recommendation for children). They were most active in summer and least active in winter (Riddoch et al. 2007).

In the 'Health survey for England 2007' (The Information Centre 2008a), 63% of girls (compared with 72% of boys) reported being physically active for 60 minutes or more on 7 days a week. Once they reached 10, girls' activity declined with age. At 15, 47% of them achieved the recommended amount – compared to 66% of boys of the same age (The Information Centre 2008a).

The 2006 survey found a link between parent's and their children's activity levels, particularly among girls (The Information Centre 2008b).

Physical activity among those aged 2–15 varies according to a range of factors including gender, ethnicity and socioeconomic status (DH 2003; The Information Centre 2008a; 2008b). There was little difference between boys and girls from the main minority ethnic groups in England (Black Caribbean, Indian, Pakistani, Bangladeshi, Chinese and Irish) when it came to participation in sports and exercise, active play and walking. The largest ethnic differences were for sports and exercise, where Indian, Pakistani, Bangladeshi and Chinese children participated less in sports and exercise than children from the general population (DH 2003).

Overall, physical activity did not differ significantly according to household income (The Information Centre 2008a; 2008b). However, the number of those participating in sports and exercise on at least one day increased according to income level, especially among girls. The number who regularly undertook continuous walks of at least 5 minutes on five or more days a week, and the mean number of days spent walking in the preceding week, decreased as income levels increased (The Information Centre 2008b).

It is important to note that the health survey provided self-reported data (or parent-reported data for under 13s) as opposed to objectively measured activity (as in the regional study by Riddoch et al.). However, although the reported activity data in the survey are likely to be less accurate, its larger sample size and greater geographical range does give an idea of general trends.

The number of children walking to school has fallen significantly during the last decade. In 2006, 52% of children aged 5–10 and 41% of those aged 11–16 walked to school. Only 3% of children aged 5–16 cycled to school (Department for Transport 2008).

The 2007/08 'School sport survey' (Department for Children, Schools and Families 2008a) found that 90% of pupils surveyed participated in at least 2 hours of 'high quality' physical education (PE) and out-of-hours school sport in a typical week, compared with 62% in 2003/04. (Seventy eight percent of them participated in at least 120 minutes of curriculum PE – compared to just 34% in the first [2003/04] survey.)

National policy

Many national policies are relevant to children and young people's physical activity. Important initiatives and policies include the following.

  • 'The children's plan' (Department for Children, Schools and Families 2007b) aims to secure the health and wellbeing of children and young people, safeguard the young and vulnerable, increase educational attainment, increase participation and achievement and keep them on the path to success. It recognises that children and young people need to enjoy childhood as well as grow up prepared for adult life. It puts play at the heart of this ambition. 'The children's plan one year on: a progress report' (Department for Children, Schools and Families 2008a) sets out the progress made and the next steps required to achieve these goals.

  • 'Change4Life' aims to improve both children and young people's diets and physical activity and 'so reduce the threat to their future health and happiness' (DH 2008a). One of its objectives is to increase the time they participate in regular physical activities. There is a particular emphasis on parent/child activities and the need to avoid prolonged periods of inactivity or sedentary behaviour. It encompasses current health campaigns and healthy living initiatives. Initially its focus is families with children aged 0–11.

  • 'Healthy weight. Healthy lives. A cross-government strategy for England' (DH 2008b) supports the obesity public service agreement (PSA) target. It aims to bring together all sectors to promote healthy eating and to help children build physical activity into their daily lives.

  • 'Choosing activity: a physical activity action plan' (DH 2005). This cross-government plan aims to promote physical activity for all, in accordance with the Chief Medical Officer's report (DH 2004). It encourages physical activity in early years establishments, schools and further and higher education, and aims to extend the use of education facilities as a community resource for sport and physical activity (including out-of-hours), building community capacity for clubs, coaches and volunteers in community sport, and outdoor play. It is linked to a number of PSA targets, two of which are relevant:

    • PSA 12: Reducing the rate of increase in obesity among children under 11 as a first step towards a long-term national ambition, by 2020, to reduce the proportion of overweight and obese children to 2000 levels in the context of tackling obesity across the population (HM Treasury 2008a).

    • PSA 22: In addition to at least 2 hours per week of high quality PE and sport in school for all aged 5–16, all children and young people aged 5–19 will be offered opportunities to participate in a further 3 hours per week of sporting activities provided through schools, further education (FE) colleges, clubs and community providers (HM Treasury 2008b).

  • The government's updated plan for physical activity ('The physical activity plan', DH 2009) includes a number of cross-government initiatives. It sets out the cost of physical inactivity in terms of health and the wider impact on the economy. It also sets out how individuals, employers, local authorities, primary care trusts and the voluntary sector can work in partnership to improve physical activity among the population as a whole.

  • The 'Child health promotion programme' (DH 2008c) highlights the importance of improving the health and wellbeing of children, as part of an integrated approach to supporting children and families. 'Every child's future matters' (Sustainable Development Commission 2007) and 'Every child matters: change for children' (Department for Education and Skills 2004) focus on wellbeing from birth to 19. They aim to ensure children and young people are 'healthy, stay safe, enjoy and achieve, make a positive contribution and achieve economic wellbeing'.

  • A number of initiatives aim to ensure the health and wellbeing of children at school. These include:

    • The National Healthy Schools Programme (DH 2007)

    • 'Extended schools: building on experience' (Department for Children, Schools and Families 2007a)

    • 'PE and sport strategy for young people (PESSYP)' (Department for Children, Schools and Families 2008c)

    • 'Health challenge England' (DH 2006).

  • There is an increasing emphasis on the importance of play, with the introduction of a cross-government programme to promote play and work to develop a regional infrastructure and local services.

    • 'The play strategy' aims to create safe, welcoming, interesting, accessible and free places to play in every residential community. Children and young people will have a role in planning. It is backed by £235 million of dedicated investment (Department for Children, Schools and Families 2008d)

    • 'Time for play' (Department for Culture, Media and Sport 2006)

    • 'Getting serious about play' (Department for Culture, Media and Sport 2004).

  • A number of initiatives focus on increasing participation in sport and sporting success. These include:

    • 'Playing to win: a new era for sport' (Department for Culture Media and Sport 2008a)

    • 'Before, during and after: making the most of the London 2012 games' (Department for Culture Media and Sport 2008b)

    • 'Sport England strategy 2008–2011' (Sport England 2008).

  • 'Free swimming for the under 16s', a cross government initiative announced in July 2008. The government is making available £25 million per annum in 2009–10 and 2010–11 and £10 million in capital funding in 2008–09 to modernise pool provision (Burnham 2008).

  • National policies on active travel and children focus predominantly on school journeys. They aim to reduce car use and promote sustainable modes of travel. Each local education authority should have a sustainable modes of travel strategy to meet the school travel needs of their area (HM Government 2006). A joint Department for Children, Schools and Families and Department for Transport target is for all schools to have an approved school travel plan that addresses sustainability and pupil health and fitness by March 2010 (Department for Education and Skills 2006a).

    • 'Travelling to school initiative' (Department for Transport 2005a)

    • 'Sustainable schools for pupils, communities and the environment' (Department for Education and Skills 2006b).

  • The Department for Transport's home zone initiative aims to make streets more attractive to pedestrians and cyclists by introducing ways to reduce traffic speed (traffic calming measures), parking areas, benches and play areas (Department for Transport 2005b).

  • 'Building brighter futures: next steps for the children's workforce' (Department for Children, Schools and Families 2008e) sets out how the government is further improving the skills and capacity of people who work with children. The aim is to deliver the high-quality, personalised and integrated services detailed in the 'Children's plan' (Department for Children, Schools and Families 2007b).

Non-government initiatives

Non-government initiatives to encourage children and young people to be physically active are also common in England. Some of the organisations working in this area are listed below.

  • Play England, part of the National Children's Bureau, provides advice and support to promote good practice. It also works to ensure that policy makers, planners and the public recognise the importance of play. Resources include briefing papers, research reports and a 'Neighbourhood play toolkit CD ROM'. Play England has a contract with the Department for Children Schools and Families and Department for Culture Media and Sport to support the government's 'Play pathfinder' and 'Playbuilder' programmes.

  • Youth Sport Trust supports the nationwide network of school sports partnerships. It also works with under-represented groups through programmes such as Girls in Sport, Living for Sport, YoUR Activity, TOP Activity and the Playground to Podium framework for young disabled people.

  • The British Heart Foundation runs initiatives and provides physical activity resources. These include: the 'Healthy schools physical activity toolkit' which supports the National Healthy Schools Programme; 'Get moving, get active participation award', a foundation key stage 1 participation award, developed with the Youth Sport Trust; and 'Active club resource pack' for out of school clubs developed with 4children.

  • The Fitness Industry Association runs 'go' (an outreach programme) and the 'Adopt a School' programme. Both were developed to help build stronger links between the fitness industry and schools. 'go' aims to help teenage girls (aged 15 and 16) to understand the benefits of being active and show that it can be fun. 'Adopt a school' targets children aged 10 and 11 in the final year of primary school.

While the examples above are by no means exhaustive they demonstrate the current plethora of policies, initiatives and resources. However, many of them focus on sport and sporting opportunities; only a minority appear to promote lifetime physical activity or focus on lifestyle and unstructured activities (Cale and Harris 2006).

  • National Institute for Health and Care Excellence (NICE)