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| Current Issues | No.64 June 2013 |

Physical Activity in Public Health Policy – Evidence of a Paradigm Shift?
Margaret Talbot

During the last two decades or more, successive advocates for the benefits of physical activity, including former Presidents of ICSSPE, national and international researchers and leaders in the emerging science of relationships between health and physical activity, have attempted to secure the attention of policy makers. One of ICSSPE’s strategic priorities is “healthy living across the life span”. The intention has been to shift the major focus of public health policy, away from clinical treatment targets and the threats of communicable diseases, towards the evidence supporting the positive benefits for health of physical activity, especially for children and young people. The evidence base is substantial and there are clear recommendations on the amount, intensity and range of physical activity which will bring health benefits for people of different age ranges (WHO, 2010).

Despite the convincing evidence base, and the fact that many countries are struggling to cope with the health and other impacts of inactivity among their populations, it seems that the dominant paradigms of public health policy remain grounded in treatment of symptoms, rather than prevention of conditions which lead to those symptoms. This short paper outlines the challenges for scientists and policy communities, in attempting to change this situation.

According to Kuhn (1962), a “dominant paradigm” refers to the values, or system of thought, in a society that are most standard and widely held at a given time – a construct which is readily applicable to scientific approaches and applications. ICSSPE, as an umbrella organisation for scientific, professional and practitioner organisations and institutes, with a focus on sport and exercise science, has long produced resources, organised events and publicised research which highlight the positive benefits of physical activity for health. In the past, ICSSPE has sent representatives to conferences and events which have addressed the apparently chronic threats posed by non-communicable diseases (NCDs); these representatives have reported, many times, that organisers and participants from the public health and medical professions have queried the presence and participation of delegates wishing to discuss the role of physical activity. The dominant paradigm appeared to be grounded in medical treatment for conditions, with some acceptance that dietary control was necessary. Calorie input appeared to be accepted as a factor – but rarely, calorie output!

This lack of acceptance of the values of physical activity for public health seems to have been reflected in almost all decision-making and policy arenas, whether at international, national or local levels. However, recent developments seem to be indicating that this situation is changing; and that the case for physical activity and exercise is becoming much more recognised among a wider range of policy communities and professional/scientific organisations.

In July 2012, ICSSPE was invited to join Nike and the American College of Sport Medicine as a co-author of “Designed To Move” (DTM), a Report which provides a systematic review of the evidence for physical activity’s health benefits – and of the threat of escalating inactivity among populations across the world. The DTM Report includes compelling economic modelling and projections of the impact on selected countries’ economies and health systems, of failure to get populations more active:

Dominant paradigms are shaped both by cultural background and by the context of the historical moment; and since those in public health and over-arching policy had been so resistant to change and presentation of evidence, it seems timely that “Designed To Move” offers the opportunity to create more effective policy communities, possibly even a social movement, which can create more relevant policy solutions and concerted action. Various professional, sectoral and scientific organisations have committed to champion the twin messages of “Designed To Move” (DTM), ie:

The DTM partnership is currently developing strategies for work with policy- and decision-makers. In the meantime, since it is known that the following are conditions that perpetuate accepted dominant paradigms:

- Dynamic leaders introduce and promote the paradigm (“policy entrepreneurs”);
- Government agencies give credence to the paradigm;
- Educators propagate the paradigm’s ideas by teaching it to students;
- Conferences are devoted to discussing ideas central to the paradigm,

the challenge is for members of the DTM partnership to use their specific expertise, networks and skills to ensure paradigm change – that is, towards recognition of the need for coordinated policies which recognise the role of physical activity in health promotion, and which invest in effective, multi-agency action to engineer behaviour change.

There are other signs of proponents of the values of physical activity being welcomed into and included in policy-related discussions and strategies whose leadership has formerly been dominated by medical or public health professionals. “Excellence in Paediatrics” is to hold a Summit at its Conference in Qatar at the end of the year, on “PEARL” – Promote Energy Balance, Active and Real Living – and has invited ICSSPE and some of its members to participate and to produce learning resources for parents and paediatricians, on the values of physical activity.

In 2011-12, the European Food Framework, whose development was led by Nutritionists, was drafted with help and support from ICSSPE members, so that the Framework embraced both dietary input and energy output.

The work of Malcolm Gladwell has influenced thinkers in educational and sport strategy, for example, in the recognition of the power of date of birth in educational achievement and progress, and to success in competitive sport (Gladwell, 2001). His argument is that timing and context are all, when aiming to make a difference – the object of all policy work. He argues that what he calls a “tipping point” – “that one dramatic moment when everything can change all at once” (Gladwell, 2001, p9) is dependent upon the same three principles which underlie epidemics – contagion; little events and causes having big effects; and that important, even radical, changes happen suddenly, triggered sometimes by unknown events or conditions, usually in context.

Gladwell’s argument, along with the case for physical activity, seems very obvious. Yet advocates for physical activity to be included in health policy have not yet been able to put this across to politicians or civil servants in a way which is compelling and contagious. Gladwell would argue that it is in our power to manipulate the context – that is, to engineer suitable opportunities to demonstrate physical activity’s efficacy; and also, to fashion the message in a more compelling way.

Heinemann (2005) argues that the “four pillars” of the welfare state - organisational, state and market forces, as well as informal settings – need continuous and ever-shifting interaction. Physical activity’s historical alignment with exercise and sport, ironically might be one of the major reasons why it has not figured as it should in public health agendas and policies. Similarly, the health case for physical education (ICSSPE 1999, 2005, 2010) might be more compelling, were it to be framed as an integral elements in the development of physical literacy – what Margaret Whitehead (2007) calls “embodied health” – rather than as the servant of sport alone.

To achieve a “tipping point” for physical activity in policy terms, it is perhaps worth radical review of its traditional alignments and contexts – and this may have far-reaching implications for the development, too, of sport science and physical education.

References
Gladwell, Malcolm (2001) The Tipping Point – how little things can make a difference, Abacus.
Heinemann, Klaus (2005) Sport in the Welfare State – Situation and Challenges, in Ksiewicz, Jerzy (ed) Sport, Culture and Society Warsaw, Josef Pilsudski Academy of Physical Education, pp 335-344.
International Council of Sport Science and Physical Education (1999) Berlin Agenda for Physical Education, Berlin www.icsspe.org.
International Council of Sport Science and Physical Education (2005) Magglingen Commitment to Physical Education, Berlin www.icsspe.org.
International Council of Sport Science and Physical Education (2010) International Position Statement on Physical Education, Berlin.
Kuhn, Thomas (1962) The Structure of Scientific Revolution Chicago, University of Chicago Press.
Tremblay, Mark (2008) Automation, Mechnization, Digitization: How Our Changing World is Changing Us , Keynote presentation, Pace Yourself, Annual Conference of the Australian Council for Health, Physical Education and Recreation, Fremantle, Australia.
Whitehead, Margaret (2007) Physical Literacy: Philosophical Considerations in Relation to Developing a Sense of Self, Universality and Propositional Knowledge, Sport, Ethics and Philosophy, 1751-133X, Volume 1, Issue 3, 01 December 2007, Pages 281 – 298.
World Health Organisation (2010) Global Recommendations on Physical Activity for Health Geneva, WHO.

Contact
Prof. Margaret Talbot, PhD OBE FRSA
President ICSSPE
89 Leeds Road, Rawdon
Leeds LS 19 6NT
United Kingdom
Email: margaret.talbot@btconnect.com

http://www.icsspe.org/