|  | Feature: Healthy Living Move for Health | No.49 January 2007 |
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HEPA Europe’s Contributions to Healthy Living and Move for Health in the European Region Sonja Kahlmeier, Francesca Racioppi and Brian W. Martin |
Abstract Physical activity is a fundamental means of improving people’s physical and mental health and it is now clearly recognised as one of the leading risk factors for a number of non-communicable diseases and conditions. HEPA Europe, the European network for the promotion of health-enhancing physical activity, was founded in May 2005 to provide a platform for sharing developments and facilitating the dissemination and implementation of evidence-based policies and strategies. Its first projects include contributions to advocacy booklets on physical activity and health and on physical activity in urban environments, respectively; and the development of a web-based inventory of existing policy instruments which will be described in more detail in this article. HEPA Europe’s activities are aimed at contributing to the promotion of healthy lifestyles and conditions favourable to physical activity by making the main facts, good examples, tools for action and existing experiences more easily available. This is meant to act as an additional stimulus for countries to undertake policy developments in physical activity promotion and healthy living. Introduction Two thirds of the adult population in the European Union is estimated to be not active enough to meet health recommendations (Sjöström et al., 2006). Physical activity is a fundamental means of improving people’s physical and mental health. It is now clearly recognised as one of the leading risk factors for a number of non-communicable diseases and conditions, including cardiovascular ones, type II diabetes, breast and colon cancer, overweight and obesity. Every year, an estimated 600 000 people in the European Region die because they are not active enough, and more than 1 million die as a result of overweight and obesity (WHO, 2002). Physical activity also benefits society by increasing social interaction and community engagement. Emerging economic estimates of the costs of physical inactivity to health systems and society place these in the order of several hundreds of euros per citizen per year (for example Department for Culture, Media and Sport, 2002; Martin et al., 2001). The magnitude of the problem calls for the development of new approaches and partnerships. In particular, there is a growing interest in the potential contribution coming from large-scale, population based, long-term and multi-sectoral interventions which promote health-enhancing physical activity as part of daily life and not an optional extra to be added at the end of a busy day. This also emphasises the promotion of changes to the physical environment to make it more supportive of healthy life-styles. Several experiences are being developed in different European countries, both in terms of national policy developments and of interventions which involve different sectors, such as those of education, urban development, transport and the environment, sports and leisure, in addition to the health sector. In this situation, HEPA Europe, the European network for the promotion of health-enhancing physical activity, was founded in May 2005 to provide a platform for sharing these developments and facilitating the dissemination and implementation of evidence-based policies and strategies (Martin et al., 2005). HEPA Europe aims at strengthening and supporting efforts and actions that increase participation in physical activity and improving the conditions favourable to a healthy lifestyle. It focuses on population-based approaches for the promotion of health-enhancing physical activity, using the best-available scientific evidence. HEPA Europe is working closely with the WHO Regional Office for Europe. The direct use for the practice of physical activity promotion and intersectoral approaches are priorities of HEPA Europe. Its first projects include an advocacy booklet on physical activity and health addressed to policy makers from a broad range of sectors (Cavill et al., 2006b) as well as supporting the development of a complementary booklet by the WHO Europe Healthy Cities and urban governance program on physical activity in urban environments (Edwards et al., 2006); and the development of a web-based inventory of existing policy instruments which will be described in more detail in this article. More information about the activities of HEPA Europe can be found at www.euro.who.int/hepa and in its work program 2006/2007 (WHO Regional Office for Europe, 2006a). Advocacy on physical activity and active living for policy makers Physical activity and health in Europe: evidence for action While a wealth of scientific literature and books on physical activity exist, there was a lack international advocacy products specifically addressed at policy makers to raise their awareness of the magnitude of the problem as well as of opportunities to act through cross-sectoral collaboration. The booklet “Physical activity and health in Europe: evidence for action” (Cavill et al., 2006b) was written to fill this gap and to reach out to policy makers with strong advocacy messages. The booklet was developed in close collaboration with HEPA Europe and with contributions from leading experts on this topic. It provides policy-makers and stakeholders in different sectors with a new advocacy product, illustrating the links between physical activity and health, the factors that influence physical activity and the approaches that can make it part of daily life. This booklet sets out the facts about health-enhancing physical activity, provides examples of action already being taken, highlights the contributions that can be made by health and other sectors and makes the case for concerted action across the WHO European Region. In the 21st century, promoting physical activity should be seen as a necessity, not a luxury and action should be based on a number of key principles: taking a population health approach using a broad definition of physical activity engaging multiple sectors improving the environment for physical activity working at multiple levels basing programs on the stated needs of the population applying multi-faceted, comprehensive and effective approaches improving equity using the best available evidence being sustainable Promoting physical activity and active living in urban environments: the role of local governments: The solid facts This complementary booklet describes how the ways in which cities are organised, the urban environment designed and access to the natural environment provided can encourage or hinder active living (Edwards et al., 2006). It also speaks about barriers that exist in the social environments within which people work, learn, play and live. Those parts of the population experiencing poverty and social disadvantage are often the same who suffer the greatest negative health effects. Ensuring equity and comprehensiveness in efforts to promote physical activity and active living, taking into account the needs and contributions of all citizens, is therefore paramount. The booklet presents good examples of physical activity within the urban environment and makes suggestions for evidence-based policy and practice at the local level. While the first booklet has a broader target audience, this booklet is primarily written for local governments and other officials in local government in different sectors. The publication will also be of particular interest to cities that are part of the Healthy Cities movement in the European Region and beyond. Both publications were also developed as a contribution to the WHO European Ministerial Conference on Counteracting Obesity which took place in November 2006 in Turkey (http://www.euro.who.int/obesity/conference2006). They aim to help establish a common understanding and a healthy dialogue between the many actors that can help to promote active living. Across the European Region, physical activity can once more be seen as a valuable and enjoyable element of healthy daily life, as people travel to school and work, learn, enjoy their neighbourhoods, and rest and have fun in leisure time. International inventory of documents on physical activity promotion An increasing number of countries have embarked on the development of policies to promote physical activity (Cavill et al., 2006a). These experiences could be of great value to other countries which are considering undertaking similar policy approaches. However, until recently there has been no comprehensive overview of the work taking place in Europe in this area of public health policy. To help fill this gap, and to disseminate and facilitate access to these experiences, HEPA Europe is establishing an inventory of approaches, policy documents and targets related to physical activity promotion in different countries, worldwide (Kahlmeier et al., 2006). This inventory is meant to serve different purposes, including: to provide Member States with information about existing policies, strategies and approaches from different European countries with regard to physical activity promotion; to disseminate existing experiences; to facilitate access to information and knowledge not readily available; to provide a supportive information basis to develop, adapt, implement and evaluate policies, plans and interventions at the national and sub-national level; to identify geographical or topical areas where information and examples are lacking. The inventory is being developed in a stepwise approach, using a combination of different methods and sources. The first step focused on the identification of national policy documents on physical activity promotion. In October 2006, the inventory counted over 350 documents, of which 275 came from Member States of the WHO European Region (Table 1) and almost 100 from non-European Region countries or international institutions. Table 1 gives an overview of the documents for the WHO European Region countries which are mostly of national scope (n=211, 77%) and about physical activity and health promotion or physical activity and transport. Fewer documents were found on physical activity and sports or environment. The same was true for the local level where, however, the largest number of documents was on physical activity and transport. Table 1: Overview of results on the inventory on physical activity promotion documents for the WHO European Region countries, by type of document and main topic (as at October 2006) The 52 national policy documents identified to date came from 22 Member States of the WHO European Region. Of these, 19 countries had at least one national policy document focusing on physical activity and public health or health promotion, while in 5 countries a national policy document on physical activity and sport and in 8, a document on physical activity and transport was identified. The inventory is available online at http://data.euro.who.int/physicalactivity , with the option to search documents by country and sector. It is an "open-ended" instrument that will be expanded as more documents become available. Conclusions The public health importance of healthy lifestyles and conditions favourable to physical activity is only beginning to emerge. Existing international instruments can act as a supportive framework for policy development in this area, such as the Global Strategy on Diet and Physical Activity and Health (WHO, 2002) and the Charter on Counteracting Obesity (WHO Regional Office for Europe, 2006b), that recognises the role of physical activity beyond the benefits related to reducing overweight and obesity and endorses a vision of societies "where healthy choices are made more accessible and easy for individuals". HEPA Europe’s activities are aimed at contributing to tackle this challenge by making the main facts, good examples, tools for action, and existing experiences more easily available. This is meant to act as an additional stimulus for countries to undertake policy development in physical activity promotion and healthy living, and/or to revise existing policies to further enhance their effectiveness. References Brian W. Martin, Sonja Kahlmeier, Francesca Racioppi, Finn Berggren, Mari Miettinen, Jean-Michel Oppert, Harry Rutter, Radim Šlachta, Mireille van Poppel, Jozica Maucec Zakotnik, Dirk Meusel, Pekka Oja & Michael Sjöström (2005). Evidence-based physical activity promotion - HEPA Europe, the European Network for the Promotion of Health-Enhancing Physical Activity. J Public Health 14: 53–57. DOI 10.1007/s10389-006-0029-5. Cavill, N., Foster, C., Oja, P. & Martin, B.W. (2006a). An evidence-based approach to physical activity promotion and policy development in Europe: contrasting case studies. Promot Educ 2006;13(2):104-11. Cavill, N., Kahlmeier, S.& Racioppi, F. (editors) (2006b). Physical activity and health: evidence for action. Copenhagen, WHO Regional Office for Europe. (www.euro.who.int/InformationSources/Publications/Catalogue/20061115_2, accessed 8 November 2006) Department for Culture, Media and Sport (DCMS) and Strategy Unit (2002). Game plan: a strategy for delivering Government’s sport and physical activity objectives. London. Cabinet Office. Edwards, P. & Tsouros, A. (2006). Promoting physical activity and active living in urban environements: the role of local governments. The solid facts. Copenhagen, WHO Regional Office for Europe. (http://www.euro.who.int/InformationSources/Publications/Catalogue/20061115_1, accessed 8 November 2006). Kahlmeier, S., Daugbjerg, S., Rostami, C., Racioppi, F., Martin-Diener, E. & Martin, B.W. (2006). international inventory of documents on physical activity promotion. Report in progress – call for contributions. Copenhagen, WHO Regional Office for Europe. Martin, B.W. et al. (2001). Economic benefits of the health-enhancing effects of physical activity: first estimates for Switzerland. Scientific position statement of the Swiss Federal Office of Sports, Swiss Federal Office of Public Health, Swiss Council for Accident Prevention, Swiss National Accident Insurance Organisation (SUVA), Department of Medical Economics of the Institute of Social and Preventive Medicine and the University Hospital of Zurich and the Network HEPA Switzerland. Schweizerische Zeitschrift für Sportmedizin und Sporttraumatologie. 49(3):131–133. (http://www.bacc.info/webcat/consells/arxiu/study_economy.pdf, accessed 8 November 2006). Sjöström, M., Oja P., Hagströmer M., Smith B.J. & Bauman A. (2006). Health-enhancing physical activity across European Union countries: the Eurobarometer study. Journal of Public Health, 14(1):1–10. WHO Regional Office for Europe (2006a). HEPA EUROPE - European network for the promotion of health-enhancing physical activity: Work programme 2006 / 2007. Copenhagen (summary available at http://www.euro.who.int/document/HEPAN/HEPAN_workprogsum_2006_2007.pdf, accessed 8 November 2006) WHO Regional Office for Europe (2006b). European Charter on counteracting obesity. Copenhagen. (http://www.euro.who.int/Document/E89567.pdf, accessed 8 November 2006) World Health Organization (WHO) (2002): The world health report 2002 - Reducing Risks, Promoting Healthy Life. Geneva. (http://www.who.int/whr/2002/en/, accessed 8 November 2006). World Health Organization (WHO) (2004). Global strategy on diet, physical activity and health. Report by the Secretariat. (http://www.who.int/gb/ebwha/pdf_files/WHA57/A57_9-en.pdf , accessed 8 November 2006). Contact Sonja Kahlmeier WHO, European Centre for Environment and Health Rome, Italy ska@ecr.euro.who.int Francesca Racioppi WHO, European Centre for Environment and Health Rome, Italy frr@ecr.euro.who.int Brian W. Martin Physical Activity and Health Branch Swiss Federal Institute of Sports Magglingen Magglingen, Switzerland brian.martin@baspo.admin.ch http://www.icsspe.org/portal/index.php?w=1&z=5 HEPA Europe’s Contributions to Healthy Living and Move for Health in the European Region Sonja Kahlmeier, Francesca Racioppi and Brian W. Martin