- by Professor John Ashton, President, UK Faculty of Public Health
Based on a speech given by Professor Ashton at the Active Lifestyle, Healthy Lives Conference organised by Open Forum Events Manchester, which took place on 8th October 2015 at the Manchester Conference Centre.
Regular exercise is an important part of a healthy lifestyle. People who engage in activity are more likely to live longer, healthier lives with reduced risk of developing serious life threatening conditions. And yet a recent report by the British Heart Foundation puts the UK lagging behind the rest of Europe. How can we wake up the nation to the dangers of inactivity and the benefits of exercise for health?
My good friend and mentor Professor Lowell Levin always points out that ‘the person who frames the question determines the range of solutions’. Nowhere is this more true than in the field of physical exercise. Are we talking about an active lifestyle and regular physical movement, sport and competition, physical Education and physical Culture, or ‘Muscular Christianity’? (1).
There is a recurring tension between a focus on whole population health and wellbeing, and a preoccupation with elite sport and excellence by the few. Government minister Michael Gove has spoken of ‘creating a sporting habit for life’ yet how many of us played competitive sport last weekend in contrast to those who went for a walk, rode a bike or did the garden? On occasions like this I am reminded of one iteration of the Sport for All theme in the late 1970s. Living in Hampshire at the time, as a family we were in the habit of taking the children to the swimming baths on a Sunday morning. On this particular Sunday we arrived at the sports centre to find ourselves excluded from participation by a ‘Sport for All’ demonstration by proficient swimmers! ‘Sport for All’ or ‘Sport for Some’?
With monotonous regularity we seem to oscillate between policies addressed at the many that fade when we are approaching the Commonwealth or Olympic Games, when the resources available magically disappear to be focused on the best prospects for gold medals and the nebulous hope of an ‘Olympic legacy’. And the confusion between competitive sport and a physically active citizenry goes on and on.
During the recent Conservative Party conference in Manchester, competitive sport played a prominent part in framing the political agenda with Boris Johnson celebrating the joys of the rugby scrum. Johnson appears to have said that “our lives are a gigantic collective effort, in which one person’s bulk (mentioning no names), makes up for another person’s slightness and where everyone is so tightly bound together that one person’s forward progress drives another person”.
Meanwhile, according to the Daily Mirror, rugby legend Lawrence Dallaglio told the Conservative Party that rugby “…can build (children’s) character and give them a chance to make something of their lives”. Whilst not doubting Dallaglio’s commitment and sincerity, he appears not to have read Allyson Pollock’s recent indictment of the price the nation’s children are paying by being forced to play the increasingly dangerous contact sport of rugby (2).
At a recent conference organised by the Epidemiology and Public Health section of the Royal Society of Medicine (3), an audience heard from speakers, many of whom were passionate rugby fans, of the crisis of concussion and injury facing a game increasingly characterised by very heavy, very fast players in life changing collisions, the association with brain damage and dementia and the increasing threat of major court action facing the viability of schools and sporting bodies.
The conference also heard that it doesn’t have to be like this and that many children, given the choice, will opt for participating in other activities that are fun and celebrate movement, friendship and the opportunity to show off a range of skills. As one speaker put it, ‘if they enjoy it they will come back’. If they did, we would be able to help them adopt a healthy lifestyle for life.
Perhaps the need for change is best summed up by a recent speech by Neil Rollings, who was a Director of Sport in HMC schools for 21 years, and is the chairman of the Professional Association of Directors of Sport at Independent Schools (4). He told the Headmasters’ and Headmistresses’ Conference that:
“More people of my generation learned to hate team games at school than learned to love them. But there was an acceptance that sport was as democratic as North Korea. Not everyone plays team games in society. Not everyone is compelled to play team games but there are a variety of alternatives, some of which are competitive and some of which aren’t.”
He continued: “British-style independent schools are the only sporting environment in the world where participation in team games is compulsory. For over 100 years, schools have hidden some shabby provision, especially for the less able, behind compulsion and an unsubstantiated view that pain and discomfort somehow ‘makes a man of you’ through a process unknown to science.”
Meanwhile, a letter in The Times from former England rugby player Jim Roberts (1960-64), provides perspective: ‘with the current laws and levels of injury I hate to think what the current players will be like when they are 50. I would not play today’.
In this context it is worth a look at the Department for Culture, Media and Sport consultation on A New Strategy for Sport. At first sight it seems promising with endorsement and contributions from no fewer than nine government ministers. But it is soon apparent which tail is wagging the dog – it is basically about competitive sport and another missed opportunity (5).
We have a problem: sedentary living combined with an ageing population mean we have a significant burden of avoidable physical and mental ill health where an active lifestyle would make a difference. Competitive sport may have a part to play but it is probably limited and it can have serious downsides. And the spectre of the ‘Nanny State’ places limits on the ability of government to intervene on behalf of the population. Although it now seems that both the Health Secretary, Jeremy Hunt, and former Health Secretary Andy Burnham are both on the same page in agreeing that when it comes to children, nannies are legitimate. So what is needed?
My view as a public health practitioner is that we need to return to our roots and reconnect a health and wellbeing life cycle approach to town and country planning. The cliche of making the healthy choices the easy choices applies here as to much else where behaviour impacts on individual and societal wellbeing. We need to re-engineer our cities, towns, villages and neighbourhoods to make active life easy and the norm.
Walking, cycling and being out and about, gardening and allotment holding, exploring the great British outdoors: these are as much part of the fabric of British life as rugby and hockey. But importantly they can be enjoyed well past the time when compulsory school sport is a faded memory. 21st century living requires us to address this challenge with the same vigour as our predecessors dealt with the slums and urban squalor. It requires vision, leadership and a practical prism to assess all policy and development from the perspective of active life. Other countries are leading the way. Let’s not be left behind (6).
(1) Wikipedia defines Muscular Christianity as ‘ ..a Christian life of brave and cheerful physical activity especially as popularly associated with the writings of Charles Kingsley and with boys public schools of the Victorian British Empire … a Christian commitment to piety and physical health basing itself on the new testament which sanctions the concepts of character and Wellbeing’.
(2) Tackling Rugby -what every parent should know about injuries, Allyson M Pollock, Verso, London 2015.
(3) Tackling school sports injury meeting, Monday 14 September 2015, RSM
(4) Parental pressure ‘threatens team games at school’, (£), The Times, 8 October 2015.
(6) Built environment and physical activity – a briefing statement ,Faculty of Public Health, 2013