Physical Inactivity (Public Health)

Baroness Keeley Excerpts

Tuesday 18th November 2014 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Weir. I congratulate my hon. Friend the Member for Blaenau Gwent (Nick Smith) on securing such an important debate. We need to promote physical activity to people across the UK. The issue is important to me as a constituency MP in an area that has very low levels of physical activity. I am co-chair of the all-party group on women’s sport and fitness, and I encourage hon. Members to support that group. Last year, I was co-chair of the all-party commission on physical activity.

As an MP in the north-west of England, I am concerned that ours is one of two regions in the north with the highest levels of inactivity in the UK. In our region, 32% of the population is classified as inactive, which represents an inactivity level 5% higher than in the south-east. Reports demonstrate that deprived areas have higher levels of inactivity than the least deprived areas; the hon. Member for North Swindon (Justin Tomlinson) has referred to some of the reasons for that. The sheer cost of undertaking physical activity and classes sometimes gets in the way. My constituency is in the top 40 local authorities with the highest inactivity rates, and 33% of people are inactive. We need action locally to tackle the problems.

There are stark differences in inactivity rates not only between regions, but between men and women. There is a worrying gap between the rates of men and women who undertake exercise. The most recent figures from Women in Sport, which was formerly the Women’s Sport and Fitness Foundation, show that only slightly more than 30% of women in England aged 16-plus take part in sport or fitness once a week, compared with more than 40% of men.

In Salford, the gap is even greater, with only 25% of women taking part in weekly exercise. Figures from Sport England demonstrate that more men take part in activity than women in every age group up to age 65. That is serious, because being physically inactive shortens a person’s life span by up to five years and is responsible for 17% of premature deaths in the UK. Indeed, if everyone in England were sufficiently active, an estimated 37,000 lives would be saved every year. We must take that seriously.

I find it interesting that inactivity is as dangerous to health as smoking. Because women are less active than men, women are subject to an increased risk of ill health and premature death. The reasons for the gender gap in inactivity rates are well established. Women and young girls either face, or feel that they face, many barriers when it comes to sports participation. Barriers exist at both grass-roots sport level and elite levels. In the all-party group on women’s sport, we work to identify those barriers and the actions needed to remove them.

The all-party group pressed the Culture, Media and Sport Committee to hold an inquiry into women in sport, which it did. The Committee’s report, which was released in July this year, contained some interesting recommendations and confirmed many of the reasons for the gender gap in activity. It is not that inactive women do not want to play sport or to be active; research from Women in Sport showed that 12 million women, more than half of whom are inactive, want to play more sport. Many of the sports that are most popular with women, such as running and swimming, are done informally—that is an interesting clue—so they are outside the formal funding structures for sport.

Women make up 62% of participants in swimming, 42% of participants in tennis and 41% of participants in athletics, particularly running. I will come on to talk about running informally, because it is an attractive sport to women who have family responsibilities or other commitments that prevent them from taking part in team sports. There is also a clue in the figures for team sports. Only 7% of participants in football, 8% of participants in rugby union and 9% of participants in cricket are women. We can see a real trend there; women are tending to do informal sports such as running and swimming.

Many girls are put off exercise and sport at a young age, and too many girls end up thinking that sport is simply not for them. Sports such as football can seem entirely male, judging from the media coverage that they receive. Women’s sport accounts for only 0.5% of all commercial investment and only 7% of the media coverage of sport, which makes it even more difficult to encourage girls and women to participate.

In terms of financial reward, it is surprising that male footballers are paid millions of pounds every year, but women’s teams are nearly always amateur or semi-professional. Members of our England women’s football team are on contracts under which they are paid £20,000 a year—not £20,000 a day or a week, but £20,000 a year—and the England women’s rugby squad were not put on paid contracts at all until after they had won the rugby world cup. Every time I mention that, I get comments on Twitter stating that that is because of a lack of interest in women playing sport. I understand that 55,000 tickets have been sold for the England-Germany women’s football match at Wembley this Sunday, so perhaps that tide is turning.

Women’s and girls’ negative perceptions of sport often stem from negative experiences of physical education and sport at school. That point is supported by the Culture, Media and Sport Committee report. A survey carried out by Women in Sport found that 51% of girls felt deterred from physical activity by their experiences of school sport and PE. Many girls describe their experience negatively, citing a lack of choice, an overly competitive environment, a lack of confidence in their own ability and concerns about body image. It is essential that we change young girls’ perceptions of sport if we want them to be active for life. We must, as my hon. Friend the Member for Blaenau Gwent said, create exercise classes and sporting activities that actually interest girls.

I look forward to the campaign being launched by Sport England, which aims to change our perception of girls and women doing sport. The campaign is called “This Girl Can”, and it will aim to see more women and girls exercising regularly or playing sport with less fear of judgment, more confidence and more enjoyment.

I will mention two very worthwhile initiatives of the sort that we see springing up now. “Fatty Must Run” is a social media advice and support initiative and Twitter account run by Julie Creffield, and it helps people who are overweight and starting to take exercise. Another great initiative is the “Couch to 5K” running group in Blackburn, where volunteers support free group running sessions to encourage inactive people to run regularly. As part of our thinking about how to increase activity levels, we must look at similar wonderful, often voluntary, initiatives and find ways to support them.

It is time to focus on the scale of the problems we face with inactivity and health. I have mentioned that we could save 37,000 lives a year if everyone in the UK were sufficiently active. Women in the UK have the 10th highest rate in the world of cancers linked to physical inactivity. In 2012, there were nearly 79,000 deaths across the country from bowel, breast and womb cancers, of which an estimated 12,000 could have been prevented if women were more physically active. In Salford, the CAN-Move project aims to ensure that physical activity is part of the pathway for patients with breast, bowel or prostate cancers, and it offers those patients a 12-week physical activity programme. Such projects should be available more widely, but the most important thing is to focus on encouraging people to be physically active earlier, not simply when they already have a cancer.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

First, I thank the hon. Member for Blaenau Gwent (Nick Smith) for securing this debate on such an important topic. It is one of my personal passions, particularly while I have been in this job. It is evident from the contributions of so many colleagues, who made so many thoughtful points, that many share my passion for this area. I do not pretend to think that I can respond to every specific point that was raised, because it has been a varied and wide-ranging debate, which demonstrates Parliament’s appetite to get stuck into this topic. I will return to the powerful role that MPs have in increasing levels of physical activity if I have time towards the end of my remarks.

Society has changed a great deal, and that sits behind everything we have been debating this morning—why we have become more sedentary—and other Members have laid that out. I will not spend too much of my speech going over the evidence base, because it has been well covered by the hon. Gentleman and other Members, but the evidence base is well established for the problems that the level of physical inactivity in our nation is causing. I was pleased to hear Members talk about not only physical conditions, but mental health. I think dementia was also mentioned. There is an important evidence base for the fact that becoming more physically active can benefit people in a great many ways. One of my personal passions is how physical activity can impact on social isolation and exclusion; I will try and touch on that later. I will not reiterate what other Members have said on the statistics on how inactive we have become as a nation, because they are all on the record; I would prefer to use my time—I am conscious of leaving a little bit of time for the hon. Gentleman to wind up—by telling the House what the Government are doing.

I will say a few words about obesity. It is a slightly complex area, as I was saying to the hon. Gentleman just before we came into the Chamber. We are clear that all the expert evidence suggests that while physical activity brings the important health benefits that we have been discussing—such things as stronger muscles and bones and improved cardiovascular health and metabolic health, as well as some of the psychological well-being aspects—tackling obesity is fundamentally about eating and drinking less. That is what will lead to significant weight loss. That is not to belittle the role of physical activity, but to emphasise its importance. Physical activity cannot just be seen through the narrow prism of its role in weight loss, because it is bigger and more important than that and goes to the heart of so many well-being and other social issues. I am keen that it is not cast only in the light of weight loss. We need to understand its role in tackling obesity, not least in encouraging active lifestyles in children from the very start and not building up problems for future generations, but it is a little more complex than that.

[Barbara Keeley]

Will the Minister acknowledge that it is important for overweight people and large people to take exercise, because they will be healthier, whatever size they are, if they do that? There is a danger in focusing just on weight loss, instead of exercise. If people take exercise, it is likely to lead to a healthier lifestyle and a desire to lose weight.

[Jane Ellison]

Absolutely. I could not agree more with the hon. Lady. It is exactly why we should not just link obesity and physical activity together. It is better for everyone to move. I will come on to some of the conditions that are helped by that, but she is right that whatever someone’s age, weight or state of health, moving more is always a better option.

Members have touched on this, but it was an important moment when we saw prevention put right at the heart of the NHS with the publication of the “NHS Five Year Forward View”. Public Health England collaborated closely with the NHS on the prevention chapter of that forward view, which states:

“The future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

It cannot be said more profoundly than that that this issue is important. The attention given to that aspect of the forward view was heartening to me as the public health Minister, because I had not heard the prevention agenda put quite so much at the heart of the health debate in our country and related to the sustainability of our great public services to that extent.

Members have talked about shifting the narrative. With the best will in the world, Governments can only do so much. We have to shift the population’s thinking from where we are now to where we need to be. A couple of Members touched on the role of some of the major charities. I have been having conversations with some of the major health charities about how they can harness the reach and reputation they enjoy among our population. For example, Macmillan Cancer Support is famous for its wonderful cancer care, but it is a bit less famous for the excellent work it does with the Ramblers on the evidence base on walking as a key element of physical activity. I have been talking to Macmillan and others, including some of the big cancer charities, about what more they can do to get people to understand more widely the role of physical activity in preventing diseases, because those charities have enormous reach into the population.

I pay tribute to Breakthrough Breast Cancer on its message, “Raise your pulse, reduce your risk”, which is a campaign that tells women that 30 minutes of daily physical activity can reduce the risk of breast cancer by at least 20%. Arthritis Research UK launched a piece around understanding arthritis, which addresses exactly the point that the hon. Member for Worsley and Eccles South (Barbara Keeley) made in her intervention. It is tackling the misguided belief that someone should rest if they have joint pain and is trying to put some of its weight, resource and reputation behind simple messages on standing, walking and being more active, even for people with some of those physical challenges.

We have dwelled a lot on physical inactivity among the young, and I will come on to some of the things that the Government are doing to help that, but the most inactive generation is the oldest generation. Only one in 10 men and one in 20 women over 75 are active enough to stay healthy. I am lucky enough to have both my parents still with me—one is 80 and the other is just under 80—and very much active and healthy. My father is still cycling 50 miles a week at 78. I look at their lifestyles and I see how much can be gained from staying active as people grow old. It helps them to remain independent for longer and tackles some of the thorny issues of social isolation. Active older people are unlikely to be lonely. We must be passionate about the activity agenda for older people, as well as the sensible focus on getting the young into good habits.

On the role of Government, experience from across the globe shows that getting everybody active every day will work only if everyone is involved, including all levels of government, so I want to discuss what we have been doing recently, because the level of activity is good. At a national level and following up on the Olympic legacy—I chair a cross-ministerial group on the physical aspect of the legacy—we started “Moving More, Living More” as a cross-Government policy to get more people active. It stresses that physical activity is everyone’s business. If it just sits in a health silo, we will fail again. I have had conversations with Lord Coe, who recognises that we have been around this circuit before. Physical activity cannot just be a health measure; it must be embedded across all levels of Government and local government.

Following on from that, we have taken a much more granular approach and have provided a proper toolkit. Just last month, Public Health England published the “Everybody Active, Every Day” framework. It was going to be published early next year, but I urged it to bring that forward to this autumn, so that it was available to local authorities when planning their 2015-16 spend. We have provided £8.2 billion for public health over three years, and it is important that we also provide the best evidence base for how to spend that money for local populations.

I want to describe how the scheme was produced, because it has been a wide-ranging collaborative effort. I hope that MPs all received their toolkit. It might still be lurking in the inbox—we all receive a lot of e-mails—but please look for it, because it was designed to give MPs a role in promoting the agenda. The campaign was co-produced with more than 1,000 cross-sector organisations and individuals at national and local level. It was begun at a workshop in January this year. Since then, we have had nine expert round tables attended by more than 200 experts. Five regional forums have been attended by some 750 individuals, including people from local authorities. The “Moving More, Living More” policy and the recommendations of the all-party commission on physical activity—I see one of its members here—fed into the process. We held sector-specific presentations and workshops, bilateral meetings with Government and nine expert rapid topic overviews.

Good and promising practice has been collated, and we have also commissioned work on what constitutes such practice, with more than 960 submissions for assessment. I have also commissioned a review of return on investment data, which is critical for local government. A public consultation was held on the draft documents, with 183 submissions raising 550 specific issues. The output from the exercise, which was launched at the Oval last month, includes a toolkit, as mentioned, for elected representatives—I worked with Public Health England on the MP toolkit and we are looking at one for locally elected members as well—and free British Medical Journal-sponsored e-learning modules. Regarding the review of promising practice in communities, we have commissioned the Centre for Sport and Exercise Science and ukactive’s research institute to consider and rate submissions. We have also done some detailed topic overviews, in particular looking at some in-depth guidance for addressing complex issues around deprivation and health inequalities, which will respond to one of the points raised by the hon. Member for Blaenau Gwent.

I have attended a high-level round table with local government leaders, who I must say are a great deal more optimistic than the shadow Minister about their ability to deliver on this agenda. The meeting was cross-party and extremely positive, and I have seen many of the things that they have been doing. This is a collaborative effort right across local and national Government to take us to the next level in terms of an evidence-based approach to physical activity. Like the right hon. Member for Rother Valley (Kevin Barron), who spoke about public health sitting well with local government, I absolutely think that it has landed in the right place. I have seen some fantastic examples of real leadership, but we need to give local government the tools to do the job. We do not want people endlessly reiterating the evidence base and endlessly trying to work out what works and carrying out their own evaluations when that can be done at a national level through the resources of Public Health England.

The four areas within “Everybody Active, Every Day” are “Active society”, “Moving professionals”, which is about ensuring that our professionals are geared up to make every contact count, “Active environments”, and “Moving at scale”, which is about the big interventions—as opposed to small, excellent micro-interventions—that will really make a difference to the population. The framework contains a lot more detail, and I urge Members to have a look at it, because it is what we are now engaging with local government leaders on. I was asked about the data that local authorities have at their disposal and the Active People survey provides them with areas to target.

In addition to all that, my Department has given £11.4 million to the Change4Life sports club programme, through which 13,500 clubs have been established to help our children to be more active. Those clubs have deliberately been set up in areas of high childhood obesity and significant deprivation. We are also investing £180 million over three years into the primary PE and sport premium to improve health outcomes for primary-age children. We have provided £30.5 million to fund the School games organisers, who are responsible for delivering the games and co-ordinating Change4Life sports clubs. Much work is ongoing with the Department for Transport around cycling cities, and we have augmented its funding by putting money into five walking cities.

Sport England recently announced that it is also making more money available to help to get people more active. I echo everything that has been said today about women’s participation and removing barriers to entry. Some extremely good points were made. I welcome the fact that Sport England has recognised that and is looking to fund things that many of us would not traditionally recognise as sport and things beyond team sport. Like my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), I remember the Lycra shame of the 1980s and the “feel the burn” movement. We do not want people to go to something once and then give it up. We must remove the barriers to entry. I heard about wonderful local government initiatives, such as T-shirt swimming days for people who do not want to swim in just a swimsuit, and other clever things.

However, we need to get the message out there, which much of the debate concentrated on. I must be honest that I do not believe the chief medical officer’s guidelines are well understood. They are difficult for health professionals to understand and the same is certainly true for the public. I have commissioned a piece of work from Public Health England to develop a mantra for physical activity similar to “five-a-day”, which, if not universally observed, is widely known and understood.

I hope that I have provided a sense of how we are trying to follow up on the Olympic and Paralympic legacies. Lord Coe has been clear that that will be judged over decades not years, because although the shadow Minister suggested that it has developed over the past five years, the problem has developed over decades, but we are taking action. MPs have a valuable role to play. It is a huge job, but we are making great strides towards getting everybody active every day. I thank Members for their participation in the debate.