Ten questions to ask if you are…scrutinising how
physical activity can be promoted through planning,
transport and the physical environment
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The Centre for Public Scrutiny (CfPS):
The Centre for Public Scrutiny promotes the value of scrutiny in modern and
effective government, not only to hold executives to account but also to create
a constructive dialogue between the public and its elected representatives to
improve the quality of public services. The Centre has received funding from
the Department of Health to run a second three-year support programme for
overview and scrutiny committees as they develop their power to promote the
well-being of local communities through effective scrutiny of healthcare
planning and delivery and wider public health and social care issues.
NICE:
The National Institute for Health and Clinical Excellence (NICE) is the
independent organisation responsible for providing national guidance on the
promotion of good health and the prevention and treatment of ill health.
NICE produces guidance in three areas of health:
• public health – guidance on the promotion of good health and the prevention
of ill health for those working in the NHS, local authorities and the wider public
and voluntary sector
• health technologies – guidance on the use of new and existing medicines,
treatments and procedures within the NHS
• clinical practice – guidance on the appropriate treatment and care of people
with specific diseases and conditions within the NHS.
Acknowledgements:
CfPS and NICE are grateful to the following people for their help in developing
this guide:
Dr Andrew Furber, Joint Executive Director of Public Health, North
Lincolnshire Council/North Lincolnshire PCT
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Maureen Moore, Sport Play & Community Development Manager, North
Lincolnshire Council Leisure Services
Lucy Johns, Health Partnerships Officer, Adult and Community Services
Directorate, Dorset County Council
Brian Smith, Director of Environment and Transport, Cambridgeshire County
Council
Dr Phil Atkinson, Interim Head of Healthier Communities, Directorate of Adults
and Older Peoples Services, Greenwich Council
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Introduction
This guide is one of a series designed to help health overview and scrutiny
committees (OSCs) carry out their work on various health, healthcare and
social care issues. Other guides in the series include:
•
‘Child and adolescent mental health’ (CfPS 2006)
•
‘NHS service design or reconfiguration’ (CfPS 2007a)
•
‘Assessing evidence’ (CfPS 2007b)
•
‘The effectiveness of your local hospital’ (CfPS 2007c)
•
‘Mainstream health services for people with learning disabilities’ (CfPS
2008).
This guide can help OSCs influence development of the 10-year local delivery
framework (LDF) for their area to ensure it supports efforts to increase the
general population’s physical activity levels. It is based on recommendations
made by the National Institute for Health and Clinical Excellence (NICE) in
‘Promoting and creating built or natural environments that encourage and
support physical activity’ (NICE 2008a). These are the first national, evidencebased recommendations on how to improve the physical environment to
encourage physical activity. They demonstrate the importance of such
improvements and the need to evaluate how they impact on the public’s
health. NICE has also produced guidance on workplace physical activity,
which complements and supports this guidance (NICE 2008b).
Reviewing the LDF and its impact on physical activity
The NICE guidance should be taken into account when developing joint NHS
and local authority strategies (for example, joint community strategies, access
plans and local area agreements). OSCs need to assess whether this is the
case. OSCs undertake a lot of background research before public meetings or
formal ’hearings’ are held to question experts, professionals and members of
the public as part of a scrutiny review. The first few questions listed below are
questions that OSCs may wish to ask themselves in preparing for a review,
before developing lines of questioning for others in their public sessions. They
may also be directed at invited witnesses at a formal, public meeting. Indeed,
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it is good practice to question witnesses in public about issues they may
already have researched in depth: asking questions and receiving answers in
public ensures that anyone reading the resulting scrutiny report can see
clearly why the conclusions have been drawn and the recommendations have
been made. This process also gives local residents and interested parties the
opportunity to hear ‘from the horse’s mouth’ about the services under
consideration.
Consulting others
To get the full picture, OSCs need to speak to people representing a variety of
perspectives. Possible witnesses are:
•
architects
•
developers
•
directors of children’s services
•
directors of public health
•
employers
•
facility managers who are responsible for public buildings (including
workplaces and schools)
•
head teachers
•
local involvement networks
•
members of school sport partnerships
•
planning service team managers
•
representatives from tenants and residents, associations
•
representatives of the voluntary sector
•
school governors
•
transport planners
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1. Why should OSCs review the impact of the built and natural
environment on physical activity levels?
Increasing people’s physical activity levels is a challenge, not just for those
directly involved in public health but for professionals, groups and individuals
in many sectors of society. Adults, young people and children can achieve the
national recommended levels by including activities such as walking, cycling
or climbing stairs as part of their everyday life. However, while interventions
aimed at individuals may be important, they are not the only (nor possibly the
main) solution. Environmental factors also need to be tackled. Indeed, there is
growing recognition that physical environments that support and encourage
physical activity can help improve the public’s health. As Schmid and
colleagues say (1995), ‘It is unreasonable to expect people to change their
behaviours when the environment discourages such changes.’
Some OSCs may choose to focus on a particular aspect of planning policy but
all the NICE recommendations should be taken into account when scrutinising
the development of joint NHS and local authority strategies (for example, joint
community strategies, access plans and local area agreements). The same is
true of plans for – and the management of – NHS services (including its
premises).
2. What information does an OSC need to need to prepare for the
review?
When preparing for the review, OSCs should know, for example, what level of
physical activity is recommended for adults. (Current guidelines state that
adults should undertake a minimum of 30 minutes of at least moderateintensity activity on most days of the week [Department of Health 2004a].
Moderate-intensity activities are those that increase the heart and breathing
rates but, at the same time, allow someone to have a normal conversation. An
example is brisk walking.)
Background reading could include:
• national service frameworks on coronary heart disease, diabetes, mental
health, older people and children (visit www.dh.gov.uk)
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• Department of Health (DH) policy documents on physical activity including
‘Choosing activity’ (DH 2005) and ‘At least five a week’ (DH 2004a)
• local documents, such as the ‘Annual public health report’ and sections of
the local development framework
• other policies including:
− the cross-cutting sustainable development strategy 'Securing
the future' (Department for Environment, Food and Rural
Affairs 2005)
− ‘Walking and cycling: an action plan’ (Department for
Transport 2004)
− ‘Sustainable communities: building for the future’ (Office of the
Deputy Prime Minister 2003)
− Public service agreements (see page 11).
3. Do local planners, transport officials, directors of public health
and others involved with built and natural
environments
understand the relationship between these environments and
physical activity levels?
Several documents explain the relationship between the characteristics of our
environment and the effect this has on levels of physical activity. Examples of
these can be found in the guide to resources developed by NICE.
• Is there reference to any of these documents or to the relationship between
physical activity and environment in any of the local planning policies?
4. How are local policies, strategies and plans developed?
The NICE guidance outlines a number of principles that need to be applied
when developing policies, strategies and plans in relation to transport, public
open spaces, buildings and schools. The following questions could be used to
check whether this is the case:
• When planning changes to the physical environment, are local communities
and experts involved at all stages of development? What evidence is there
that the local community’s views have been heard?
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• Are planning applications for new developments assessed to ensure they
prioritise the need for people (including those whose mobility is impaired) to
be physically active as a routine part of their daily life?
• Are developers encouraged to ensure local facilities and services are easily
accessible on foot, by bicycle or by other modes of transport involving
physical activity?
• Are developers encouraged to ensure children can participate in physically
active play?
5. How do local planners assess the potential effect of their
decisions on the health of the population?
The NICE guidance recommends that planners assess in advance the likely
impact (both intended and unintended) that their plans will have on the
physical activity levels of the local population. To assess whether this is being
done, ask the following:
• Is the impact on physical activity levels assessed before proposals are
presented for approval?
• Are the results of this assessment made publicly available and accessible?
6. Does the local transport plan prioritise pedestrians, cyclists and
users of other modes of transport that involve physical activity?
The NICE guidance recommends that planners give priority to walkers,
cyclists and those using other modes of transport involving physical activity.
To assess compliance, OSCs could check if any of the following have been
introduced:
•
pavement widening (or any other means of re-allocating road space to
support physically active modes of transport)
•
restrictions on motor vehicle access
•
cycle lanes
•
road-user charging schemes
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•
traffic-calming schemes
•
safe routes to schools.
OSCs could also check:
•
Were there any particular issues/problems which affected plans to reallocate road space?
•
Can people access key public buildings without using private transport?
7. What provision has been made for walking, cycling and using
other modes of transport involving physical activity?
The location and accessibility of facilities such as schools and workplaces can
affect whether or not people choose to walk or cycle there. To assess whether
adequate provision has been made, OSCs could ask the following questions:
• Is there a comprehensive network of walking and cycling routes available?
• Are the following destinations included within the network: workplaces,
homes, schools and other public facilities?
• Are the routes built and maintained to a high standard (and what provision
is made for maintenance)?
• Are all local campus sites (for example, hospitals and universities) and new
workplaces linked to these routes?
8. How are public open spaces developed and maintained?
The NICE guidance recommends that public open spaces, which include
coastal, forest and riverside paths and canal towpaths, need to be designed
and maintained so that they encourage physical activity.
In order to assess this, OSCs could ask:
• Can public open spaces be reached by walking?
• Can public open spaces be reached by cycling?
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• Are public open spaces maintained to a high standard?
• Are they safe, attractive and welcoming?
9. How are buildings developed and maintained?
Building design can encourage (or discourage) the use of stairs. The NICE
guidance recommends that during building design or refurbishment, planners
should ensure that staircases are designed and positioned to encourage
people to use them. To assess this, OSCs could ask:
• Are staircases in public building and workplaces:
– attractive to use?
– signposted?
−
10.
How are school playgrounds developed and maintained?
Participation in physical activity is fundamental for healthy growth and
development. It can reduce the risk of chronic conditions (for example,
obesity) and improve children’s health and wellbeing. The government
recommends that children should do a minimum of 60 minutes of at least
moderate-intensity physical activity each day (DH 2004b). This can be
achieved not just through organised sport, but through outdoor play. To check
compliance with the NICE guidance, OSCs should ask the following:
• Are playgrounds designed to encourage varied, physically active play?
• How many primary schools playgrounds allocate specific areas for
individual and group physical activities (for instance, by using different
colours)?
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Related public service agreements
•
PSA 12: improve the health and wellbeing of children and young
people. This includes reducing the proportion of overweight and obese
children under 11 by 2020. One target is to ensure all those aged 5–16
spend 2 hours a week doing PE and school sport as part of (and
outside) the curriculum. That means increasing the numbers taking part
from 25% (2002) to 85% by 2008. The Department for Children,
Schools and Families leads on this (HM Government 2007a).
•
PSA 18: promote better health and wellbeing for all. This includes
reducing: the rate of all causes of mortality among all age groups; the
mortality rate for cancer among people under 75 (by 20% by 2010); the
mortality rate for heart disease, stroke and related diseases among
people under 75 (by 40% by 2010). The number of people from poorer
backgrounds dying from these diseases (compared to those from more
affluent backgrounds) also has to be reduced. The aim is to reduce this
‘health inequalities gap’ by at least 6% for cancer and 40% for heart
disease, stroke and related diseases, by 2010 (HM Government
2007b).
•
PSA 21: increase the uptake of cultural and sporting opportunities
by adults and young people aged 16 and above. One target is to
increase adult participation in at least nine sporting or cultural events
by 2008. The Department for Communities and Local Government
leads on this (HM Government 2007c).
•
PSA 22: deliver a successful Olympic Games in 2012 and a
sustainable legacy. In addition to providing all those aged 5–16 with 2
hours a week of PE and sport, a further indicator will be an increase in
the percentage of those aged 5–19 participating in a further 3 hours a
week. The Department for Culture, Media and Sport) leads on this (HM
Government 2007d).
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•
PSA 27: lead the global effort to avoid dangerous climate change.
This includes a target to reduce net CO2 emissions in the UK by 26–
32% by 2020. Ways of achieving this include encouraging more people
to cycle and walk. The Department for Environment, Foods and Rural
Affairs leads on these agreements between local authorities, PCTs and
other partners
to increase local physical activity levels (HM
Government 2007e).
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Glossary
Access/accessibility
‘Access’ is used to mean that a particular place or destination is accessible to
local residents using a mode of transport that involves physical activity.
Destinations may include work, healthcare and education facilities and shops.
Active play
The Children's Play Council defines play as: ' …freely chosen, personally
directed, intrinsically motivated behaviour that actively engages the child... '
(National Playing Fields Association 2000). Active play involves physical
activity. (For a definition of physical activity see below.)
Mobility impairment
Mobility impairment means that an individual has difficulty getting about. This
includes disabilities such as visual impairment as well as impairment due to
old age and frailty. It also includes temporary problems due, for instance, to
transporting young children in buggies or prams.
Physical activity
Physical activity is: ’Any force exerted by skeletal muscle that results in
energy expenditure above resting level’ (Caspersen et al. 1985). It includes
the full range of human movement and can encompass everything from
competitive sport and active hobbies to walking, cycling and the general
activities involved in daily living (such as housework).
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References
Caspersen CJ, Powell KE, Christensen G (1985) Physical activity, exercise
and physical fitness: definitions and distinctions of health-related research.
Public Health Reports 100: 126–131.
Centre for Public Scrutiny (2008) Ten questions to ask if you’re scrutinising
mainstream health services for people with learning disabilities. London:
Centre for Public Scrutiny.
Centre for Public Scrutiny (2007a) Ten questions to ask if you’re scrutinising
NHS service redesign or reconfiguration. London: Centre for Public Scrutiny.
Centre for Public Scrutiny (2007b) Ten questions to ask if you’re assessing
evidence. London: Centre for Public Scrutiny.
Centre for Public Scrutiny (2007c) Ten questions to ask if you’re scrutinising
the effectiveness of your local hospital. London: Centre for Public Scrutiny.
Centre for Public Scrutiny (2006) 10 questions to ask if you’re scrutinising
child and adolescent mental health services. London: Centre for Public
Scrutiny.
Department for Environment, Food and Rural Affairs (2005) Securing the
future: delivering the sustainable development strategy. London: The
Stationery Office.
Department for Transport (2004) Walking and cycling: an action plan. London:
Department for Transport. Department of Health (2005) Choosing activity: a
physical activity action plan. London: Department of Health.
Department of Health (2004a) At least five a week: evidence on the impact of
physical activity and its relationship to health. London: Department of Health.
• Department of Health (2004b) National service framework for children.
London: Department of Health.
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National Institute for Health and Clinical Excellence (2008a) Promoting and
creating built or natural environments that encourage and support physical
activity. London: National Institute for Health and Clinical Excellence.
National Institute for Health and Clinical Excellence (2008b) Promoting
physical activity in the workplace. London: National Institute for Health and
Clinical Excellence.
National Institute for Health and Clinical Excellence (2008c) Physical activity
and the environment. Guide to resources. London: National Institute for Health
and Clinical Excellence.
National Playing Fields Association, PLAYLINK, Children’s Play Council
(2000) Best play. London: National Playing Fields Association.
Office of the Deputy Prime Minister (2003) Sustainable communities: building
for the future. London: Office of the Deputy Prime Minister.
Schmid T, Pratt M, Howze E (1995) Policy as intervention: environmental and
policy approaches to the prevention of cardiovascular disease. American
Journal of Public Health 85(9): 1207–11.
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