L37 - International Perspectives & Health Inequalities

• Worldwide levels of physical inactivity:

  • Difficult research as PA not always seen the same
  • What they consider PA & how they measure it
  • Be critical to think limitations big research like this has
  • eg self-reported (overestimated amount of PA) vs accelerometers don’t meet global recommendations
• Worldwide levels of Physical Inactiviy:

  • 23% adults, 81% adolescents don’t meet global recommendations
  • Big differences bw/ countries & sub populations
  • Lowest physical inactivity in southeast asia
  • Economic development - facilities & transport
  • Less access to accessible & appropriate PA opportunities for some populations (health inequalities)
  • Decrease in PA levels based on income levels
• Exercise Across the World:

  • Very different forms of exercise across the world
  • eg Chin - high level of tai chi
  • eg Sweden - exercise outdoors, have outdoor gyms, (9% not active enough)
  • eg Franche - parkour; w/ high urbanisation
  • eg Iceland - crossfit
  • eg India - big on yoga
  • eg Netherlands - big on biking
• Fitness

  • Highest in Columbia
• Running

  • Huge in China
• Swimming

  • Very high in Turkey
• What barriers, if any, stop you from practising sports as much as you like? - Lack of time

  • Highly in Saudi Arabia, Peru, & Russia
  • Career driven countries?
• What barriers, if any, stop you from practising sports as much as you like? - Lack of money

  • High in Turkey
• What barriers, if any, stop you from practising sports as much as you like? - Weather too hot / cold

  • Highest in Saudi Arabia, South Africa & Turkey
• What barriers, if any, stop you from practising sports as much as you like? - Lack of facilities

  • Highest in Malaysia
  • Higher in lower economic countries/societies; as have less facilities
• Case Studies of (Inter)National PA Programmes

  • Most initiatives haven’t worked (‘ wicked ’ problem)
• Fighting Fit in the Factory:

  • Around the time of WW2
  • Mass push for fit population, esp for men to be ready to fight if/when needed for war
• Brazil:

  • Agita São Paulo
  • Developed in 1996
  • Combat low levels of PA in São Paulo
  • Community based with minimal funding
  • Famous PA initiative
  • Good things:
  • Developed incredibly clear brand
  • Lots of partnerships
  • Programme encouraged residents to get 30 min activity per day
  • Branding with clock (project Agita)
  • Half hr man
  • Proportion of inactive individuals declined from 10 to 3%
  • Very beneficial campaign
• Singapore:

  • Trim & Fit Singapore
  • 1992-2007
  • Targeting child obesity in schools
  • Reducing obesity rates from 14% to 9.2%
  • Came with psychological cost
  • Being stigmatised
  • Increased number of children diagnosed with eating disorders (‘wicked’ problem)
  • What NOT to do!
  • Weight loss programme
  • Introduced by Minister of Education
  • Educated on calorie control, & intense PA
• Other Problems with Campaigns:

  • Lose funding (good ones too)
  • To stop & see what happens after (not good for behavioural change)
  • Multiple reasons why
• Canada:

  • Canada on the move
  • 2004
  • Promoting both pedometers & walking
  • About increasing steps per day
  • Reached over 30% of adults
  • Camign bw/ health research & PA promotion
  • Good example of creating an initiative that signergises public & private sectors together
  • Research at base & promotion to enable & monitor health status
  • Sign up & record steps per day
  • ‘Donate your steps to research’
• Uganda:

  • Gum Marom Kids League
  • One of the very few low-income large scale PA intervention
  • Sport-for-development intervention in Gulu, Uganda
  • Almost 2000 children
  • Improving physical & mental health
  • esp post-war conflict very important
  • Recovering from 20 years of civil war
  • High prevalence of children soldiers - lot of mental health deficits
  • During post-conflict period
  • Very rapid urbanisation after
  • 9 week competitive soccer league, with regular training
• Australia:

  • Health-Promoting Communities: Being Active & Eating Well
  • Community-based-health-promotion intervention in areas if socio-economic disadvantage (2007-2010)
  • Increase healthy eating & PA & promote healthy weight
  • Almost 2,500 children & 500 adults
  • Very small to moderate effects & only 1 out of 6 communities decreased BMI
  • Bc/ BMI useless
  • & focusing on body weight not good
  • Primary target groups: primary, secondary school students & adults in workplace
  • Also promoting healthy weights (not so great)
• Four Policy Action Areas:

  • Challenges:
  • Lack of political role
  • Insufficient researches
  • Diverging (change in parliament & funding)
  • Lack of clear strategy for addressing physical (in)activity
  • Good: increase awareness
  • 2018 WHO new global action plan
  • Policy changes to help improve PA on global scale
  • Active environments, systems, societies & people
  • Making sure that the world we live in is functional enough to be PA
• Different life expectancy across the world:

  • Physical inactivity is a worldwide & global challenge
  • Disease burden is not uniformly disturbed
• Health Inequalities:

  • Defined (by WHO) as ‘differences in health status or in the distribution of health determinants bw/ different population groups’
  • Socio-economic status (SES)
  • Age
  • Gender
  • Disability
  • Race
  • Religion
  • Sexual orientation
  • Gender identity
  • Exist both bw/ & within countries
• Health Inequalities:

  • Many interventions neglect inequalities
  • Determinants not taken into account in PA research
  • Got to be critical
  • Research often done in males (esp middle aged)
  • What may be effective for males may not be for females
  • Too difficult to work with disabled people so they don’t (not good)
• PA-related Health Inequalities:

  • Socio-economic status (SES)
  • Most studies reported those with high SES were more PA during leisure time that those with lower SES
  • Minority neighbourhoods - lack of facilities
  • However high work PA in lower SES
• PA-related Health Inequalities:

  • Age
  • Less for older adults - less confident
  • Age & gender: Adolescent girls less PA than boys; less opportunity for girls to be active in a safe environment
  • Gender
• PA-related Health Inequalities:

  • Disability
  • Disable people almost 2x as likely not to be PA than those without any disability
  • Inequality increases sharply with the more number of impairments (severity) the more physical inactivity that person does
• PA-related Health Inequalities:

  • Race
  • Work-based PA lower in Asians, higher for other ethnicities
  • Leisure PA lower (by 26%) for blacks - often bc/ they feel unsafe, no safe opportunity to be PA
• PA-related Health Inequalities:

  • Religion
  • Big influence on PA as well - participation in sport & PA higher for some faith groups than others
  • Buddhism, Christianism, Jewish more likely to be PA
• PA-related Health Inequalities:

  • Sexual orientation & gender identity
  • Men & those identifying as straight more likely to reach PA recommendations - then less for any other
• PA-related Health Inequalities

  • COVID-19 pandemic
  • Made inequalities worse (esp for young women, elderly, minority ethnic groups & those in low SES have found it hard to be active)
• Health Inequalities in Aotearoa:

  • Indigenous people often have a poorer health even when SES is taken into account
  • 7 ½ yr difference
  • Importance of individualised ExRx (keep inequalities in mind)
• Recommendations:

  • Public Health England: ‘Understanding & addressing inequalities in PA Evidence-based guidance for commissioners’
  • Recommendations:
  • Appropriate engagement
  • Knowledge of the local community
  • Meaningful consultation
  • Community role models
  • Flexible client centred approach
  • Providing a diverse choice
  • Not just bc/ they might like something else but what they have access to
  • A holistic approach
  • Listen to individual
  • Measuring impact
  • Can be done thru conversation, not just tests
  • Partnership working